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Burnell M, Gaba F, Sobocan M, Desai R, Sanderson S, Loggenberg K, Gessler S, Side L, Brady AF, Dorkins H, Wallis Y, Jacobs C, Legood R, Beller U, Tomlinson I, Wardle J, Menon U, Jacobs I, Manchanda R. Randomised trial of population-based BRCA testing in Ashkenazi Jews: long-term secondary lifestyle behavioural outcomes. BJOG 2022; 129:1970-1980. [PMID: 35781768 PMCID: PMC9796935 DOI: 10.1111/1471-0528.17253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 04/22/2022] [Accepted: 05/16/2022] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Ashkenazi-Jewish (AJ) population-based BRCA testing is acceptable, cost-effective and amplifies primary prevention for breast & ovarian cancer. However, data describing lifestyle impact are lacking. We report long-term results of population-based BRCA testing on lifestyle behaviour and cancer risk perception. DESIGN Two-arm randomised controlled trials (ISRCTN73338115, GCaPPS): (a) population-screening (PS); (b) family history (FH)/clinical criteria testing. SETTING North London AJ-population. POPULATION/SAMPLE AJ women/men >18 years. EXCLUSIONS prior BRCA testing or first-degree relatives of BRCA-carriers. METHODS Participants were recruited through self-referral. All participants received informed pre-test genetic counselling. The intervention included genetic testing for three AJ BRCA-mutations: 185delAG(c.68_69delAG), 5382insC(c.5266dupC) and 6174delT(c.5946delT). This was undertaken for all participants in the PS arm and participants fulfilling FH/clinical criteria in the FH arm. Patients filled out customised/validated questionnaires at baseline/1-year/2-year/3-year follow-ups. Generalised linear-mixed models adjusted for covariates and appropriate contrast tests were used for between-group/within-group analysis of lifestyle and behavioural outcomes along with evaluating factors associated with these outcomes. Outcomes are adjusted for multiple testing (Bonferroni method), with P < 0.0039 considered significant. OUTCOME MEASURES Lifestyle/behavioural outcomes at baseline/1-year/2-year/3-year follow-ups. RESULTS 1034 participants were randomised to PS (n = 530) or FH (n = 504) arms. No significant difference was identified between PS- and FH-based BRCA testing approaches in terms of dietary fruit/vegetable/meat consumption, vitamin intake, alcohol quantity/ frequency, smoking behaviour (frequency/cessation), physical activity/exercise or routine breast mammogram screening behaviour, with outcomes not affected by BRCA test result. Cancer risk perception decreased with time following BRCA testing, with no difference between FH/PS approaches, and the perception of risk was lowest in BRCA-negative participants. Men consumed fewer fruits/vegetables/vitamins and more meat/alcohol than women (P < 0.001). CONCLUSION Population-based and FH-based AJ BRCA testing have similar long-term lifestyle impacts on smoking, alcohol, dietary fruit/vegetable/meat/vitamin, exercise, breast screening participation and reduced cancer risk perception.
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Affiliation(s)
- Matthew Burnell
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and MethodologyUniversity College LondonLondonUK
| | - Faiza Gaba
- Wolfson Institute of Population Health, Barts CRUK Cancer CentreQueen Mary University of LondonLondonUK,Department of Gynaecological OncologyBarts Health NH TrustLondonUK
| | - Monika Sobocan
- Wolfson Institute of Population Health, Barts CRUK Cancer CentreQueen Mary University of LondonLondonUK,Department of Gynaecological OncologyBarts Health NH TrustLondonUK
| | - Rakshit Desai
- Department of Gynaecological OncologyBarts Health NH TrustLondonUK
| | - Saskia Sanderson
- Behavioural Sciences UnitDepartment Epidemiology and Public HealthUniversity College LondonLondonUK
| | - Kelly Loggenberg
- Department Clinical GeneticsNorth East Thames Regional Genetics UnitGreat Ormond Street HospitalLondonUK
| | - Sue Gessler
- Department of Gynaecological OncologyInstitute for Women's HealthUniversity College LondonLondonUK
| | - Lucy Side
- University Hospital Southampton NHS Foundation TrustSouthamptonUK
| | - Angela F. Brady
- Department Clinical GeneticsNorth West Thames Regional Genetics UnitNorthwick Park HospitalLondonUK
| | - Huw Dorkins
- St Peter's CollegeUniversity of OxfordOxfordUK
| | - Yvonne Wallis
- West Midlands Regional Genetics LaboratoryBirmingham Women's NHS Foundation TrustBirminghamUK,Depatment Clinical GeneticsWest Midlands Regional Genetics ServiceBirmingham Women's NHS Foundation TrustBirminghamUK
| | - Chris Jacobs
- Depatment Clinical GeneticsGuy's HospitalLondonUK,University of Technology SydneySydneyNew South WalesAustralia
| | - Rosa Legood
- Department of Health Services Research and PolicyLondon School of Hygiene & Tropical MedicineLondonUK
| | - Uziel Beller
- Department of GynaecologyShaare Zedek Medical CenterJerusalemIsrael
| | - Ian Tomlinson
- Institute of Cancer and Genomic SciencesUniversity of BirminghamBirminghamUK
| | - Jane Wardle
- Behavioural Sciences UnitDepartment Epidemiology and Public HealthUniversity College LondonLondonUK
| | - Usha Menon
- Department of Gynaecological OncologyBarts Health NH TrustLondonUK
| | - Ian Jacobs
- University of New South WalesSydneyNew South WalesAustralia
| | - Ranjit Manchanda
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and MethodologyUniversity College LondonLondonUK,Wolfson Institute of Population Health, Barts CRUK Cancer CentreQueen Mary University of LondonLondonUK,Department of Gynaecological OncologyBarts Health NH TrustLondonUK,Department of Health Services Research and PolicyLondon School of Hygiene & Tropical MedicineLondonUK,Department of GynaecologyAll India Institute of Medical SciencesNew DelhiIndia
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2
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Reisel D, Burnell M, Side L, Loggenberg K, Gessler S, Desai R, Sanderson S, Brady AF, Dorkins H, Wallis Y, Jacobs C, Legood R, Beller U, Tomlinson I, Wardle J, Menon U, Jacobs I, Manchanda R. Jewish cultural and religious factors and uptake of population-based BRCA testing across denominations: a cohort study. BJOG 2021; 129:959-968. [PMID: 34758513 DOI: 10.1111/1471-0528.16994] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 09/11/2021] [Accepted: 09/30/2021] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To evaluate the association of Jewish cultural and religious identity and denominational affiliation with interest in, intention to undertake and uptake of population-based BRCA (Breast Cancer Gene)-testing. DESIGN Cohort-study set within recruitment to GCaPPS-trial (ISRCTN73338115). SETTING London Ashkenazi-Jewish (AJ) population. POPULATION OR SAMPLE AJ men and women, >18 years. METHODS Participants were self-referred, and attended recruitment clinics (clusters) for pre-test counselling. Subsequently consenting individuals underwent BRCA testing. Participants self-identified to one Jewish denomination: Conservative/Liberal/Reform/Traditional/Orthodox/Unaffiliated. Validated scales measured Jewish Cultural-Identity (JI) and Jewish Religious-identity (JR). Four-item Likert-scales analysed initial 'interest' and 'intention to test' pre-counselling. Item-Response-Theory and graded-response models, modelled responses to JI and JR scales. Ordered/multinomial logistic regression modelling evaluated association of JI-scale, JR-scale and Jewish Denominational affiliation on interest, intention and uptake of BRCA testing. MAIN OUTCOME MEASURES Interest, intention, uptake of BRCA testing. RESULTS In all, 935 AJ women/men of mean age = 53.8 (S.D = 15.02) years, received pre-test education and counselling through 256 recruitment clinic clusters (median cluster size = 3). Denominational affiliations included Conservative/Masorti = 91 (10.2%); Liberal = 82 (9.2%), Reform = 135 (15.1%), Traditional = 212 (23.7%), Orthodox = 239 (26.7%); and Unaffiliated/Non-practising = 135 (15.1%). Overall BRCA testing uptake was 88%. Pre-counselling, 96% expressed interest and 60% intention to test. JI and JR scores were highest for Orthodox, followed by Conservative/Masorti, Traditional, Reform, Liberal and Unaffiliated Jewish denominations. Regression modelling showed no significant association between overall Jewish Cultural or Religious Identity with either interest, intention or uptake of BRCA testing. Interest, intention and uptake of BRCA testing was not significantly associated with denominational affiliation. CONCLUSIONS Jewish religious/cultural identity and denominational affiliation do not appear to influence interest, intention or uptake of population-based BRCA testing. BRCA testing was robust across all Jewish denominations. TWEETABLE ABSTRACT Jewish cultural/religious factors do not affect BRCA testing, with robust uptake seen across all denominational affiliations.
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Affiliation(s)
- D Reisel
- Institute for Women's Health, University College, London, UK
| | - M Burnell
- Institute for Women's Health, University College, London, UK
| | - L Side
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - K Loggenberg
- Institute for Women's Health, University College, London, UK
| | - S Gessler
- Institute for Women's Health, University College, London, UK
| | - R Desai
- Institute for Women's Health, University College, London, UK
| | - S Sanderson
- Behavioral Sciences Unit, Dept Epidemiology and Public Health, University College London, London, UK
| | - A F Brady
- North West Thames Regional Genetics Service, Northwick Park Hospital, Harrow, UK
| | - H Dorkins
- St Peter's College, University of Oxford, Oxford, UK
| | - Y Wallis
- West Midlands Regional Genetics Laboratory, Birmingham Women's NHS Foundation Trust, Birmingham, UK
| | - C Jacobs
- Dept Clinical Genetics, Guy's Hospital, London, UK.,University of Technology Sydney, Ultimo, NSW, Australia
| | - R Legood
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - U Beller
- Department of Gynaecology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - I Tomlinson
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - J Wardle
- Behavioral Sciences Unit, Dept Epidemiology and Public Health, University College London, London, UK
| | - U Menon
- MRC Clinical Trials Unit, University College London, London, UK
| | - I Jacobs
- Institute for Women's Health, University College, London, UK.,University of New South Wales, Sydney, NSW, Australia
| | - R Manchanda
- MRC Clinical Trials Unit, University College London, London, UK.,Wolfson Institute of Population Health, CRUK Barts Centre, Queen Mary University of London, London, UK.,Department of Gynaecological Oncology, St Bartholomew's Hospital, London, UK
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3
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Beeken RJ, Leurent B, Vickerstaff V, Wilson R, Croker H, Morris S, Omar RZ, Nazareth I, Wardle J. Correction to: A brief intervention for weight control based on habit-formation theory delivered through primary care: results from a randomised controlled trial. Int J Obes (Lond) 2021; 45:2137-2138. [PMID: 34099843 PMCID: PMC8380537 DOI: 10.1038/s41366-021-00862-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- R J Beeken
- Department of Epidemiology and Public Health, University College London, London, UK.
| | - B Leurent
- Department of Primary Care and Population Health, University College London, London, UK
| | - V Vickerstaff
- Department of Primary Care and Population Health, University College London, London, UK
| | - R Wilson
- Department of Epidemiology and Public Health, University College London, London, UK
| | - H Croker
- Department of Epidemiology and Public Health, University College London, London, UK
| | - S Morris
- Department of Epidemiology and Public Health, University College London, London, UK
| | - R Z Omar
- Department of Statistical Science, University College London, London, UK
| | - I Nazareth
- Department of Primary Care and Population Health, University College London, London, UK
| | - J Wardle
- Department of Epidemiology and Public Health, University College London, London, UK
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4
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Dunn JM, Steel AE, Adams J, Lloyd I, De Groot N, Hausser T, Wardle J. Characteristics of global naturopathic education, regulation, and practice frameworks: results from an international survey. BMC Complement Med Ther 2021; 21:67. [PMID: 33602181 PMCID: PMC7893718 DOI: 10.1186/s12906-021-03217-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 01/12/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND This descriptive study provides the first examination of global naturopathic education, regulation and practice frameworks that have potential to constrain or assist professional formation and integration in global health systems. Despite increasing public use, a significant workforce, and World Health Organization calls for national policy development to support integration of services, existent frameworks as potential barriers to integration have not been examined. METHODS This cross-sectional survey utilized purposive sampling of 65 naturopathic organisations (educational institutions, professional associations, and regulatory bodies) from 29 countries. Organizational representatives completed an on-line survey, conducted between Nov 2016 - Aug 2019. Frequencies and cross-tabulation statistics were analyzed using SPSSv.25. Qualitative responses were hand-coded and thematically analysed where appropriate. RESULTS Sixty-five of 228 naturopathic organizations completed the survey (29% response rate) from 29 of 46 countries (63% country response rate). Most education programs (68%) were delivered via a national framework. Higher education qualifications (60%) predominated. Organizations influential in education were professional associations (75.4%), particularly where naturopathy was unregulated, and accreditation bodies (41.5%) and regulatory boards (33.8%) where regulated. Full access to controlled acts, and to health insurance rebates were more commonly reported where regulated. Attitude of decision-makers, opinions of other health professions and existing legislation were perceived to most impact regulation, which was globally heterogeneous. CONCLUSION Education and regulation of the naturopathic profession has significant heterogeneity, even in the face of global calls for consistent regulation that recognizes naturopathy as a medical system. Standards are highest and consistency more apparent in countries with regulatory frameworks.
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Affiliation(s)
- J M Dunn
- University of Technology Sydney, 15 Broadway, Ultimo, NSW, 2007, Australia. .,World Naturopathic Federation, 20 Holly St, Suite, Toronto, 200, Canada.
| | - A E Steel
- Australian Research Centre in Complementary & Integrative Medicine (ARCCIM), School of Public Health, University of Technology Sydney, 15 Broadway, Ultimo, NSW, 2007, Australia
| | - J Adams
- Australian Research Centre in Complementary & Integrative Medicine (ARCCIM), School of Public Health, University of Technology Sydney, 15 Broadway, Ultimo, NSW, 2007, Australia
| | - I Lloyd
- World Naturopathic Federation, 20 Holly St, Suite, Toronto, 200, Canada
| | - N De Groot
- World Naturopathic Federation, 20 Holly St, Suite, Toronto, 200, Canada.,Canadian College of Naturopathic Medicine, 1255 Sheppard Ave East, Toronto, Ontario, Canada
| | - T Hausser
- World Naturopathic Federation, 20 Holly St, Suite, Toronto, 200, Canada
| | - J Wardle
- Australian Research Centre in Complementary & Integrative Medicine (ARCCIM), School of Public Health, University of Technology Sydney, 15 Broadway, Ultimo, NSW, 2007, Australia.,National Centre for Naturopathic Medicine, Southern Cross University, Military Road, Lismore, NSW, 2480, Australia
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5
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Quaife SL, Ruparel M, Dickson JL, Beeken RJ, McEwen A, Baldwin DR, Bhowmik A, Navani N, Sennett K, Duffy SW, Wardle J, Waller J, Janes SM. Lung Screen Uptake Trial (LSUT): Randomized Controlled Clinical Trial Testing Targeted Invitation Materials. Am J Respir Crit Care Med 2020; 201:965-975. [PMID: 31825647 PMCID: PMC7159423 DOI: 10.1164/rccm.201905-0946oc] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 12/10/2019] [Indexed: 12/25/2022] Open
Abstract
Rationale: Low uptake of low-dose computed tomography (LDCT) lung cancer screening, particularly by current smokers of a low socioeconomic position, compromises effectiveness and equity.Objectives: To compare the effect of a targeted, low-burden, and stepped invitation strategy versus control on uptake of hospital-based Lung Health Check appointments offering LDCT screening.Methods: In a two-arm, blinded, between-subjects, randomized controlled trial, 2,012 participants were selected from 16 primary care practices using these criteria: 1) aged 60 to 75 years, 2) recorded as a current smoker within the last 7 years, and 3) no prespecified exclusion criteria contraindicating LDCT screening. Both groups received a stepped sequence of preinvitation, invitation, and reminder letters from their primary care practitioner offering prescheduled appointments. The key manipulation was the accompanying leaflet. The intervention group's leaflet targeted psychological barriers and provided low-burden information, mimicking the concept of the U.K. Ministry of Transport's annual vehicle test ("M.O.T. For Your Lungs").Measurements and Main Results: Uptake was 52.6%, with no difference between intervention (52.3%) and control (52.9%) groups in unadjusted (odds ratio [OR], 0.98; 95% confidence interval [CI], 0.82-1.16) or adjusted (OR, 0.98; 95% CI, 0.82-1.17) analyses. Current smokers were less likely to attend (adjusted OR, 0.70; 95% CI, 0.56-0.86) than former smokers. Socioeconomic deprivation was significantly associated with lower uptake for the control group only (P < 0.01).Conclusions: The intervention did not improve uptake. Regardless of trial arm, uptake was considerably higher than previous clinical and real-world studies, particularly given that the samples were predominantly lower socioeconomic position smokers. Strategies common to both groups, including a Lung Health Check approach, could represent a minimum standard.Clinical trial registered with www.clinicaltrials.gov (NCT02558101) and registered prospectively with the International Standard Registered Clinical/Social Study (N21774741).
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Affiliation(s)
| | - Mamta Ruparel
- Lungs for Living Research Centre, UCL Respiratory, Division of Medicine, University College London, London, United Kingdom
| | - Jennifer L. Dickson
- Lungs for Living Research Centre, UCL Respiratory, Division of Medicine, University College London, London, United Kingdom
| | - Rebecca J. Beeken
- Research Department of Behavioural Science and Health and
- Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
| | - Andy McEwen
- National Centre for Smoking Cessation and Training, Dorchester, United Kingdom
| | - David R. Baldwin
- Respiratory Medicine Unit, David Evans Research Centre, Nottingham University Hospitals, Nottingham, United Kingdom
| | - Angshu Bhowmik
- Department of Thoracic Medicine, Homerton University Hospital, London, United Kingdom
| | - Neal Navani
- Department of Thoracic Medicine, University College London Hospital, London, United Kingdom
| | - Karen Sennett
- Killick Street Health Centre, London, United Kingdom
| | - Stephen W. Duffy
- Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom; and
| | - Jane Wardle
- Research Department of Behavioural Science and Health and
| | - Jo Waller
- Research Department of Behavioural Science and Health and
- School of Cancer and Pharmaceutical Sciences, King’s College London, London, United Kingdom
| | - Samuel M. Janes
- Lungs for Living Research Centre, UCL Respiratory, Division of Medicine, University College London, London, United Kingdom
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6
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Manchanda R, Burnell M, Gaba F, Desai R, Wardle J, Gessler S, Side L, Sanderson S, Loggenberg K, Brady AF, Dorkins H, Wallis Y, Chapman C, Jacobs C, Legood R, Beller U, Tomlinson I, Menon U, Jacobs I. Randomised trial of population‐based
BRCA
testing in Ashkenazi Jews: long‐term outcomes. BJOG 2019; 127:364-375. [PMID: 31507061 DOI: 10.1111/1471-0528.15905] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2019] [Indexed: 12/31/2022]
Affiliation(s)
- R Manchanda
- Wolfson Institute of Preventive Medicine Barts Cancer Institute Queen Mary University of London London UK
- Department of Gynaecological Oncology St Bartholomew's Hospital London UK
- MRC Clinical Trials Unit University College London London UK
| | - M Burnell
- MRC Clinical Trials Unit University College London London UK
| | - F Gaba
- Wolfson Institute of Preventive Medicine Barts Cancer Institute Queen Mary University of London London UK
| | - R Desai
- MRC Clinical Trials Unit University College London London UK
| | - J Wardle
- Behavioural Sciences Unit Department of Epidemiology and Public Health University College London London UK
| | - S Gessler
- MRC Clinical Trials Unit University College London London UK
| | - L Side
- University Hospital Southampton NHS Foundation Trust Southampton UK
| | - S Sanderson
- Behavioural Sciences Unit Department of Epidemiology and Public Health University College London London UK
| | - K Loggenberg
- North East Thames Regional Genetics Unit Department of Clinical Genetics Great Ormond Street Hospital London UK
| | - AF Brady
- North West Thames Regional Genetics Service Northwick Park Hospital Harrow UK
| | - H Dorkins
- St Peter's College University of Oxford Oxford UK
| | - Y Wallis
- West Midlands Regional Genetics Laboratory Birmingham Women's NHS Foundation Trust Birmingham UK
| | - C Chapman
- West Midlands Regional Genetics Service Department of Clinical Genetics Birmingham Women's NHS Foundation Trust Birmingham UK
| | - C Jacobs
- Department of Clinical Genetics Guy's Hospital London UK
- University of Technology Sydney Sydney NSW Australia
| | - R Legood
- Department of Health Services Research and Policy London School of Hygiene and Tropical Medicine London UK
| | - U Beller
- Department of Gynaecology Shaare Zedek Medical Centre Jerusalem Israel
| | - I Tomlinson
- Institute of Cancer and Genomic Sciences University of Birmingham Birmingham UK
| | - U Menon
- MRC Clinical Trials Unit University College London London UK
| | - I Jacobs
- University of New South Wales UNSW Sydney Sydney NSW Australia
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7
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Manchanda R, Burnell M, Gaba F, Sanderson S, Loggenberg K, Gessler S, Wardle J, Side L, Desai R, Brady AF, Dorkins H, Wallis Y, Chapman C, Jacobs C, Tomlinson I, Beller U, Menon U, Jacobs I. Attitude towards and factors affecting uptake of population-based BRCA testing in the Ashkenazi Jewish population: a cohort study. BJOG 2019; 126:784-794. [PMID: 30767407 DOI: 10.1111/1471-0528.15654] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate factors affecting unselected population-based BRCA testing in Ashkenazi Jews (AJ). DESIGN Cohort-study set within recruitment to the GCaPPS trial (ISRCTN73338115). SETTING North London AJ population. POPULATION OR SAMPLE Ashkenazi Jews women/men >18 years, recruited through self-referral. METHODS Ashkenazi Jews women/men underwent pre-test counselling for BRCA testing through recruitment clinics (clusters). Consenting individuals provided blood samples for BRCA testing. Data were collected on socio-demographic/family history/knowledge/psychological well-being along with benefits/risks/cultural influences (18-item questionnaire measuring 'attitude'). Four-item Likert-scales analysed initial 'interest' and 'intention-to-test' pre-counselling. Uni- and multivariable logistic regression models evaluated factors affecting uptake/interest/intention to undergo BRCA testing. Statistical inference was based on cluster robust standard errors and joint Wald tests for significance. Item-Response Theory and graded-response models modelled responses to 18-item questionnaire. MAIN OUTCOME MEASURES Interest, intention, uptake, attitude towards BRCA testing. RESULTS A total of 935 individuals (women = 67%/men = 33%; mean age = 53.8 (SD = 15.02) years) underwent pre-test genetic-counselling. During the pre-counselling, 96% expressed interest in and 60% indicated a clear intention to undergo BRCA testing. Subsequently, 88% opted for BRCA testing. BRCA-related knowledge (P = 0.013) and degree-level education (P = 0.01) were positively and negatively (respectively) associated with intention-to-test. Being married/cohabiting had four-fold higher odds for BRCA testing uptake (P = 0.009). Perceived benefits were associated with higher pre-counselling odds for interest in and intention to undergo BRCA testing. Reduced uncertainty/reassurance were the most important factors contributing to decision-making. Increased importance/concern towards risks/limitations (confidentiality/insurance/emotional impact/inability to prevent cancer/marriage ability/ethnic focus/stigmatisation) were significantly associated with lower odds of uptake of BRCA testing, and discriminated between acceptors and decliners. Male gender/degree-level education (P = 0.001) had weaker correlations, whereas having children showed stronger (P = 0.005) associations with attitudes towards BRCA testing. CONCLUSIONS BRCA testing in the AJ population has high acceptability. Pre-test counselling increases awareness of disadvantages/limitations of BRCA testing, influencing final cost-benefit perception and decision-making on undergoing testing. TWEETABLE ABSTRACT BRCA testing in Ashkenazi Jews has high acceptability and uptake. Pre-test counselling facilitates informed decision-making.
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Affiliation(s)
- R Manchanda
- Barts Cancer Institute, Queen Mary University of London, London, UK
- Department of Gynaecological Oncology, St Bartholomew's Hospital, London, UK
| | - M Burnell
- MRC Clinical Trials Unit, University College London, London, UK
| | - F Gaba
- Barts Cancer Institute, Queen Mary University of London, London, UK
- Department of Gynaecological Oncology, St Bartholomew's Hospital, London, UK
| | - S Sanderson
- Behavioural Sciences Unit, Department of Epidemiology and Public Health, University College London, London, UK
| | - K Loggenberg
- Department of Clinical Genetics, North East Thames Regional Genetics Unit, Great Ormond Street Hospital, London, UK
| | - S Gessler
- MRC Clinical Trials Unit, University College London, London, UK
| | - J Wardle
- Behavioural Sciences Unit, Department of Epidemiology and Public Health, University College London, London, UK
| | - L Side
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - R Desai
- MRC Clinical Trials Unit, University College London, London, UK
| | - A F Brady
- Department of Clinical Genetics, North West Thames Regional Genetics Unit, Northwick Park Hospital, London, UK
| | - H Dorkins
- St Peter's College, University of Oxford, Oxford, UK
| | - Y Wallis
- West Midlands Regional Genetics Laboratory, Birmingham Women's NHS Foundation Trust, Birmingham, UK
| | - C Chapman
- Department of Clinical Genetics, West Midlands Regional Genetics Service, Birmingham Women's NHS Foundation Trust, Birmingham, UK
| | - C Jacobs
- Department of Clinical Genetics, Guy's Hospital, London, UK
- University of Technology Sydney, Sydney, NSW, Australia
| | - I Tomlinson
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - U Beller
- Department of Gynecology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - U Menon
- MRC Clinical Trials Unit, University College London, London, UK
| | - I Jacobs
- University of New South Wales, UNSW Sydney, Sydney, NSW, Australia
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8
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James PB, Wardle J, Steel A, Adams J. Post-Ebola psychosocial experiences and coping mechanisms among Ebola survivors: a systematic review. Trop Med Int Health 2019; 24:671-691. [PMID: 30843627 DOI: 10.1111/tmi.13226] [Citation(s) in RCA: 90] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE A myriad of physical and psychosocial sequelae have been reported among Ebola survivors from previous Ebola virus disease (EVD) outbreaks, including the most recent in West Africa. This review examines the various forms of psychological distress experienced by EVD survivors, family and community reactions to EVD survivors and EVD survivors' coping mechanisms. METHODS We conducted a literature search of original articles employing Medline (Ovid), PubMed, Web of Science, Scopus, CINAHL, EBSCO host academic search complete, PsycINFO (EBSCO) and Embase databases. RESULTS Our search identified 1890 articles of which 24 met our inclusion criteria. Various forms of psychological distress were prevalent among EVD survivors including depression, anxiety, anger, grief, guilt, flashbacks, sadness, worthlessness, substance addiction, suicidal tendencies and self-stigmatisation. Family and community responses to EVD survivors ranged from acceptance to rejection, isolation, stigmatisation and discrimination. EVD survivors' coping strategies included engagement with religious faith, EVD survivors associations and involvement in EVD prevention and control interventions. CONCLUSION Psychological distress, including that resulting from family and community stigma and discrimination, appears common among EVD survivors. Community-based mental health and psychosocial interventions integrated within a broader package of care for EVD survivors that also recognises the physical health challenges are required. Well-designed longitudinal studies can provide clear insights on the nature and trajectory of the psychosocial issues currently experienced by EVD survivors.
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Affiliation(s)
- P B James
- Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia.,Faculty of Pharmaceutical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - J Wardle
- Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - A Steel
- Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - J Adams
- Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
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Foley H, Steel A, Cramer H, Wardle J, Adams J. Disclosure of complementary medicine use to medical providers: a systematic review and meta-analysis. Sci Rep 2019; 9:1573. [PMID: 30733573 PMCID: PMC6367405 DOI: 10.1038/s41598-018-38279-8] [Citation(s) in RCA: 103] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 12/20/2018] [Indexed: 12/03/2022] Open
Abstract
Concomitant complementary medicine (CM) and conventional medicine use is frequent and carries potential risks. Yet, CM users frequently neglect to disclose CM use to medical providers. Our systematic review examines rates of and reasons for CM use disclosure to medical providers. Observational studies published 2003-2016 were searched (AMED, CINAHL, MEDLINE, PsycINFO). Eighty-six papers reporting disclosure rates and/or reasons for disclosure/non-disclosure of CM use to medical providers were reviewed. Fourteen were selected for meta-analysis of disclosure rates of biologically-based CM. Overall disclosure rates varied (7-80%). Meta-analysis revealed a 33% disclosure rate (95%CI: 24% to 43%) for biologically-based CM. Reasons for non-disclosure included lack of inquiry from medical providers, fear of provider disapproval, perception of disclosure as unimportant, belief providers lacked CM knowledge, lacking time, and belief CM was safe. Reasons for disclosure included inquiry from medical providers, belief providers would support CM use, belief disclosure was important for safety, and belief providers would give advice about CM. Disclosure appears to be influenced by the nature of patient-provider communication. However, inconsistent definitions of CM and lack of a standard measure for disclosure created substantial heterogeneity between studies. Disclosure of CM use to medical providers must be encouraged for safe, effective patient care.
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Affiliation(s)
- H Foley
- Faculty of Health, University of Technology Sydney, Ultimo, Australia.
| | - A Steel
- Faculty of Health, University of Technology Sydney, Ultimo, Australia
| | - H Cramer
- Faculty of Health, University of Technology Sydney, Ultimo, Australia
- Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
| | - J Wardle
- Faculty of Health, University of Technology Sydney, Ultimo, Australia
| | - J Adams
- Faculty of Health, University of Technology Sydney, Ultimo, Australia
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10
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Rahman B, Side L, Gibbon S, Meisel SF, Fraser L, Gessler S, Wardle J, Lanceley A. Moving towards population-based genetic risk prediction for ovarian cancer. BJOG 2018; 124:855-858. [PMID: 28217902 DOI: 10.1111/1471-0528.14603] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2017] [Indexed: 12/16/2022]
Affiliation(s)
- B Rahman
- Department of Women's Cancer, EGA Institute for Women's Health, University College London, London, UK
| | - L Side
- Department of Women's Cancer, EGA Institute for Women's Health, University College London, London, UK.,North East Thames Regional Genetics Service, London, UK
| | - S Gibbon
- UCL Anthropology, University College London, London, UK
| | - S F Meisel
- Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, London, UK
| | - L Fraser
- Department of Women's Cancer, EGA Institute for Women's Health, University College London, London, UK
| | - S Gessler
- Department of Women's Cancer, EGA Institute for Women's Health, University College London, London, UK
| | | | - A Lanceley
- Department of Women's Cancer, EGA Institute for Women's Health, University College London, London, UK
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11
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Steel A, Wardle J, Frawley J, Adams J, Sibbritt D, Lauche R. Associations between complementary medicine utilisation and the use of contraceptive methods: Results of a national cross-sectional survey. Complement Ther Clin Pract 2018; 33:100-106. [PMID: 30396606 DOI: 10.1016/j.ctcp.2018.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 08/24/2018] [Accepted: 09/08/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND PURPOSE This study examines the relationship between the use of complementary medicine (CM) interventions or consultations with CM practitioners and women's choice of contraceptive method. MATERIALS AND METHODS A secondary analysis of a cross-sectional survey of Australian Women aged 34-39 years from the Australian Longitudinal Study on Women's Health (ALSWH) was conducted. Associations between use of CM and contraception were analysed using Chi-squared tests and multivariate logistic regression. RESULTS Based on the responses from the included women (n = 7299), women who consulted a naturopath/herbalist were less likely to use implant contraceptives (OR 0.56; 95% confidence interval (CI) 0.33; 0.95). Those consulting a chiropractor (OR 1.54; 95%CI 1.05; 2.25) or an osteopath (OR 2.16; 95% CI 1.32; 3.54) were more likely to use natural contraception. CONCLUSION There may be a link between women's choice of contraceptive method and their use of CM, in particular, with CM practitioner consultations.
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Affiliation(s)
- A Steel
- Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), Faculty of Health, University of Technology Sydney, 15 Broadway, Ultimo, NSW, 2007, Australia; Office of Research, Endeavour College of Natural Health, Level 2, 269 Wickham Street, Fortitude Valley, QLD, 4006, Australia.
| | - J Wardle
- Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), Faculty of Health, University of Technology Sydney, 15 Broadway, Ultimo, NSW, 2007, Australia.
| | - J Frawley
- Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), Faculty of Health, University of Technology Sydney, 15 Broadway, Ultimo, NSW, 2007, Australia.
| | - J Adams
- Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), Faculty of Health, University of Technology Sydney, 15 Broadway, Ultimo, NSW, 2007, Australia.
| | - D Sibbritt
- Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), Faculty of Health, University of Technology Sydney, 15 Broadway, Ultimo, NSW, 2007, Australia.
| | - R Lauche
- Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), Faculty of Health, University of Technology Sydney, 15 Broadway, Ultimo, NSW, 2007, Australia.
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12
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Chorley AJ, Hirst Y, Vrinten C, von Wagner C, Wardle J, Waller J. Public understanding of the purpose of cancer screening: A population-based survey. J Med Screen 2018; 25:64-69. [PMID: 28530514 PMCID: PMC5956561 DOI: 10.1177/0969141317699440] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 02/22/2017] [Indexed: 12/18/2022]
Abstract
Objectives In examining informed choice in cancer screening, we investigated public awareness that some screening programmes aim to prevent cancer, while others seek to detect cancer at an early stage. Methods A population-based survey of adults aged 50-70 in England (n = 1433), including data on demographic characteristics and screening experience. Participants were asked to select the main purpose of cervical, breast, and colorectal cancer screening (both faecal occult blood testing and flexible sigmoidoscopy). Results Across all four screening programmes, most people thought the main aim was to catch cancer early (71-78%). Only 18 and 14% knew that cervical screening and flexible sigmoidoscopy, respectively, are primarily preventive. Knowledge of the preventive aspect of these two programmes was low across the board, with few demographic patterns. By contrast, 78 and 73% of the sample were aware that breast screening and the faecal occult blood test, respectively, predominantly aim to detect cancer early. For these programmes, accurate knowledge was socially graded, lower in ethnic minority groups, and positively associated with previous participation in the programmes. Conclusions Our findings suggest that although awareness of the purpose of early detection screening is high, awareness that screening can prevent cancer is low across all demographic groups. Understanding the purpose of screening is a key aspect of informed choice but despite current communication strategies highlighting these differences, people do not seem to have a nuanced understanding of these differing aims. Our findings may be indicative of a broader public scepticism about the preventability of cancer.
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Affiliation(s)
- Amanda J Chorley
- Research Department of Behavioural Science and Health, UCL, London, UK
| | - Yasemin Hirst
- Research Department of Behavioural Science and Health, UCL, London, UK
| | - Charlotte Vrinten
- Research Department of Behavioural Science and Health, UCL, London, UK
| | | | | | - Jo Waller
- Research Department of Behavioural Science and Health, UCL, London, UK
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13
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Erne P, Wardle J, Sanders K, Lewis SM, Maseri A. Mean Platelet Volume and Size Distribution and Their Sensitivity to Agonists in Patients with Coronary Artery Disease and Congestive Heart Failure. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1642766] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
SummaryMean platelet volume was related to platelet count in patients with myocardial infarction (n = 55) and patients with congestive heart failure (n = 9). 18 patients with acute myocardial infarction were tested at admission and 4-7 days later, together with 13 patients with chronic stable angina and 10 patients with chest pain which was not related to coronary artery disease. In citrated blood a relative reduced frequency of large platelets (>13 fl) occured in patients with acute myocardial infarction at admission but was not seen during recovery or in patients with chronic stable angina. This suggests consumption of large platelets at time of thrombus formation. No relation was found between plasma catecholamine levels and mean platelet volumes. Effects of serotonine, adrenaline and CGP 28392, a calcium agonist, on platelet volume distributions were determined. Sensitivity of platelets to adrenaline was increased in patients with acute myocardial infarction on admission and reduced 4-7 days later, while in patients with congestive heart failure reactivity to both serotonine and adrenaline were reduced. This indicates a fast down-regulation during the early recovery phase of myocardial infarction and chronically in congestive heart failure.
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Affiliation(s)
- P Erne
- The Cardiovascular Research Unit, Royal Postgraduate Medical School, Hammersmith Hospital, London, UK
| | - J Wardle
- Department of Haematology, Royal Postgraduate Medical School, Hammersmith Hospital, London, UK
| | - K Sanders
- Department of Haematology, Royal Postgraduate Medical School, Hammersmith Hospital, London, UK
| | - S M Lewis
- Department of Haematology, Royal Postgraduate Medical School, Hammersmith Hospital, London, UK
| | - A Maseri
- The Cardiovascular Research Unit, Royal Postgraduate Medical School, Hammersmith Hospital, London, UK
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Abstract
Background Cancer screening is a behavior that represents investment in future health. Such investment may depend on how much ‘future’ a person expects. Purpose The purpose of this study was to investigate the prospective association between perceived personal life expectancy and participation in fecal occult blood test screening for colorectal cancer (CRC) in a national program. Methods Data were from interviews with 3975 men and women in the English Longitudinal Study of Ageing (ELSA) within the eligible age range for the national screening program (60 to 74 years). Perceived life expectancy was indexed as the individual’s estimate of their chance of living another 10–15 years (exact time varied by age), assessed in 2008/2009. Participation in CRC screening from 2010 to 2012/2013 was assessed in 2012/2013. Logistic regression was used to estimate the association between perceived life expectancy and screening participation, adjusted for numeracy and known mortality risk factors. Results Overall, 71% of respondents (2817/3975) reported completing at least one fecal occult blood test (FOBt) during the follow-up. Screening uptake was 76% (1272/1683) among those who estimated their 10–15-year life expectancy as 75–100%, compared with 52% (126/243) among those who estimated theirs as 0–25% (adjusted OR 1.74, 95% CI 1.29–2.34). Conclusions A longer perceived life expectancy is associated with greater likelihood of participating in CRC screening in England. However, half of people with a low perceived life expectancy still participated in screening. Given that CRC screening is recommended for adults with a remaining life expectancy of ≥10 years, future research should investigate how to communicate the aims of screening more effectively.
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Affiliation(s)
- Lindsay C Kobayashi
- Center for Population and Development Studies, Harvard T.H. Chan School of Public Health, Harvard University, 9 Bow St, Cambridge, MA, 02138, USA.
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, London, UK.
| | - Christian von Wagner
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, London, UK
| | - Jane Wardle
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, London, UK
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15
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Meisel SF, Fraser LSM, Side L, Gessler S, Hann KEJ, Wardle J, Lanceley A. Anticipated health behaviour changes and perceived control in response to disclosure of genetic risk of breast and ovarian cancer: a quantitative survey study among women in the UK. BMJ Open 2017; 7:e017675. [PMID: 29275340 PMCID: PMC5770899 DOI: 10.1136/bmjopen-2017-017675] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Genetic risk assessment for breast cancer and ovarian cancer (BCOC) is expected to make major inroads into mainstream clinical practice. It is important to evaluate the potential impact on women ahead of its implementation in order to maximise health benefits, as predictive genetic testing without adequate support could lead to adverse psychological and behavioural responses to risk disclosure. OBJECTIVE To examine anticipated health behaviour changes and perceived control to disclosure of genetic risk for BCOC and establish demographic and person-specific correlates of adverse anticipated responses in a population-based sample of women. DESIGN Cross-sectional quantitative survey study carried out by the UK Office for National Statistics in January and March 2014. SETTING Face-to-face computer-assisted interviews conducted by trained researchers in participants' homes. PARTICIPANTS 837 women randomly chosen from households across the UK identified from the Royal Mail's Postcode Address File. OUTCOME MEASURES Anticipated health behaviour change and perceived control to disclosure of BCOC risk. RESULTS In response to a genetic test result, most women (72%) indicated 'I would try harder to have a healthy lifestyle', and over half (55%) felt 'it would give me more control over my life'. These associations were independent of demographic factors or perceived risk of BCOC in Bonferroni-corrected multivariate analyses. However, a minority of women (14%) felt 'it isn't worth making lifestyle changes' and that 'I would feel less free to make choices in my life' (16%) in response to BCOC risk disclosure. The former belief was more likely to be held by women who were educated below university degree level (P<0.001) after adjusting for other demographic and person-specific correlates. CONCLUSION These findings indicate that women in the UK largely anticipate that they would engage in positive health behaviour changes in response to BCOC risk disclosure.
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Affiliation(s)
- Susanne F Meisel
- Dept of Psychology, Institute of Psychology, Psychiatry and Neuroscience, King’s College London, London, UK
- Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, London, UK
| | | | - Lucy Side
- Clinical Genetics, University Hospital Southampton NHS Trust, Southampton, UK
| | - Sue Gessler
- Dept of Women’s Cancer, UCL EGA Institute for Women’s Health, University College London, London, UK
- Gynaecological Cancer Centre, University College London Hospitals (UCLH), London, UK
| | - Katie E J Hann
- Dept of Women’s Cancer, UCL EGA Institute for Women’s Health, University College London, London, UK
| | - Jane Wardle
- Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, London, UK
| | - Anne Lanceley
- Dept of Women’s Cancer, UCL EGA Institute for Women’s Health, University College London, London, UK
- Gynaecological Cancer Centre, University College London Hospitals (UCLH), London, UK
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16
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Smith L, van Jaarsveld CHM, Llewellyn CH, Fildes A, López Sánchez GF, Wardle J, Fisher A. Genetic and Environmental Influences on Developmental Milestones and Movement: Results From the Gemini Cohort Study. Res Q Exerc Sport 2017; 88:401-407. [PMID: 29048262 DOI: 10.1080/02701367.2017.1373268] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
PURPOSE Variability in the timing of infant developmental milestones is poorly understood. We used a twin analysis to estimate genetic and environmental influences on motor development and activity levels in infancy. METHOD Data were from the Gemini Study, a twin birth cohort of 2,402 families with twins born in the United Kingdom in 2007. Parents reported motor activity level for each of the twins at age 3 months using the Revised Infant Behavior Rating Scale and reported the ages at which they first sat unsupported, crawled, and walked unaided. RESULTS Activity level at 3 months and ages when first sitting and crawling were about equally influenced by the shared family environment (45%-54%) and genes (45%-48%). Genetic influences dominated for age when children took their first independent steps (84%). CONCLUSION Aspects of the shared family environment appear to be important influences on motor activity levels and early milestones, although the timing of walking may have a stronger genetic influence. Further research to identify the specific environmental and genetic factors that promote early activity may be important for longer-term health outcomes.
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17
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Meisel SF, Freeman M, Waller J, Fraser L, Gessler S, Jacobs I, Kalsi J, Manchanda R, Rahman B, Side L, Wardle J, Lanceley A, Sanderson SC. Impact of a decision aid about stratified ovarian cancer risk-management on women's knowledge and intentions: a randomised online experimental survey study. BMC Public Health 2017; 17:882. [PMID: 29145813 PMCID: PMC5689140 DOI: 10.1186/s12889-017-4889-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 11/06/2017] [Indexed: 02/03/2023] Open
Abstract
Background Risk stratification using genetic and other types of personal information could improve current best available approaches to ovarian cancer risk reduction, improving identification of women at increased risk of ovarian cancer and reducing unnecessary interventions for women at lower risk. Amounts of information given to women may influence key informed decision-related outcomes, e.g. knowledge. The primary aim of this study was to compare informed decision-related outcomes between women given one of two versions (gist vs. extended) of a decision aid about stratified ovarian cancer risk-management. Methods This was an experimental survey study comparing the effects of brief (gist) information with lengthier, more detailed (extended) information on cognitions relevant to informed decision-making about participating in risk-stratified ovarian cancer screening. Women with no personal history of ovarian cancer were recruited through an online survey company and randomised to view the gist (n = 512) or extended (n = 519) version of a website-based decision aid and completed an online survey. Primary outcomes were knowledge and intentions. Secondary outcomes included attitudes (values) and decisional conflict. Results There were no significant differences between the gist and extended conditions in knowledge about ovarian cancer (time*group interaction: F = 0.20, p = 0.66) or intention to participate in ovarian cancer screening based on genetic risk assessment (t(1029) = 0.43, p = 0.67). There were also no between-groups differences in secondary outcomes. In the sample overall (n = 1031), knowledge about ovarian cancer increased from before to after exposure to the decision aid (from 5.71 to 6.77 out of a possible 10: t = 19.04, p < 0.001), and 74% of participants said that they would participate in ovarian cancer screening based on genetic risk assessment. Conclusions No differences in knowledge or intentions were found between women who viewed the gist version and women who viewed the extended version of a decision aid about risk-stratified ovarian cancer screening. Knowledge increased for women in both decision aid groups. Further research is needed to determine the ideal volume and type of content for decision aids about stratified ovarian cancer risk-management. Trial registrations This study was registered with the ISRCTN registry; registration number: ISRCTN48627877. Electronic supplementary material The online version of this article (10.1186/s12889-017-4889-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Susanne F Meisel
- Department of Behavioural Science and Health, University College London, London, UK.,Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Maddie Freeman
- Department of Behavioural Science and Health, University College London, London, UK
| | - Jo Waller
- Department of Behavioural Science and Health, University College London, London, UK
| | - Lindsay Fraser
- Department of Women's Cancer, Institute for Women's Health, University College London, London, UK
| | - Sue Gessler
- Department of Women's Cancer, Institute for Women's Health, University College London, London, UK
| | - Ian Jacobs
- University of New South Wales, Sydney, NSW, Australia
| | - Jatinderpal Kalsi
- Department of Women's Cancer, Institute for Women's Health, University College London, London, UK
| | - Ranjit Manchanda
- Department of Women's Cancer, Institute for Women's Health, University College London, London, UK
| | - Belinda Rahman
- Department of Women's Cancer, Institute for Women's Health, University College London, London, UK
| | - Lucy Side
- University College Southampton, Southampton, UK
| | - Jane Wardle
- Department of Behavioural Science and Health, University College London, London, UK
| | - Anne Lanceley
- Department of Women's Cancer, Institute for Women's Health, University College London, London, UK
| | - Saskia C Sanderson
- Department of Behavioural Science and Health, University College London, London, UK. .,Great Ormond Street Hospital, London, UK.
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18
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Beeken RJ, Croker H, Heinrich M, Obichere A, Finer N, Murphy N, Goldin R, Guppy NJ, Wilson R, Fisher A, Steptoe A, Gunter MJ, Wardle J. The Impact of Diet-Induced Weight Loss on Biomarkers for Colorectal Cancer: An Exploratory Study (INTERCEPT). Obesity (Silver Spring) 2017; 25 Suppl 2:S95-S101. [PMID: 29086510 PMCID: PMC8515939 DOI: 10.1002/oby.21984] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 08/01/2017] [Accepted: 08/09/2017] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The aim of this study was to explore the potential effects of diet-induced weight loss on molecular biomarkers of colorectal cancer risk in serum and colorectal tissue. METHODS This single-arm exploratory study included 20 adults with BMI ≥ 30 kg/m2 completing an 8-week, complete, low-energy liquid diet. Pre- and postintervention anthropometric measurements, fasting blood draws, and endoscopic examinations to procure colorectal biopsies were performed. Fasting insulin, glucose, insulinlike growth factor 1 (IGF-1), C-reactive protein (CRP), and blood lipids were measured in serum, and tissue markers of apoptosis (M30), colonocyte proliferation (Ki-67), and insulin signaling (phospho-mTOR) were assessed using immunohistochemical staining. RESULTS Participants achieved substantial weight loss (mean = 13.56%). Mean concentrations of insulin, glucose, and cholesterol were significantly reduced (P < 0.05), but IGF-1 and CRP were not. Colorectal tissue expression of Ki-67 was significantly reduced (preintervention mean score = 7, postintervention mean score = 3.9, mean % change -43.8; P = 0.027). There were no significant changes in M30 or phospho-mTOR. CONCLUSIONS Weight loss in individuals with obesity was associated with improvements in insulin sensitivity and blood lipid profiles and a significant reduction in tissue Ki-67 expression. This is one of the first studies to demonstrate potential cancer-relevant changes in colorectal tissue following weight loss achieved through diet.
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Affiliation(s)
- Rebecca J. Beeken
- Department of Behavioural Science & HealthUniversity College LondonLondonUK
- Leeds Institute of Health SciencesUniversity of LeedsLeedsUK
| | - Helen Croker
- Department of Behavioural Science & HealthUniversity College LondonLondonUK
| | | | - Austin Obichere
- Colorectal Service, University College London HospitalLondonUK
| | - Nicholas Finer
- Centre for Obesity ResearchUniversity College LondonLondonUK
| | - Neil Murphy
- Section of Nutrition and Metabolism, International Agency for Research on CancerLyonFrance
| | - Robert Goldin
- Department of MedicineImperial College LondonLondonUK
| | | | | | - Abigail Fisher
- Department of Behavioural Science & HealthUniversity College LondonLondonUK
| | - Andrew Steptoe
- Department of Behavioural Science & HealthUniversity College LondonLondonUK
| | - Marc J. Gunter
- Section of Nutrition and Metabolism, International Agency for Research on CancerLyonFrance
| | - Jane Wardle
- Department of Behavioural Science & HealthUniversity College LondonLondonUK
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Jelenkovic A, Yokoyama Y, Sund R, Pietiläinen KH, Hur YM, Willemsen G, Bartels M, van Beijsterveldt TCEM, Ooki S, Saudino KJ, Stazi MA, Fagnani C, D’Ippolito C, Nelson TL, Whitfield KE, Knafo-Noam A, Mankuta D, Abramson L, Heikkilä K, Cutler TL, Hopper JL, Wardle J, Llewellyn CH, Fisher A, Corley RP, Huibregtse BM, Derom CA, Vlietinck RF, Loos RJF, Bjerregaard-Andersen M, Beck-Nielsen H, Sodemann M, Tarnoki AD, Tarnoki DL, Burt SA, Klump KL, Ordoñana JR, Sánchez-Romera JF, Colodro-Conde L, Dubois L, Boivin M, Brendgen M, Dionne G, Vitaro F, Harris JR, Brandt I, Nilsen TS, Craig JM, Saffery R, Rasmussen F, Tynelius P, Bayasgalan G, Narandalai D, Haworth CMA, Plomin R, Ji F, Ning F, Pang Z, Rebato E, Krueger RF, McGue M, Pahlen S, Boomsma DI, Sørensen TIA, Kaprio J, Silventoinen K. Association between birthweight and later body mass index: an individual-based pooled analysis of 27 twin cohorts participating in the CODATwins project. Int J Epidemiol 2017; 46:1488-1498. [PMID: 28369451 PMCID: PMC5837357 DOI: 10.1093/ije/dyx031] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2017] [Indexed: 11/30/2022] Open
Abstract
Background There is evidence that birthweight is positively associated with body mass index (BMI) in later life, but it remains unclear whether this is explained by genetic factors or the intrauterine environment. We analysed the association between birthweight and BMI from infancy to adulthood within twin pairs, which provides insights into the role of genetic and environmental individual-specific factors. Methods This study is based on the data from 27 twin cohorts in 17 countries. The pooled data included 78 642 twin individuals (20 635 monozygotic and 18 686 same-sex dizygotic twin pairs) with information on birthweight and a total of 214 930 BMI measurements at ages ranging from 1 to 49 years. The association between birthweight and BMI was analysed at both the individual and within-pair levels using linear regression analyses. Results At the individual level, a 1-kg increase in birthweight was linearly associated with up to 0.9 kg/m2 higher BMI (P < 0.001). Within twin pairs, regression coefficients were generally greater (up to 1.2 kg/m2 per kg birthweight, P < 0.001) than those from the individual-level analyses. Intra-pair associations between birthweight and later BMI were similar in both zygosity groups and sexes and were lower in adulthood. Conclusions These findings indicate that environmental factors unique to each individual have an important role in the positive association between birthweight and later BMI, at least until young adulthood.
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Affiliation(s)
- Aline Jelenkovic
- Department of Social Research, University of Helsinki, Helsinki, Finland
- Department of Genetics, Physical Anthropology and Animal Physiology, University of the Basque Country UPV/EHU, Leioa, Spain
| | - Yoshie Yokoyama
- Department of Public Health Nursing, Osaka City University, Osaka, Japan
| | - Reijo Sund
- Department of Social Research, University of Helsinki, Helsinki, Finland
| | - Kirsi H Pietiläinen
- Obesity Research Unit, Research Programs Unit, University of Helsinki, Helsinki, Finland and Abdominal Center, Endocrinology, Helsinki University Central Hospital, Helsinki, Finland
| | - Yoon-Mi Hur
- Department of Education, Mokpo National University, Jeonnam, South Korea
| | - Gonneke Willemsen
- Department of Biological Psychology, VU University Amsterdam, Amsterdam, The Netherlands
| | - Meike Bartels
- Department of Biological Psychology, VU University Amsterdam, Amsterdam, The Netherlands
| | | | - Syuichi Ooki
- Department of Health Science, Ishikawa Prefectural Nursing University, Kahoku, Ishikawa, Japan
| | - Kimberly J Saudino
- Boston University, Department of Psychological and Brain Sciencies, Boston, MA, USA
| | - Maria A Stazi
- Istituto Superiore di Sanità—National Center for Epidemiology, Surveillance and Health Promotion, Rome, Italy
| | - Corrado Fagnani
- Istituto Superiore di Sanità—National Center for Epidemiology, Surveillance and Health Promotion, Rome, Italy
| | - Cristina D’Ippolito
- Istituto Superiore di Sanità—National Center for Epidemiology, Surveillance and Health Promotion, Rome, Italy
| | - Tracy L Nelson
- Department of Health and Exercise Sciencies and Colorado School of Public Health, Colorado State University, USA
| | | | | | - David Mankuta
- Hadassah Hospital Obstetrics and Gynecology Department, Hebrew University Medical School, Jerusalem, Israel
| | - Lior Abramson
- The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Kauko Heikkilä
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Tessa L Cutler
- The Australian Twin Registry, Centre for Epidemiology and Biostatistics, The University of Melbourne, Melbourne, Victoria, Australia
| | - John L Hopper
- The Australian Twin Registry, Centre for Epidemiology and Biostatistics, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Epidemiology, School of Public Health, Seoul National University, Seoul, Korea
| | - Jane Wardle
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, Institute of Epidemiology and Health Care, University College London, London, UK
| | - Clare H Llewellyn
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, Institute of Epidemiology and Health Care, University College London, London, UK
| | - Abigail Fisher
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, Institute of Epidemiology and Health Care, University College London, London, UK
| | - Robin P Corley
- Institute for Behavioral Genetics, University of Colorado, Boulder, Colorado, USA
| | - Brooke M Huibregtse
- Institute for Behavioral Genetics, University of Colorado, Boulder, Colorado, USA
| | - Catherine A Derom
- Centre of Human Genetics, University Hospitals Leuven, Leuven, Belgium
- Department of Obstetrics and Gynaecology, Ghent University Hospitals, Ghent, Belgium
| | | | - Ruth JF Loos
- The Charles Bronfman Institute for Personalized Medicine, The Mindich Child Health and Development Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Morten Bjerregaard-Andersen
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau
- Research Center for Vitamins and Vaccines, Statens Serum Institute, Copenhagen, Denmark
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
| | | | - Morten Sodemann
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark
| | - Adam D Tarnoki
- Department of Radiology and Oncotherapy, Semmelweis University, Budapest, Hungary
- Hungarian Twin Registry, Budapest, Hungary
| | - David L Tarnoki
- Department of Radiology and Oncotherapy, Semmelweis University, Budapest, Hungary
- Hungarian Twin Registry, Budapest, Hungary
| | | | - Kelly L Klump
- Michigan State University, East Lansing, Michigan, USA
| | - Juan R Ordoñana
- Department of Human Anatomy and Psychobiology, University of Murcia, Murcia, Spain
- IMIB-Arrixaca, Murcia, Spain
| | - Juan F Sánchez-Romera
- IMIB-Arrixaca, Murcia, Spain
- Department of Developmental and Educational Psychology, University of Murcia, Murcia, Spain
| | - Lucia Colodro-Conde
- Department of Human Anatomy and Psychobiology, University of Murcia, Murcia, Spain
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Lise Dubois
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Michel Boivin
- School of Psycholoy, Laval University, Quebec, Canada
- Institute of Genetic, Neurobiological, and Social Foundations of Child Development, Tomsk State University, Russian Federation
| | - Mara Brendgen
- Departement of Psychology, University of Quebec at Montreal, Montreal, Quebec, Canada
| | | | - Frank Vitaro
- School of Psychoeducation, University of Montreal, Montreal, Quebec, Canada
| | | | | | | | - Jeffrey M Craig
- Murdoch Childrens Research Institute, Royal Children’s Hospital, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Richard Saffery
- Murdoch Childrens Research Institute, Royal Children’s Hospital, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Finn Rasmussen
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Per Tynelius
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | | | - Danshiitsoodol Narandalai
- Healthy Twin Association of Mongolia, Ulaanbaatar, Mongolia
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Claire MA Haworth
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Robert Plomin
- King’s College London, MRC Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Fuling Ji
- Department of Noncommunicable Diseases Prevention, Qingdao Centers for Disease Control and Prevention, Qingdao, China
| | - Feng Ning
- Department of Noncommunicable Diseases Prevention, Qingdao Centers for Disease Control and Prevention, Qingdao, China
| | - Zengchang Pang
- Department of Noncommunicable Diseases Prevention, Qingdao Centers for Disease Control and Prevention, Qingdao, China
| | - Esther Rebato
- Department of Genetics, Physical Anthropology and Animal Physiology, University of the Basque Country UPV/EHU, Leioa, Spain
| | - Robert F Krueger
- Department of Psychology, University of Minnesota, Minneapolis, MN, USA
| | - Matt McGue
- Department of Psychology, University of Minnesota, Minneapolis, MN, USA
| | - Shandell Pahlen
- Department of Psychology, University of Minnesota, Minneapolis, MN, USA
| | - Dorret I Boomsma
- Department of Biological Psychology, VU University Amsterdam, Amsterdam, The Netherlands
| | - Thorkild IA Sørensen
- Novo Nordisk Foundation Centre for Basic Metabolic Research (Section on Metabolic Genetics), and Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Epidemiology (formely Institute of Preventive Medicine), Bispebjerg and Frederiksberg Hospitals, Copenhagen, The Capital Region, Denmark
| | - Jaakko Kaprio
- Department of Social Research, University of Helsinki, Helsinki, Finland
- Obesity Research Unit, Research Programs Unit, University of Helsinki, Helsinki, Finland and Abdominal Center, Endocrinology, Helsinki University Central Hospital, Helsinki, Finland
- National Institute for Health and Welfare, Helsinki, Finland
- Institute for Molecular Medicine FIMM, Helsinki, Finland
| | - Karri Silventoinen
- Department of Social Research, University of Helsinki, Helsinki, Finland
- Osaka University Graduate School of Medicine, Osaka University, Osaka, Japan
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Wardle J, Steel A, Lauche R, Adams J. Collaborating with medicine? Perceptions of Australian naturopaths on integrating within the conventional medical system. J Interprof Care 2017; 31:734-743. [DOI: 10.1080/13561820.2017.1351424] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- J. Wardle
- Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia
| | - A. Steel
- Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia
- Office of Research, Endeavour College of Natural Health, Fortitude Valley, QLD, Australia
| | - R. Lauche
- Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia
| | - J. Adams
- Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia
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Walabyeki J, Adamson J, Buckley HL, Sinclair H, Atkin K, Graham H, Whitaker K, Wardle J, Macleod U. Experience of, awareness of and help-seeking for potential cancer symptoms in smokers and non-smokers: A cross-sectional study. PLoS One 2017; 12:e0183647. [PMID: 28846706 PMCID: PMC5573210 DOI: 10.1371/journal.pone.0183647] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 08/08/2017] [Indexed: 01/27/2023] Open
Abstract
Background Presenting to primary care with potential cancer symptoms is contingent on one’s ability to recognize potentially serious symptoms. We investigated differences between smokers and non-smokers in symptoms experienced, awareness and consulting of potential respiratory, head and neck cancer symptoms. Methods Smokers and non-smokers aged over 50 from Yorkshire general practice lists were sent a postal questionnaire asking about symptoms, consulting and awareness of cancer symptoms. Data were analysed using STATA14. Results Response rate after one reminder was 30.5% (1205/3954). Smoking status was associated with experience of cough (p<0.001), breathlessness (p = 0.002) and tiredness (p = 0.004) with smokers (25.8% of population) more likely than never-smokers (53.6% of population) to experience all three symptoms (cough OR = 2.56;95%CI[1.75–3.75], breathlessness OR = 2.39;95%CI[1.43–4.00], tiredness OR = 1.57;95%CI[1.12–2.19]). Smoking status was associated with awareness of breathlessness as a potential cancer symptom (p = 0.035) and consulting for cough (p = 0.011) with smokers less likely to consult than never-smokers (OR = 0.37;95% CI[0.17–0.80]). Conclusion Our findings suggest that current smokers are more likely to experience cough, breathlessness and tiredness, but are less likely to consult for cough than never-smokers. To increase cancer awareness and promote consulting among smokers, innovative interventions improving symptom recognition and empowering smokers to seek help are required.
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Affiliation(s)
- Julie Walabyeki
- Hull York Medical School, University of Hull, Hull, United Kingdom
- * E-mail:
| | - Joy Adamson
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Hannah L. Buckley
- Department of Health Sciences, University of York, Heslington, York, United Kingdom
| | - Helena Sinclair
- Hull York Medical School, University of Hull, Hull, United Kingdom
| | - Karl Atkin
- Department of Health Sciences, University of York, Heslington, York, United Kingdom
| | - Hilary Graham
- Department of Health Sciences, University of York, Heslington, York, United Kingdom
| | - Katriina Whitaker
- School of Health Sciences, University of Surrey, Guildford, Surrey, United Kingdom
| | - Jane Wardle
- Health Behaviour Research Centre, University College London, London, United Kingdom
| | - Una Macleod
- Hull York Medical School, University of Hull, Hull, United Kingdom
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22
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Smith SG, Wardle J, Atkin W, Raine R, McGregor LM, Vart G, Morris S, Duffy SW, Moss S, Hackshaw A, Halloran S, Kralj-Hans I, Howe R, Snowball J, Handley G, Logan RF, Rainbow S, Smith S, Thomas M, Counsell N, von Wagner C. Reducing the socioeconomic gradient in uptake of the NHS bowel cancer screening Programme using a simplified supplementary information leaflet: a cluster-randomised trial. BMC Cancer 2017; 17:543. [PMID: 28806955 PMCID: PMC5556676 DOI: 10.1186/s12885-017-3512-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 07/28/2017] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Uptake of colorectal cancer screening is low in the English NHS Bowel Cancer Screening Programme (BCSP). Participation in screening is strongly associated with socioeconomic status. The aim of this study was to determine whether a supplementary leaflet providing the 'gist' of guaiac-based Faecal Occult Blood test (gFOBt) screening for colorectal cancer could reduce the socioeconomic status (SES) gradient in uptake in the English NHS BCSP. METHODS The trial was integrated within routine BCSP operations in November 2012. Using a cluster randomised controlled design all adults aged 59-74 years who were being routinely invited to complete the gFOBt were randomised based on day of invitation. The Index of Multiple Deprivation was used to create SES quintiles. The control group received the standard information booklet ('SI'). The intervention group received the SI booklet and the Gist leaflet ('SI + Gist') which had been designed to help people with lower literacy engage with the invitation. Blinding of hubs was not possible and invited subjects were not made aware of a comparator condition. The primary outcome was the gradient in uptake across IMD quintiles. RESULTS In November 2012, 163,525 individuals were allocated to either the 'SI' intervention (n = 79,104) or the 'SI + Gist' group (n = 84,421). Overall uptake was similar between the intervention and control groups (SI: 57.3% and SI + Gist: 57.6%; OR = 1.02, 95% CI: 0.92-1.13, p = 0.77). Uptake was 42.0% (SI) vs. 43.0% (SI + Gist) in the most deprived quintile and 65.6% vs. 65.8% in the least deprived quintile (interaction p = 0.48). The SES gradient in uptake was similar between the study groups within age, gender, hub and screening round sub-groups. CONCLUSIONS Providing supplementary simplified information in addition to the standard information booklet did not reduce the SES gradient in uptake in the NHS BCSP. The effectiveness of the Gist leaflet when used alone should be explored in future research. TRIAL REGISTRATION ISRCTN74121020 , registered: 17/20/2012.
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Affiliation(s)
- Samuel G. Smith
- Leeds Institute of Health Sciences, University of Leeds, Leeds, LS2 9LB UK
| | - Jane Wardle
- Department of Behavioural Science and Health, University College London, London, WC1E 7HB UK
| | - Wendy Atkin
- Faculty of Medicine, Department of Surgery & Cancer, Imperial College London, London, W2 1NY UK
| | - Rosalind Raine
- Department of Applied Health Research, University College London, London, WC1E 7HB UK
| | - Lesley M. McGregor
- Department of Behavioural Science and Health, University College London, London, WC1E 7HB UK
| | - Gemma Vart
- Department of Behavioural Science and Health, University College London, London, WC1E 7HB UK
- Research & Enterprise Royal Holloway University of London, London, England
| | - Steve Morris
- Department of Applied Health Research, University College London, London, WC1E 7HB UK
| | - Stephen W. Duffy
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, EC1M 6BQ UK
| | - Susan Moss
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, EC1M 6BQ UK
| | - Allan Hackshaw
- Cancer Research UK & UCL Cancer Trials Centre, University College London, London, WC1E 7HB UK
| | - Stephen Halloran
- Bowel Cancer Screening Southern Programme Hub, Guildford, GU2 7XX UK
| | - Ines Kralj-Hans
- Academic Neuroscience Centre, King’s College London, London, SE5 8AF UK
| | - Rosemary Howe
- Faculty of Medicine, Department of Surgery & Cancer, Imperial College London, London, W2 1NY UK
| | - Julia Snowball
- Bowel Cancer Screening Southern Programme Hub, Guildford, GU2 7XX UK
| | - Graham Handley
- North East Bowel Cancer Screening Hub, Gateshead, NE9 6SX UK
| | - Richard F. Logan
- Eastern Hub of the Bowel Cancer Screening Programme, Nottingham, NG7 2UH UK
| | - Sandra Rainbow
- Bowel Cancer Screening Programme London Programme Hub, London, HA1 3UJ UK
| | - Steve Smith
- Midlands & North West Bowel Cancer Screening Programme Hub, Rugby, CV22 5PX UK
| | - Mary Thomas
- Department of Applied Health Research, University College London, London, WC1E 7HB UK
| | - Nicholas Counsell
- Cancer Research UK & UCL Cancer Trials Centre, University College London, London, WC1E 7HB UK
| | - Christian von Wagner
- Department of Behavioural Science and Health, University College London, London, WC1E 7HB UK
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Duijts SFA, van der Beek AJ, Bleiker EMA, Smith L, Wardle J. Cancer and heart attack survivors' expectations of employment status: results from the English Longitudinal Study of Ageing. BMC Public Health 2017; 17:640. [PMID: 28784134 PMCID: PMC5547521 DOI: 10.1186/s12889-017-4659-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 07/31/2017] [Indexed: 11/10/2022] Open
Abstract
Background Sociodemographic, health- and work-related factors have been found to influence return to work in cancer survivors. It is feasible though that behavioural factors, such as expectation of being at work, could also affect work-related outcomes. Therefore, the effect of earlier identified factors and expectation of being at work on future employment status in cancer survivors was explored. To assess the degree to which these factors specifically concern cancer survivors, a comparison with heart attack survivors was made. Methods Data from the English Longitudinal Study of Ageing were used. Cancer and heart attack survivors of working age in the UK were included and followed up for 2 years. Baseline characteristics of both cancer and heart attack survivors were compared regarding employment status. Univariate and multivariate regression analyses were performed in survivors at work, and the interaction between independent variables and diagnose group was assessed. Results In cancer survivors at work (N = 159), alcohol consumption, participating in moderate or vigorous sport activities, general health and participation were univariate associated with employment status at two-year follow-up. Only fair general health (compared to very good general health) remained statistically significant in the multivariate model (OR 0.31; 95% CI 0.13–0.76; p = 0.010). In heart attack survivors at work (N = 78), gender, general health and expectation of being at work were univariate associated with employment status at follow-up. Female gender (OR 0.03; 95% CI 0.00–0.57; p = 0.018) and high expectation of being at work (OR 10.68; 95% CI 1.23–93.92; p = 0.033) remained significant in the multivariate model. The influence of gender (p = 0.066) and general health (p = 0.020) regarding employment status was found to differ significantly between cancer and heart attack survivors. Conclusions When predicting future employment status in cancer survivors in the UK, general health is the most relevant factor to consider. While expectation of being at work did not show any significant influence in cancer survivors, in heart attack survivors, it should not be disregarded though, when developing interventions to affect their employment status. Future research should focus on more specific measures for expectation, and additional behavioural factors, such as self-efficacy, and their effect on employment status.
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Affiliation(s)
- Saskia F A Duijts
- Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands. .,The Netherlands Cancer Institute, Division of Psychosocial Research and Epidemiology, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.
| | - Allard J van der Beek
- Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.,Research Center for Insurance Medicine AMC-UMCG-UWV-VUmc, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
| | - Eveline M A Bleiker
- The Netherlands Cancer Institute, Division of Psychosocial Research and Epidemiology, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Lee Smith
- Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge, CB1 1PT, UK
| | - Jane Wardle
- Department of Epidemiology and Public Health, Health Behaviour Research Centre, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
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Quaife SL, Marlow LAV, McEwen A, Janes SM, Wardle J. Attitudes towards lung cancer screening in socioeconomically deprived and heavy smoking communities: informing screening communication. Health Expect 2017; 20:563-573. [PMID: 27397651 PMCID: PMC5513004 DOI: 10.1111/hex.12481] [Citation(s) in RCA: 102] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2016] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND While discussion continues over the future implementation of lung cancer screening, low participation from higher risk groups could limit the effectiveness of any national screening programme. OBJECTIVES To compare smokers' beliefs about lung cancer screening with those of former and never smokers within a low socioeconomic status (SES) sample, to explore the views of lower SES smokers and ex-smokers in-depth, and to provide insights into effective engagement strategies. DESIGN, SETTING AND PARTICIPANTS Using proactive, community-based recruitment methods, we surveyed 175 individuals from socioeconomically deprived communities with high smoking prevalence and subsequently interviewed 21 smokers and ex-smokers. Participants were approached in community settings or responded to a mail-out from their housing association. RESULTS Interviewees were supportive of screening in principle, but many were doubtful about its ability to deliver long-term survival benefit for their generation of "heavy smokers." Lung cancer was perceived as an uncontrollable disease, and the survey data showed that fatalism, worry and perceived risk of lung cancer were particularly high among smokers compared with non-smokers. Perceived blame and stigma around lung cancer as a self-inflicted smokers' disease were implicated by interviewees as important social deterrents of screening participation. The belief that lungs are not a treatable organ appeared to be a common lay explanation for poor survival and undermined the potential value of screening. CONCLUSIONS Attitudes towards screening among this high-risk group are complex. Invitation strategies need to be carefully devised to achieve equitable participation in screening.
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Affiliation(s)
- Samantha L. Quaife
- Health Behaviour Research CentreDepartment of Epidemiology and Public HealthUniversity College LondonLondonUK
| | - Laura A. V. Marlow
- Health Behaviour Research CentreDepartment of Epidemiology and Public HealthUniversity College LondonLondonUK
| | - Andy McEwen
- Health Behaviour Research CentreDepartment of Epidemiology and Public HealthUniversity College LondonLondonUK
| | - Samuel M. Janes
- Lungs for Living Research CentreUCL RespiratoryDivision of MedicineUniversity College LondonLondonUK
| | - Jane Wardle
- Health Behaviour Research CentreDepartment of Epidemiology and Public HealthUniversity College LondonLondonUK
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25
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Steel A, Sundberg T, Reid R, Ward L, Bishop F, Leach M, Cramer H, Wardle J, Adams J. Corrigendum to "Osteopathic manipulative treatment: A systematic review and critical appraisal of comparative effectiveness and health economics research" [Musculoskelet. Sci. Pract. 27 165-175]. Musculoskelet Sci Pract 2017; 30:86. [PMID: 28283320 DOI: 10.1016/j.msksp.2017.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- A Steel
- Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, 15 Broadway, Ultimo, NSW, 2007, Australia; Endeavour College of Natural Health, Level 2, 269 Wickham St, Fortitude Valley, QLD, 4006, Australia.
| | - T Sundberg
- Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, 15 Broadway, Ultimo, NSW, 2007, Australia; Research Unit for Studies of Integrative Health Care, Karolinska Institutet (NVS/OMV), Alfred Nobels Alle 23, 141 83, Stockholm, Sweden
| | - R Reid
- Endeavour College of Natural Health, Level 2, 269 Wickham St, Fortitude Valley, QLD, 4006, Australia
| | - L Ward
- Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, 15 Broadway, Ultimo, NSW, 2007, Australia; Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences (NDORMS), B4495, OX3 7LD, University of Oxford, Oxford, United Kingdom
| | - F Bishop
- Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, 15 Broadway, Ultimo, NSW, 2007, Australia; Centre for Applications of Health Psychology, Faculty of Social Human and Mathematical Sciences, Building 44 Highfield Campus, University of Southampton, Southampton, SO17 1BJ, United Kingdom
| | - M Leach
- Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, 15 Broadway, Ultimo, NSW, 2007, Australia; School of Nursing & Midwifery, Health Economics & Social Policy Group, University of South Australia, 101 Currie St, Adelaide, Australia
| | - H Cramer
- Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, 15 Broadway, Ultimo, NSW, 2007, Australia; Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, 45141, Duisburg, Germany
| | - J Wardle
- Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, 15 Broadway, Ultimo, NSW, 2007, Australia
| | - J Adams
- Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, 15 Broadway, Ultimo, NSW, 2007, Australia
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Patel N, Godfrey KM, Pasupathy D, Levin J, Flynn AC, Hayes L, Briley AL, Bell R, Lawlor DA, Oteng-Ntim E, Nelson SM, Robson SC, Sattar N, Singh C, Wardle J, White S, Seed PT, Poston L. Infant adiposity following a randomised controlled trial of a behavioural intervention in obese pregnancy. Int J Obes (Lond) 2017; 41:1018-1026. [PMID: 28216644 PMCID: PMC5482395 DOI: 10.1038/ijo.2017.44] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 11/09/2016] [Accepted: 01/31/2017] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Randomised controlled trials are required to address causality in the reported associations between maternal influences and offspring adiposity. The aim of this study was to determine whether an antenatal lifestyle intervention, associated with improvements in maternal diet and reduced gestational weight gain (GWG) in obese pregnant women leads to a reduction in infant adiposity and sustained improvements in maternal lifestyle behaviours at 6 months postpartum. SUBJECTS AND METHODS We conducted a planned postnatal follow-up of a randomised controlled trial (UK Pregnancies Better Eating and Activity Trial (UPBEAT)) of a complex behavioural intervention targeting maternal diet (glycaemic load (GL) and saturated fat intake) and physical activity in 1555 obese pregnant women. The main outcome measure was infant adiposity, assessed by subscapular and triceps skinfold thicknesses. Maternal diet and physical activity, indices of the familial lifestyle environment, were assessed by questionnaire. RESULTS A total of 698 (45.9%) infants (342 intervention and 356 standard antenatal care) were followed up at a mean age of 5.92 months. There was no difference in triceps skinfold thickness z-scores between the intervention vs standard care arms (difference -0.14 s.d., 95% confidence interval -0.38 to 0.10, P=0.246), but subscapular skinfold thickness z-score was 0.26 s.d. (-0.49 to -0.02; P=0.03) lower in the intervention arm. Maternal dietary GL (-35.34; -48.0 to -22.67; P<0.001) and saturated fat intake (-1.93% energy; -2.64 to -1.22; P<0.001) were reduced in the intervention arm at 6 months postpartum. Causal mediation analysis suggested that lower infant subscapular skinfold thickness was partially mediated by changes in antenatal maternal diet and GWG rather than postnatal diet. CONCLUSIONS This study provides evidence from follow-up of a randomised controlled trial that a maternal behavioural intervention in obese pregnant women has the potential to reduce infant adiposity and to produce a sustained improvement in maternal diet at 6 months postpartum.
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Affiliation(s)
- Nashita Patel
- Division of Women’s Health, Women’s Health Academic Centre, Faculty of Life Sciences and Medicine, King’s College London, St Thomas’ Hospital, London, UK
| | - Keith M. Godfrey
- MRC Lifecourse Epidemiology Unit and NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Dharmintra Pasupathy
- Division of Women’s Health, Women’s Health Academic Centre, Faculty of Life Sciences and Medicine, King’s College London, St Thomas’ Hospital, London, UK
| | - Julia Levin
- London School of Hygiene and Tropical Medicine, London, UK
| | - Angela C Flynn
- Division of Women’s Health, Women’s Health Academic Centre, Faculty of Life Sciences and Medicine, King’s College London, St Thomas’ Hospital, London, UK
- Division of Diabetes and Nutritional Sciences, King’s College London, London, UK
| | - Louise Hayes
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Annette L Briley
- Division of Women’s Health, Women’s Health Academic Centre, Faculty of Life Sciences and Medicine, King’s College London, St Thomas’ Hospital, London, UK
| | - Ruth Bell
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Debbie A Lawlor
- MRC Integrative Epidemiology Unit at the University of Bristol & School of Social and Community Medicine, Bristol, England, UK
| | | | | | - Stephen C. Robson
- Institute of Cellular Medicine Uterine Cell Signalling Group Newcastle University, Newcastle, UK
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Claire Singh
- Guys and St Thomas’ NHS Foundation Trust, London, UK
| | - Jane Wardle
- Health Behaviour Research Centre, Institute of Epidemiology and Health, University College London, London, UK
| | - Sara White
- Division of Women’s Health, Women’s Health Academic Centre, Faculty of Life Sciences and Medicine, King’s College London, St Thomas’ Hospital, London, UK
| | - Paul T Seed
- Division of Women’s Health, Women’s Health Academic Centre, Faculty of Life Sciences and Medicine, King’s College London, St Thomas’ Hospital, London, UK
| | - Lucilla Poston
- Division of Women’s Health, Women’s Health Academic Centre, Faculty of Life Sciences and Medicine, King’s College London, St Thomas’ Hospital, London, UK
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Kobayashi LC, Jackson SE, Lee SJ, Wardle J, Steptoe A. The development and validation of an index to predict 10-year mortality risk in a longitudinal cohort of older English adults. Age Ageing 2017; 46:427-432. [PMID: 27810854 PMCID: PMC5405757 DOI: 10.1093/ageing/afw199] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 09/30/2016] [Indexed: 12/23/2022] Open
Abstract
Background we aimed to develop and validate a population-representative 10-year mortality risk index for older adults in England. Methods data were from 10,798 men and women aged 50 years and older in the population-based English Longitudinal Study of Ageing in 2002/03, randomly split into development (n = 5,377) and validation cohorts (n = 5,421). Participants were asked about their sociodemographics, health behaviours, comorbidities, and functional status in the home-based interviews. Variables that were independently associated with all-cause mortality through March 2013 in the development cohort were weighted relative to one another to develop risk point scores for the index that was calibrated in the validation cohort. Results the validated 10-year mortality risk index assigns points for: increasing age (50–59 years: 0 points; 60–64: 1 point; 65–69: 3 points; 70–74: 5 points; 75–79: 7 points; 80–84: 9 points; ≥85: 12 points), male (2 points), no vigorous physical activity (1 point), smoking (2 points), having a diagnosis of cancer (1 point), chronic lung disease (2 points) or heart failure (4 points), and having difficulty preparing a hot meal (2 points), pushing or pulling large objects (1 point) or walking 100 yards (1 point). In the full study cohort, 10-year mortality rates increased from 1.7% (11/664) in those with 0 points to 95% (189/199) among those with ≥16 points. Conclusion this highly predictive 10-item mortality risk index is valid in the English population aged 50 years and older. It uses simple information that is often available in research studies and patient reports, and does not require biomarker data to predict mortality.
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Affiliation(s)
- Lindsay C. Kobayashi
- Center for Population and Development Studies, Harvard T.H. Chan School of Public Health, Harvard University, Cambridge, MA, USA
- Department of Epidemiology and Public Health, Institute of Epidemiology and Health Care, University College London, London, UK
| | - Sarah E. Jackson
- Department of Epidemiology and Public Health, Institute of Epidemiology and Health Care, University College London, London, UK
| | - Sei J. Lee
- Division of Geriatrics, School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Jane Wardle
- Department of Epidemiology and Public Health, Institute of Epidemiology and Health Care, University College London, London, UK
| | - Andrew Steptoe
- Department of Epidemiology and Public Health, Institute of Epidemiology and Health Care, University College London, London, UK
- Address correspondence to: A. Steptoe. Tel: (+44) 207 679 1804; Fax: (+44) 207 916 8542.
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Robb KA, Gatting L, Wardle J. What impact do questionnaire length and monetary incentives have on mailed health psychology survey response? Br J Health Psychol 2017; 22:671-685. [PMID: 28422369 PMCID: PMC5655741 DOI: 10.1111/bjhp.12239] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 03/02/2017] [Indexed: 02/01/2023]
Abstract
Objectives Response rates to health‐related surveys are declining. This study tested two strategies to improve the response rate to a health psychology survey mailed through English general practices: (1) sending a shortened questionnaire and (2) offering a monetary incentive to return a completed questionnaire. Design Randomized controlled trial. Methods Adults (n = 4,241) aged 45–59 years, from four General Practices in South‐East England, were mailed a survey on attitudes towards bowel cancer screening. Using a 2 × 4 factorial design, participants were randomized to receive a ‘short’ (four A4 pages) or a ‘long’ (seven A4 pages) questionnaire, and one of four monetary incentives to return a completed questionnaire – (1) no monetary incentive, (2) £2.50 shop voucher, (3) £5.00 shop voucher, and (4) inclusion in a £250 shop voucher prize draw. Age, gender, and area‐level deprivation were obtained from the General Practices. Results The overall response rate was 41% (n = 1,589). Response to the ‘short’ questionnaire (42%) was not significantly different from the ‘long’ questionnaire (40%). The £2.50 incentive (43%) significantly improved response rates in univariate analyses, and remained significant after controlling for age, gender, area‐level deprivation, and questionnaire length. The £5.00 (42%) and £250 prize draw (41%) incentives had no significant impact on response rates compared to no incentive (38%). Conclusions A small monetary incentive (£2.50) may slightly increase response to a mailed health psychology survey. The length of the questionnaire (four pages vs. seven pages) did not influence response. Although frequently used, entry into a prize draw did not increase response. Achieving representative samples remains a challenge for health psychology. Statement of contribution What is already known on this subject Response rates to mailed questionnaires continue to decline, threatening the representativeness of data. Prize draw incentives are frequently used but there is little evidence to support their efficacy. Research on interactions between incentives, questionnaire length, and demographics is lacking.
What does this study add Contrary to previous findings, questionnaire length did not influence response rate. A £2.50 incentive increased response, while incentives of £5.00 and a £250 prize draw did not. Achieving representative samples to questionnaires remains a challenge for health psychology.
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Affiliation(s)
- Kathryn A Robb
- Institute of Health and Wellbeing, General Practice and Primary Care, University of Glasgow, UK.,Health Behaviour Research Centre, Department of Epidemiology and Public Health, UCL, London, UK
| | - Lauren Gatting
- Institute of Health and Wellbeing, General Practice and Primary Care, University of Glasgow, UK
| | - Jane Wardle
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, UCL, London, UK
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Atkin W, Brenner A, Martin J, Wooldrage K, Shah U, Lucas F, Greliak P, Pack K, Kralj-Hans I, Thomson A, Perera S, Wood J, Miles A, Wardle J, Kearns B, Tappenden P, Myles J, Veitch A, Duffy SW. The clinical effectiveness of different surveillance strategies to prevent colorectal cancer in people with intermediate-grade colorectal adenomas: a retrospective cohort analysis, and psychological and economic evaluations. Health Technol Assess 2017; 21:1-536. [PMID: 28621643 PMCID: PMC5483643 DOI: 10.3310/hta21250] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The UK guideline recommends 3-yearly surveillance for patients with intermediate-risk (IR) adenomas. No study has examined whether or not this group has heterogeneity in surveillance needs. OBJECTIVES To examine the effect of surveillance on colorectal cancer (CRC) incidence; assess heterogeneity in risk; and identify the optimum frequency of surveillance, the psychological impact of surveillance, and the cost-effectiveness of alternative follow-up strategies. DESIGN Retrospective multicentre cohort study. SETTING Routine endoscopy and pathology data from 17 UK hospitals (n = 11,944), and a screening data set comprising three pooled cohorts (n = 2352), followed up using cancer registries. SUBJECTS Patients with IR adenoma(s) (three or four small adenomas or one or two large adenomas). PRIMARY OUTCOMES Advanced adenoma (AA) and CRC detected at follow-up visits, and CRC incidence after baseline and first follow-up. METHODS The effects of surveillance on long-term CRC incidence and of interval length on findings at follow-up were examined using proportional hazards and logistic regression, adjusting for patient, procedural and polyp characteristics. Lower-intermediate-risk (LIR) subgroups and higher-intermediate-risk (HIR) subgroups were defined, based on predictors of CRC risk. A model-based cost-utility analysis compared 13 surveillance strategies. Between-group analyses of variance were used to test for differences in bowel cancer worry between screening outcome groups (n = 35,700). A limitation of using routine hospital data is the potential for missed examinations and underestimation of the effect of interval and surveillance. RESULTS In the hospital data set, 168 CRCs occurred during 81,442 person-years (pys) of follow-up [206 per 100,000 pys, 95% confidence interval (CI) 177 to 240 pys]. One surveillance significantly lowered CRC incidence, both overall [hazard ratio (HR) 0.51, 95% CI 0.34 to 0.77] and in the HIR subgroup (n = 9265; HR 0.50, 95% CI 0.34 to 0.76). In the LIR subgroup (n = 2679) the benefit of surveillance was less clear (HR 0.62, 95% CI 0.16 to 2.43). Additional surveillance lowered CRC risk in the HIR subgroup by a further 15% (HR 0.36, 95% CI 0.20 to 0.62). The odds of detecting AA and CRC at first follow-up (FUV1) increased by 18% [odds ratio (OR) 1.18, 95% CI 1.12 to 1.24] and 32% (OR 1.32, 95% CI 1.20 to 1.46) per year increase in interval, respectively, and the odds of advanced neoplasia at second follow-up increased by 22% (OR 1.22, 95% CI 1.09 to 1.36), after adjustment. Detection rates of AA and CRC remained below 10% and 1%, respectively, with intervals to 3 years. In the screening data set, 32 CRCs occurred during 25,745 pys of follow-up (124 per 100,000 pys, 95% CI 88 to 176 pys). One follow-up conferred a significant 73% reduction in CRC incidence (HR 0.27, 95% CI 0.10 to 0.71). Owing to the small number of end points in this data set, no other outcome was significant. Although post-screening bowel cancer worry was higher in people who were offered surveillance, worry was due to polyp detection rather than surveillance. The economic evaluation, using data from the hospital data set, suggested that 3-yearly colonoscopic surveillance without an age cut-off would produce the greatest health gain. CONCLUSIONS A single surveillance benefited all IR patients by lowering their CRC risk. We identified a higher-risk subgroup that benefited from further surveillance, and a lower-risk subgroup that may require only one follow-up. A surveillance interval of 3 years seems suitable for most IR patients. These findings should be validated in other studies to confirm whether or not one surveillance visit provides adequate protection for the lower-risk subgroup of intermediate-risk patients. STUDY REGISTRATION Current Controlled Trials ISRCTN15213649. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Wendy Atkin
- Cancer Screening and Prevention Research Group (CSPRG), Department of Surgery and Cancer, Imperial College London, London, UK
| | - Amy Brenner
- Cancer Screening and Prevention Research Group (CSPRG), Department of Surgery and Cancer, Imperial College London, London, UK
| | - Jessica Martin
- Cancer Screening and Prevention Research Group (CSPRG), Department of Surgery and Cancer, Imperial College London, London, UK
| | - Katherine Wooldrage
- Cancer Screening and Prevention Research Group (CSPRG), Department of Surgery and Cancer, Imperial College London, London, UK
| | - Urvi Shah
- Cancer Screening and Prevention Research Group (CSPRG), Department of Surgery and Cancer, Imperial College London, London, UK
| | - Fiona Lucas
- Cancer Screening and Prevention Research Group (CSPRG), Department of Surgery and Cancer, Imperial College London, London, UK
| | - Paul Greliak
- Cancer Screening and Prevention Research Group (CSPRG), Department of Surgery and Cancer, Imperial College London, London, UK
| | - Kevin Pack
- Cancer Screening and Prevention Research Group (CSPRG), Department of Surgery and Cancer, Imperial College London, London, UK
| | - Ines Kralj-Hans
- Cancer Screening and Prevention Research Group (CSPRG), Department of Surgery and Cancer, Imperial College London, London, UK
| | - Ann Thomson
- Cancer Screening and Prevention Research Group (CSPRG), Department of Surgery and Cancer, Imperial College London, London, UK
| | - Sajith Perera
- Cancer Screening and Prevention Research Group (CSPRG), Department of Surgery and Cancer, Imperial College London, London, UK
| | - Jill Wood
- Cancer Screening and Prevention Research Group (CSPRG), Department of Surgery and Cancer, Imperial College London, London, UK
| | - Anne Miles
- Department of Psychological Sciences, Birkbeck, University of London, London, UK
| | - Jane Wardle
- Cancer Research UK Health Behaviour Centre, University College London, London, UK
| | - Benjamin Kearns
- School of Health and Related Research (ScHARR), Health Economics and Decision Science Section, University of Sheffield, Sheffield, UK
| | - Paul Tappenden
- School of Health and Related Research (ScHARR), Health Economics and Decision Science Section, University of Sheffield, Sheffield, UK
| | - Jonathan Myles
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | | | - Stephen W Duffy
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
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Poston L, Bell R, Briley AL, Godfrey KM, Nelson SM, Oteng-Ntim E, Sandall J, Sanders TAB, Sattar N, Seed PT, Robson SC, Trépel D, Wardle J. Improving pregnancy outcome in obese women: the UK Pregnancies Better Eating and Activity randomised controlled Trial. Programme Grants Appl Res 2017. [DOI: 10.3310/pgfar05100] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BackgroundObesity in pregnancy is associated with insulin resistance, which underpins many common complications including gestational diabetes mellitus (GDM) and fetal macrosomia.ObjectivesTo assess the effect of a complex behavioural intervention based on diet and physical activity (PA) on the risk of GDM and delivery of a large-for-gestational age (LGA) infant.DesignThree phases: (1) the development phase, (2) the pilot study and (3) a multicentre randomised controlled trial (RCT) comparing a behavioural intervention to improve glycaemic control with standard antenatal care in obese pregnant women. A cost–utility analysis was undertaken to estimate the cost-effectiveness of the health training (intervention) over and above standard care (control).SettingPilot study: antenatal clinics in four inner-city UK hospitals. RCT: eight antenatal clinics in eight UK inner-city hospitals.ParticipantsWomen were eligible for inclusion if they had a body mass index of ≥ 30 kg/m2, were pregnant with a single fetus and at 15+0to 18+6weeks’ gestation, were able to give written informed consent and were without predefined disorders.InterventionThe intervention comprised an initial session with a health trainer, followed by eight weekly sessions. Dietary advice recommended foods with a low dietary glycaemic index, avoidance of sugar-sweetened beverages and reduced saturated fats. Women were encouraged to increase daily PA.Main outcome measuresDevelopment phase: intervention development, acceptability and optimal approach for delivery. Pilot study: change in dietary and PA behaviours at 28 weeks’ gestation. RCT: the primary outcome of the RCT was, for the mother, GDM [as measured by the International Association of the Diabetes and Pregnancy Study Groups (IADPSG)’s diagnostic criteria] and, for the infant, LGA delivery (i.e. customised birthweight ≥ 90th centile for gestational age).ResultsDevelopment phase: following a literature meta-analysis, a study of dietary intention questionnaires and semistructured interviews, an intervention based on behavioural science was developed that incorporated optimal and acceptable methods for delivery. Pilot study: the pilot study demonstrated improvement in dietary behaviours in the intervention compared with the standard care arm but no increase in objectively measured PA. Process evaluation demonstrated feasibility and general acceptability. RCT: the RCT showed no effect of the intervention on GDM in obese pregnant women or the number of deliveries of LGA infants. There was a reduction in dietary glycaemic load (GL) and reduced saturated fat intake, an increase in PA and a modest reduction in gestational weight gain, all secondary outcomes. Lower than expected was the number of LGA infant deliveries in all women, which suggested that universal screening for GDM with IADPSG’s diagnostic criteria, and subsequent treatment, may reduce the number of deliveries of LGA infants. According to the cost–utility analysis, the estimated probability that the UK Pregnancies Better Eating and Activity Trial (UPBEAT) behavioural intervention is cost-effective at the £30,000/quality-adjusted life-year willingness-to-pay threshold was 1%.LimitationsIncluded the high refusal rate for participation and self-reported assessment of diet and PA.ConclusionsThe UPBEAT intervention, an intense theoretically based intervention in obese pregnant women, did not reduce the risk of GDM in women or the number of LGA infant deliveries, despite successfully reducing the dietary GL. Based on total cost to the NHS provider and health gains, the UPBEAT intervention provided no supporting evidence to suggest that the intervention represents value for money based on the National Institute for Health and Care Excellence benchmarks for cost-effectiveness.Future workAlternative strategies for reducing the risk of GDM in obese pregnant women and the number of LGA infant deliveries should be considered, including development of clinically effective interventions to prevent obesity in women of reproductive age, of clinically effective interventions to reduce weight retention following pregnancy and of risk stratification tools in early pregnancy.Trial registrationCurrent Controlled Trials ISRCTN89971375 and UK Clinical Research Network Portfolio 5035.FundingThis project was funded by the NIHR Programme Grant for Applied Research programme and will be published in full inProgramme Grants for Applied Research, Vol. 5, No. 10. See the NIHR journals library website for further project information. Contributions to funding were also provided by the Chief Scientist Office CZB/4/680, Scottish Government Health Directorates, Edinburgh; Guys and St Thomas’ Charity, Tommy’s Charity (Lucilla Poston, Annette L Briley, Paul T Seed) and the NIHR Biomedical Research Centre at Guy’s and St Thomas’ NHS Foundation Trust and King’s College London, UK and the Academy of Finland, Finland. Keith M Godfrey was supported by the National Institute for Health Research through the NIHR Southampton Biomedical Research Centre. Lucilla Poston and Keith M Godfrey were supported by the European Union’s Seventh Framework Programme (FP7/2007-2013), project EarlyNutrition under grant agreement number 289346.
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Affiliation(s)
- Lucilla Poston
- Division of Women’s Health, King’s College London, King’s Health Partners, London, UK
| | - Ruth Bell
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Annette L Briley
- Division of Women’s Health, King’s College London, King’s Health Partners, London, UK
| | - Keith M Godfrey
- Lifecourse Epidemiology Unit and NIHR Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Scott M Nelson
- School of Medicine, University of Glasgow, Glasgow Royal Infirmary, Glasgow, UK
| | | | - Jane Sandall
- Division of Women’s Health, King’s College London, King’s Health Partners, London, UK
| | - Thomas AB Sanders
- Division of Diabetes and Nutritional Sciences, King’s College London, London, UK
| | - Naveed Sattar
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Paul T Seed
- Division of Women’s Health, King’s College London, King’s Health Partners, London, UK
| | - Stephen C Robson
- Institute of Cellular Medicine, The Medical School, Newcastle University, Newcastle upon Tyne, UK
| | - Dominic Trépel
- Department of Health Sciences, University of York, York, UK
| | - Jane Wardle
- Health Behaviour Research Centre, Institute of Epidemiology and Health, University College London, London, UK
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Raine R, Atkin W, von Wagner C, Duffy S, Kralj-Hans I, Hackshaw A, Counsell N, Moss S, McGregor L, Palmer C, Smith SG, Thomas M, Howe R, Vart G, Band R, Halloran SP, Snowball J, Stubbs N, Handley G, Logan R, Rainbow S, Obichere A, Smith S, Morris S, Solmi F, Wardle J. Testing innovative strategies to reduce the social gradient in the uptake of bowel cancer screening: a programme of four qualitatively enhanced randomised controlled trials. Programme Grants Appl Res 2017. [DOI: 10.3310/pgfar05080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BackgroundBowel cancer screening reduces cancer-specific mortality. There is a socioeconomic gradient in the uptake of the English NHS Bowel Cancer Screening Programme (BCSP), which may lead to inequalities in cancer outcomes.ObjectiveTo reduce socioeconomic inequalities in uptake of the NHS BCSP’s guaiac faecal occult blood test (gFOBt) without compromising uptake in any socioeconomic group.DesignWorkstream 1 explored psychosocial determinants of non-uptake of gFOBt in focus groups and interviews. Workstream 2 developed and tested four theoretically based interventions: (1) ‘gist’ information, (2) a ‘narrative’ leaflet, (3) ‘general practice endorsement’ (GPE) and (4) an ‘enhanced reminder’ (ER). Workstream 3 comprised four national cluster randomised controlled trials (RCTs) of the cost-effectiveness of each intervention.MethodsInterventions were co-designed with user panels, user tested using interviews and focus groups, and piloted with postal questionnaires. RCTs compared ‘usual care’ (existing NHS BCSP invitations) with usual care plus each intervention. The four trials tested: (1) ‘gist’ leaflet (n = 163,525), (2) ‘narrative’ leaflet (n = 150,417), (3) GPE on the invitation letter (n = 265,434) and (4) ER (n = 168,480). Randomisation was based on day of mailing of the screening invitation. The Index of Multiple Deprivation (IMD) score associated with each individual’s home address was used as the marker of socioeconomic circumstances (SECs). Change in the socioeconomic gradient in uptake (interaction between treatment group and IMD quintile) was the primary outcome. Screening uptake was defined as the return of a gFOBt kit within 18 weeks of the invitation that led to a ‘definitive’ test result of either ‘normal’ (i.e. no further investigation required) or ‘abnormal’ (i.e. requiring referral for further testing). Difference in overall uptake was the secondary outcome.ResultsThe gist and narrative trials showed no effect on the SECs gradient or overall uptake (57.6% and 56.7%, respectively, compared with 57.3% and 58.5%, respectively, for usual care; allp-values > 0.05). GPE showed no effect on the gradient (p = 0.5) but increased overall uptake [58.2% vs. 57.5% in usual care, odds ratio (OR) = 1.07, 95% confidence interval (CI) 1.04 to 1.10;p < 0.0001]. ER showed a significant interaction with SECs (p = 0.005), with a stronger effect in the most deprived IMD quintile (14.1% vs. 13.3% in usual care, OR = 1.11, 95% CI 1.04 to 1.20;p = 0.003) than the least deprived (34.7% vs. 34.9% in usual care OR = 1.00, 95% CI 0.94 to 1.06;p = 0.98), and higher overall uptake (25.8% vs. 25.1% in usual care, OR = 1.07, 95% CI 1.03 to 1.11;p = 0.001). All interventions were inexpensive to provide.LimitationsIn line with NHS policy, the gist and narrative leaflets supplemented rather than replaced existing NHS BCSP information. This may have undermined their effect.ConclusionsEnhanced reminder reduced the gradient and modestly increased overall uptake, whereas GPE increased overall uptake but did not reduce the gradient. Therefore, given their effectiveness and very low cost, the findings suggest that implementation of both by the NHS BCSP would be beneficial. The gist and narrative results highlight the challenge of achieving equitable delivery of the screening offer when all communication is written; the format is universal and informed decision-making mandates extensive medical information.Future workSocioculturally tailored research to promote communication about screening with family and friends should be developed and evaluated.Trial registrationCurrent Controlled Trials ISRCTN74121020.FundingThis project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full inProgramme Grants for Applied Research; Vol. 5, No. 8. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Rosalind Raine
- Department of Applied Health Research, University College London, London, UK
| | - Wendy Atkin
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Christian von Wagner
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Stephen Duffy
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Ines Kralj-Hans
- Department of Biostatistics, King’s Clinical Trials Unit, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Allan Hackshaw
- University College London Cancer Trials Centre, London, UK
| | | | - Sue Moss
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Lesley McGregor
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Cecily Palmer
- Department of Applied Health Research, University College London, London, UK
| | - Samuel G Smith
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Mary Thomas
- Department of Applied Health Research, University College London, London, UK
| | - Rosemary Howe
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Gemma Vart
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Roger Band
- Patient and Public Involvement Representative, Evesham, UK
| | - Stephen P Halloran
- NHS Bowel Cancer Screening Programme Southern Hub, Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Julia Snowball
- NHS Bowel Cancer Screening Programme Southern Hub, Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
| | - Neil Stubbs
- NHS Bowel Cancer Screening Programme Southern Hub, Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
| | - Graham Handley
- NHS Bowel Cancer Screening Programme North East Hub, Gateshead Health NHS Foundation Trust, Queen Elizabeth Hospital, Gateshead, UK
| | - Richard Logan
- NHS Bowel Cancer Screening Programme Eastern Hub, Nottingham University Hospitals, Nottingham, UK
| | - Sandra Rainbow
- NHS Bowel Cancer Screening Programme London Hub, Northwick Park and St Marks Hospitals NHS Trust, Harrow, UK
| | - Austin Obichere
- North Central London Bowel Cancer Screening Centre, University College London Hospitals NHS Foundation Trust, London, UK
| | - Stephen Smith
- NHS Bowel Cancer Screening Programme Midlands and North West Hub, University Hospitals Coventry and Warwickshire NHS Trust, Hospital of St Cross, Rugby, UK
| | - Stephen Morris
- Department of Applied Health Research, University College London, London, UK
| | - Francesca Solmi
- Department of Applied Health Research, University College London, London, UK
| | - Jane Wardle
- Department of Epidemiology and Public Health, University College London, London, UK
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Marlow LAV, Meisel SF, Wardle J. Ethnic minority women prefer strong recommendations to be screened for cancer. BMC Public Health 2017; 17:164. [PMID: 28158990 PMCID: PMC5291956 DOI: 10.1186/s12889-017-4093-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 01/31/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cancer screening invitations can explicitly recommend attendance or encourage individuals to consider the risks and benefits before deciding for themselves. Public preferences for these approaches might vary. We explored ethnic minority women's preferences for a strong recommendation to be screened. METHODS Women aged 30-60 years from Indian, Pakistani, Bangladeshi, Caribbean, African and white British backgrounds (n = 120 per group) completed face-to-face interviews with a multi-lingual interviewer. The interview included a question on which approach to screening invitations they would prefer: i) A strong recommendation from the National Health Service (NHS) to go for screening, ii) A statement that the NHS thinks you should go for screening, but it's up to you to decide, iii) No recommendation. Analyses examined predictors of preference for a strong recommendation. RESULTS Preferences varied by ethnicity (χ 2(5) = 98.20, p <.001). All ethnic minority groups had a preference for a strong recommendation to be screened (53-86% across ethnic groups vs 31% white British). Socio-demographic factors (marital status, education and employment), and indicators of acculturation (main language and migration status), contributed to explaining recommendation preferences (χ 2(5) = 35.95 and χ 2(3) = 11.59, respectively, both p <.001), but did not mediate the ethnicity effect entirely. Self-rated comprehension of written health information did not contribute to the model. CONCLUSIONS A strong recommendation to participate in cancer screening appears to be important for ethnic minority women, particularly non-English speakers. Future research could explore how to best arrive at a consensus that respects patient autonomy while also accommodating those that would prefer to be guided by a trusted source.
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Affiliation(s)
- Laura A V Marlow
- Cancer Research UK Health Behaviour Research Centre, Department of Epidemiology & Public Health, UCL, Gower Street, London, WC1E 6BT, UK.
| | - Susanne F Meisel
- Cancer Research UK Health Behaviour Research Centre, Department of Epidemiology & Public Health, UCL, Gower Street, London, WC1E 6BT, UK
| | - Jane Wardle
- Cancer Research UK Health Behaviour Research Centre, Department of Epidemiology & Public Health, UCL, Gower Street, London, WC1E 6BT, UK
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Ghanouni A, Nuttall E, Wardle J, von Wagner C. Testing whether barriers to a hypothetical screening test affect unrelated perceived benefits and vice versa: A randomised, experimental study. Patient Educ Couns 2017; 100:e1-e24. [PMID: 27692493 PMCID: PMC5332122 DOI: 10.1016/j.pec.2016.09.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 09/07/2016] [Accepted: 09/15/2016] [Indexed: 05/20/2023]
Abstract
OBJECTIVE Determine whether (fictitious) health screening test benefits affect perceptions of (unrelated) barriers, and barriers affect perceptions of benefits. METHODS UK adults were recruited via an online survey panel and randomised to receive a vignette describing a hypothetical screening test with either high or low benefits (higher vs. lower mortality reduction) and high or low barriers (severe vs. mild side-effects; a 2×2 factorial design). ANOVAs compared mean perceived benefits and barriers scores. Screening 'intentions' were compared using Pearson's χ2 test. RESULTS Benefits were rated less favourably when barriers were high (mean: 27.4, standard deviation: 5.3) than when they were low (M: 28.5, SD: 4.8; p=0.010, partial η2=0.031). Barriers were rated more negatively when benefits were low (M: 17.1, SD: 7.6) than when they were high (M: 15.7, SD: 7.3; p=0.023, partial η2=0.024). Most intended to have the test in all conditions (73-81%); except for the low benefit-high barrier condition (37%; p<0.0005; N=218). CONCLUSIONS Perceptions of test attributes may be influenced by unrelated characteristics. PRACTICE IMPLICATIONS Reducing screening test barriers alone may have suboptimal effects on perceptions of barriers if benefits remain low; increasing screening benefits may not improve perceptions of benefits if barriers remain high.
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Affiliation(s)
- Alex Ghanouni
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Ella Nuttall
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Jane Wardle
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Christian von Wagner
- Department of Epidemiology and Public Health, University College London, London, UK.
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Smith L, Croker H, Fisher A, Williams K, Wardle J, Beeken RJ. Cancer survivors’ attitudes towards and knowledge of physical activity, sources of information, and barriers and facilitators of engagement: A qualitative study. Eur J Cancer Care (Engl) 2017; 26. [DOI: 10.1111/ecc.12641] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2016] [Indexed: 12/23/2022]
Affiliation(s)
- L. Smith
- Department of Life Sciences; The Cambridge Centre for Sport and Exercise Science; Anglia Ruskin University; Cambridge UK
| | - H. Croker
- Department of Epidemiology and Public Health; Health Behaviour Research Centre; University College London; London UK
| | - A. Fisher
- Department of Epidemiology and Public Health; Health Behaviour Research Centre; University College London; London UK
| | - K. Williams
- Department of Epidemiology and Public Health; Health Behaviour Research Centre; University College London; London UK
| | - J. Wardle
- Department of Epidemiology and Public Health; Health Behaviour Research Centre; University College London; London UK
| | - R. J. Beeken
- Department of Epidemiology and Public Health; Health Behaviour Research Centre; University College London; London UK
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Jackson SE, Heinrich M, Beeken RJ, Wardle J. Weight Loss and Mortality in Overweight and Obese Cancer Survivors: A Systematic Review. PLoS One 2017; 12:e0169173. [PMID: 28060948 PMCID: PMC5218508 DOI: 10.1371/journal.pone.0169173] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 12/13/2016] [Indexed: 12/17/2022] Open
Abstract
Background Excess adiposity is a risk factor for poorer cancer survival, but there is uncertainty over whether losing weight reduces the risk. We conducted a critical review of the literature examining weight loss and mortality in overweight or obese cancer survivors. Methods We systematically searched PubMed and EMBASE for articles reporting associations between weight loss and mortality (cancer-specific or all-cause) in overweight/obese patients with obesity-related cancers. Where available, data from the same studies on non-overweight patients were compared. Results Five articles describing observational studies in breast cancer survivors were included. Four studies reported a positive association between weight loss and mortality in overweight/obese survivors, and the remaining study observed no significant association. Results were similar for non-overweight survivors. Quality assessment indicated high risk of bias across studies. Conclusions There is currently a lack of observational evidence that weight loss improves survival for overweight and obese cancer survivors. However, the potential for bias in these studies is considerable and the results likely reflect the consequences of disease-related rather than intentional weight loss. There is a need for stronger study designs, incorporating measures of intentionality of weight loss, and extended to other cancers.
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Affiliation(s)
- Sarah E. Jackson
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, London, WC1E 6BT, United Kingdom
- * E-mail:
| | - Malgorzata Heinrich
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, London, WC1E 6BT, United Kingdom
| | - Rebecca J. Beeken
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, London, WC1E 6BT, United Kingdom
| | - Jane Wardle
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, London, WC1E 6BT, United Kingdom
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Abstract
OBJECTIVE To test whether the number of reports of enjoyment of life over a four year period is quantitatively associated with all cause mortality, and with death from cardiovascular disease and from other causes. DESIGN AND SETTING Longitudinal observational population study using the English Longitudinal Study of Ageing (ELSA), a nationally representative sample of older men and women living in England. PARTICIPANTS 9365 men and women aged 50 years or older (mean 63, standard deviation 9.3) at recruitment. MAIN OUTCOME MEASURES Time to death, based on mortality between the third phase of data collection (wave 3 in 2006) and March 2013 (up to seven years). RESULTS Subjective wellbeing with measures of enjoyment of life were assessed in 2002 (wave 1), 2004 (wave 2), and 2006 (wave 3). 2264 (24%) respondents reported no enjoyment of life on any assessment, with 1833 (20%) reporting high enjoyment on one report of high enjoyment of life, 2063 (22%) on two reports, and 3205 (34%) on all three occasions. 1310 deaths were recorded during follow-up. Mortality was inversely associated with the number of occasions on which participants reported high enjoyment of life. Compared with the no high enjoyment group, the hazard ratio for all cause mortality was 0.83 (95% confidence interval 0.70 to 0.99) for two reports of enjoyment of life, and 0.76 (0.64 to 0.89) for three reports, after adjustment for demographic factors, baseline health, mobility impairment, and depressive symptoms. The same association was observed after deaths occurring within two years of the third enjoyment measure were excluded (0.90 (0.85 to 0.95) for every additional report of enjoyment), and in the complete case analysis (0.90 (0.83 to 0.96)). CONCLUSIONS This is an observational study, so causal conclusions cannot be drawn. Nonetheless, the results add a new dimension to understanding the significance of subjective wellbeing for health outcomes by documenting the importance of sustained wellbeing over time.
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Affiliation(s)
- Paola Zaninotto
- Department of Epidemiology and Public Health, University College London, London WC1E 6BT, UK
| | - Jane Wardle
- Department of Epidemiology and Public Health, University College London, London WC1E 6BT, UK
| | - Andrew Steptoe
- Department of Epidemiology and Public Health, University College London, London WC1E 6BT, UK
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Raine R, Moss SM, von Wagner C, Atkin W, Hans IK, Howe R, Solmi F, Morris S, Counsell N, Hackshaw A, Halloran S, Handley G, Logan RF, Rainbow S, Smith S, Snowball J, Seaman H, Thomas M, Smith SG, McGregor LM, Vart G, Wardle J, Duffy SW. A national cluster-randomised controlled trial to examine the effect of enhanced reminders on the socioeconomic gradient in uptake in bowel cancer screening. Br J Cancer 2016; 115:1479-1486. [PMID: 27875518 PMCID: PMC5155361 DOI: 10.1038/bjc.2016.365] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 09/20/2016] [Accepted: 10/13/2016] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The NHS Bowel Cancer Screening Programme in England offers biennial guaiac faecal occult blood testing (gFOBt). There is a socioeconomic gradient in participation and socioeconomically disadvantaged groups have worse colorectal cancer survival than more advantaged groups. We compared the effectiveness and cost of an enhanced reminder letter with the usual reminder letter on overall uptake of gFOBt and the socioeconomic gradient in uptake. METHODS We enhanced the usual reminder by including a heading 'A reminder to you' and a short paragraph restating the offer of screening in simple language. We undertook a cluster-randomised trial of all 168 480 individuals who were due to receive a reminder over 20 days in 2013. Randomisation was based on the day of invitation. Blinding of individuals was not possible, but the possibility of bias was minimal owing to the lack of direct contact with participants. The enhanced reminder was sent to 78 067 individuals and 90 413 received the usual reminder. The primary outcome was the proportion of people adequately screened and its variation by quintile of Index of Multiple Deprivation. Data were analysed by logistic regression with conservative variance estimates to take account of cluster randomisation. RESULTS There was a small but statistically significant (P=0.001) increase in participation with the enhanced reminder (25.8% vs 25.1%). There was significant (P=0.005) heterogeneity of the effect by socioeconomic status with an 11% increase in the odds of participation in the most deprived quintile (from 13.3 to 14.1%) and no increase in the least deprived. We estimated that implementing the enhanced reminder nationally could result in up to 80 more people with high or intermediate risk colorectal adenomas and up to 30 more cancers detected each year if it were implemented nationally. The intervention incurred a small one-off cost of £78 000 to modify the reminder letter. CONCLUSIONS The enhanced reminder increases overall uptake and reduces the socioeconomic gradient in bowel cancer screening participation at little additional cost.
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Affiliation(s)
- Rosalind Raine
- Department of Applied Health Research, University College London, London, WC1E 7HB, UK
| | - Sue M Moss
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London EC1M6BQ, UK
| | - Christian von Wagner
- Cancer Research UK Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, London, WC1E 7HB, UK
| | - Wendy Atkin
- Cancer Screening and Prevention Group, Faculty of Medicine, Department of Surgery & Cancer, Imperial College London, London, SW7 2AZ UK
| | - Ines Kralj Hans
- Department of Biostatistics, King's Clinical Trials Unit, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Rosemary Howe
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Francesca Solmi
- UCL Division of Psychiatry, 6th Floor, Wing B, Maple House, 149 Tottenham Court Road, London W1T 7NF, UK
| | - Stephen Morris
- Department of Applied Health Research, University College London, London, WC1E 7HB, UK
| | - Nicholas Counsell
- Cancer Research UK & UCL Cancer Trials Centre, Cancer Institute, University College London, 90 Tottenham Court Road, London, W1T 4TJ, UK
| | - Allan Hackshaw
- Cancer Research UK & UCL Cancer Trials Centre, Cancer Institute, University College London, 90 Tottenham Court Road, London, W1T 4TJ, UK
| | - Stephen Halloran
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey GU2 7XH, UK
| | - Graham Handley
- North East Bowel Cancer Screening Programme Hub, Biochemistry Department, Gateshead Health NHS Foundation Trust, Queen Elizabeth Hospital, Gateshead NE9 6SX, UK
| | - Richard F Logan
- Eastern Bowel Cancer Screening Programme Hub, Nottingham University Hospitals, Nottingham NG7 2UH, UK
| | - Sandra Rainbow
- London Bowel Cancer Screening Programme Hub, The Northwest London Hospitals NHS Trust, Northwick Park & St Mark's Hospitals, Watford Road, Harrow, Middlesex HA1 3UJ, UK
| | - Steve Smith
- Midlands and North West Bowel Cancer Screening Programme Hub, Hospital of St Cross, Barby Road, Rugby CV22 5PX, UK
| | - Julia Snowball
- Southern Bowel Cancer Screening Programme Hub, Surrey Research Park, 20 Priestly Road, Guildford Road, Surrey GU2 7YS, UK
| | - Helen Seaman
- Southern Bowel Cancer Screening Programme Hub, Surrey Research Park, 20 Priestly Road, Guildford Road, Surrey GU2 7YS, UK
| | - Mary Thomas
- NIHR CLAHRC North Thames, Department of Applied Health Research, University College London, London, WC1E 7HB, UK
| | - Samuel G Smith
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London EC1M 6BQ, UK
- Cancer Research UK Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, London, WC1E 7HB, UK
| | - Lesley M McGregor
- Cancer Research UK Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, London, WC1E 7HB, UK
| | - Gemma Vart
- Research Office, University of Roehampton, London SW15 5PU UK
| | - Jane Wardle
- Department of Epidemiology and Public Health, Cancer Research UK Health Behaviour Research Centre, University College London, London, WC1E 7HB, UK
| | - Stephen W Duffy
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London EC1M 6BQ, UK
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Flynn AC, Seed PT, Patel N, Barr S, Bell R, Briley AL, Godfrey KM, Nelson SM, Oteng-Ntim E, Robinson SM, Sanders TA, Sattar N, Wardle J, Poston L, Goff LM. Dietary patterns in obese pregnant women; influence of a behavioral intervention of diet and physical activity in the UPBEAT randomized controlled trial. Int J Behav Nutr Phys Act 2016; 13:124. [PMID: 27894316 PMCID: PMC5126873 DOI: 10.1186/s12966-016-0450-2] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 11/21/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Understanding dietary patterns in obese pregnant women will inform future intervention strategies to improve pregnancy outcomes and the health of the child. The aim of this study was to investigate the effect of a behavioral intervention of diet and physical activity advice on dietary patterns in obese pregnant woman participating in the UPBEAT study, and to explore associations of dietary patterns with pregnancy outcomes. METHODS In the UPBEAT randomized controlled trial, pregnant obese women from eight UK multi-ethnic, inner-city populations were randomly assigned to receive a diet/physical activity intervention or standard antenatal care. The dietary intervention aimed to reduce glycemic load and saturated fat intake. Diet was assessed using a food frequency questionnaire (FFQ) at baseline (15+0-18+6 weeks' gestation), post intervention (27+0-28+6 weeks) and in late pregnancy (34+0-36+0 weeks). Dietary patterns were characterized using factor analysis of the baseline FFQ data, and changes compared in the control and intervention arms. Patterns were related to pregnancy outcomes in the combined control/intervention cohort (n = 1023). RESULTS Four distinct baseline dietary patterns were defined; Fruit and vegetables, African/Caribbean, Processed, and Snacks, which were differently associated with social and demographic factors. The UPBEAT intervention significantly reduced the Processed (-0.14; 95% CI -0.19, -0.08, P <0.0001) and Snacks (-0.24; 95% CI -0.31, -0.17, P <0.0001) pattern scores. In the adjusted model, baseline scores for the African/Caribbean (quartile 4 compared with quartile 1: OR = 2.46; 95% CI 1.41, 4.30) and Processed (quartile 4 compared with quartile 1: OR = 2.05; 95% CI 1.23, 3.41) patterns in the entire cohort were associated with increased risk of gestational diabetes. CONCLUSIONS In a diverse cohort of obese pregnant women an intensive dietary intervention improved Processed and Snack dietary pattern scores. African/Caribbean and Processed patterns were associated with an increased risk of gestational diabetes, and provide potential targets for future interventions. TRIAL REGISTRATION Current controlled trials; ISRCTN89971375.
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Affiliation(s)
- Angela C Flynn
- Division of Women's Health, King's College London, 10th Floor North Wing, St. Thomas' Hospital, London, UK.,Division of Diabetes and Nutritional Sciences, King's College London, Franklin-Wilkins Building, 150 Stamford Street, London, UK
| | - Paul T Seed
- Division of Women's Health, King's College London, 10th Floor North Wing, St. Thomas' Hospital, London, UK
| | - Nashita Patel
- Division of Women's Health, King's College London, 10th Floor North Wing, St. Thomas' Hospital, London, UK
| | - Suzanne Barr
- Department of Cardiovascular Medicine, Imperial College London, London, UK
| | - Ruth Bell
- Institute of Health & Society Newcastle University, UK Baddiley-Clark Building Richardson Road, Newcastle upon Tyne, UK
| | - Annette L Briley
- Division of Women's Health, King's College London, 10th Floor North Wing, St. Thomas' Hospital, London, UK
| | - Keith M Godfrey
- MRC Lifecourse Epidemiology Unit and NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Mailpoint 95, Southampton, UK
| | - Scott M Nelson
- School of Medicine, University of Glasgow, New Lister Building, Glasgow Royal Infirmary, Glasgow, UK
| | - Eugene Oteng-Ntim
- Guys and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, UK
| | - Sian M Robinson
- MRC Lifecourse Epidemiology Unit and NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Mailpoint 95, Southampton, UK
| | - Thomas A Sanders
- Division of Diabetes and Nutritional Sciences, King's College London, Franklin-Wilkins Building, 150 Stamford Street, London, UK
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences, RC214 Level C2, British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Jane Wardle
- Health Behaviour Research Centre, Institute of Epidemiology and Health, University College London, 1-19 Torrington Place, London, UK
| | - Lucilla Poston
- Division of Women's Health, King's College London, 10th Floor North Wing, St. Thomas' Hospital, London, UK
| | - Louise M Goff
- Division of Diabetes and Nutritional Sciences, King's College London, Franklin-Wilkins Building, 150 Stamford Street, London, UK.
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Beeken RJ, Croker H, Heinrich M, Smith L, Williams K, Hackshaw A, Hines J, Machesney M, Krishnaswamy M, Cavanagh S, Roylance R, Hill A, Pritchard-Jones K, Wardle J, Fisher A. Study protocol for a randomised controlled trial of brief, habit-based, lifestyle advice for cancer survivors: exploring behavioural outcomes for the Advancing Survivorship Cancer Outcomes Trial (ASCOT). BMJ Open 2016; 6:e011646. [PMID: 27881518 PMCID: PMC5178807 DOI: 10.1136/bmjopen-2016-011646] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 08/11/2016] [Accepted: 10/17/2016] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Positive health behaviours such as regular physical activity and a healthy diet have significant effects on cancer outcomes. There is a need for simple but effective behaviour change interventions with the potential to be implemented within the cancer care pathway. Habit-based advice encourages repetition of a behaviour in a consistent context so that the behaviour becomes increasingly automatic in response to a specific contextual cue. This approach therefore encourages long-term behaviour change and can be delivered through printed materials. 'Healthy Habits for Life' is a brief intervention based on habit theory, and incorporating printed materials plus a personally tailored discussion, that has been designed specifically for patients with a diagnosis of cancer. The aim of this trial was to test the effect of 'Healthy Habits for Life' on a composite health behaviour risk index (CHBRI) over 3 months in patients with a diagnosis of breast, colorectal or prostate cancer. METHOD AND ANALYSIS A 2-arm, individually randomised controlled trial in patients with breast, colorectal and prostate cancer. Patients will be recruited over 18 months from 7 National Health Service Trusts in London and Essex. Following baseline assessments and allocation to intervention or usual care, patients are followed up at 3 and 6 months. The primary outcome will be change in CHBRI at 3 months. Maintenance of any changes over 6 months, and changes in individual health behaviours (including dietary intake, physical activity, alcohol consumption and smoking status) will also be explored. ETHICS AND DISSEMINATION Ethical approval was obtained through the National Research Ethics Service Committee South Central-Oxford B via the Integrated Research Application System (reference number 14/SC/1369). Results of this study will be disseminated through peer-reviewed publications and scientific presentations. TRIAL REGISTRATION NUMBER 17421871.
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Affiliation(s)
- Rebecca J Beeken
- Department of Epidemiology & Public Health, University College London, London, UK
| | - Helen Croker
- Department of Epidemiology & Public Health, University College London, London, UK
| | - Maggie Heinrich
- Department of Epidemiology & Public Health, University College London, London, UK
| | - Lee Smith
- Department of Life Sciences, The Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge, UK
| | - Kate Williams
- Department of Epidemiology & Public Health, University College London, London, UK
| | - Allan Hackshaw
- The Cancer Research UK and UCL Cancer Trials Centre, University College London, London, UK
| | - John Hines
- Barts Health NHS Trust, St Bartholomew's Hospital, London, UK
| | | | | | | | | | | | | | - Jane Wardle
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Abigail Fisher
- Department of Epidemiology & Public Health, University College London, London, UK
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Winstanley K, Renzi C, Smith CF, Wardle J, Whitaker KL. The impact of body vigilance on help-seeking for cancer 'alarm' symptoms: a community-based survey. BMC Public Health 2016; 16:1172. [PMID: 27871273 PMCID: PMC5117619 DOI: 10.1186/s12889-016-3846-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 11/15/2016] [Indexed: 12/19/2022] Open
Abstract
Background The act of detecting bodily changes is a pre-requisite for subsequent responses to symptoms, such as seeking medical help. This is the first study to explore associations between self-reported body vigilance and help-seeking in a community sample currently experiencing cancer ‘alarm’ symptoms. Methods Using a cross-sectional study design, a ‘health survey’ was mailed through primary care practices to 4913 UK adults (age ≥50 years, no cancer diagnosis), asking about symptom experiences and medical help-seeking over the previous three months. Body vigilance, cancer worry and current illness were assessed with a small number of self-report items derived from existing measures. Results The response rate was 42% (N = 2042). Almost half the respondents (936/2042; 46%) experienced at least one cancer alarm symptom. Results from logistic regression analysis revealed that paying more attention to bodily changes was significantly associated with help-seeking for cancer symptoms (OR = 1.44; 1.06-1.97), after controlling for socio-demographics, current illness and cancer worry. Being more sensitive to bodily changes was not significantly associated with help-seeking. Conclusions Respondents who paid attention to their bodily changes were more likely to seek help for their symptoms. Although the use of a cross-sectional study design and the limited assessment of key variables preclude any firm conclusions, encouraging people to be body vigilant may contribute towards earlier cancer diagnosis. More needs to be understood about the impact this might have on cancer-related anxiety.
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Affiliation(s)
- Kelly Winstanley
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, London, WC1E 6BT, UK
| | - Cristina Renzi
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, London, WC1E 6BT, UK
| | - Claire Friedemann Smith
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, London, WC1E 6BT, UK
| | - Jane Wardle
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, London, WC1E 6BT, UK
| | - Katriina L Whitaker
- School of Health Sciences, University of Surrey, Guildford, Surrey, GU2 7XH, UK.
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Waller J, McCaffery K, Forrest S, Szarewski A, Cadman L, Austin J, Wardle J. Acceptability of unsupervised HPV self-sampling using written instructions. J Med Screen 2016; 13:208-13. [PMID: 17217611 DOI: 10.1177/096914130601300409] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives The study measured the acceptability of self-sampling for human papillomavirus (HPV) testing in the context of cervical cancer screening. Women carried out self-sampling unsupervised, using a written instruction sheet. Setting Participants were women attending either a family planning clinic or a primary care trust for routine cervical screening. Methods Women (n = 902) carried out self-sampling for HPV testing and then a clinician did a routine cervical smear and HPV test. Immediately after having the two tests, participants completed a measure of acceptability for both tests, and answered questions about ease of using the instruction sheet and willingness to use self-sampling in the future. Results The majority of women found self-sampling more acceptable than the clinician-administered test, but there was a lack of confidence that the test had been done correctly. Significant demographic differences in attitudes were found, with married women having more favourable attitudes towards self-sampling than single women, and Asian women having more negative attitudes than women in other ethnic groups. Intention to use self-sampling in the future was very high across all demographic groups. Conclusion Self-sampling for HPV testing was highly acceptable in this large and demographically diverse sample, and women were able to carry out the test alone, using simple written instructions. Consistent with previous studies, women were concerned about doing the test properly and this issue will need to be addressed if self-sampling is introduced. More work is needed to see whether the demographic differences we found are robust and to identify reasons for lower acceptability among single women and those from Asian background.
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Affiliation(s)
- J Waller
- Cancer Research UK Health Behaviour Unit, Department of Epidemiology and Public Health, UCL, London, UK.
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van Jaarsveld CHM, Miles A, Edwards R, Wardle J. Marriage and cancer prevention: Does marital status and inviting both spouses together influence colorectal cancer screening participation? J Med Screen 2016; 13:172-6. [PMID: 17217605 DOI: 10.1177/096914130601300403] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives This study examined the influence of marital status and inviting both partners together on participation in colorectal cancer screening. Setting Data were from a subset of participants from the UK Flexible Sigmoidoscopy Trial (1996–1999). Methods Marital status was self-reported, and co-invitation of partner was obtained from the trial database. Screening intentions were assessed in 16,527 adults aged 55–64 years. Attendance was recorded in the 4130 respondents who were subsequently invited. Results Multivariate analyses, controlling for age and educational level, indicate that married (or cohabiting) people have more positive intentions (odds ratio [OR] 1.26; 95% confidence interval [CI] 1.14–1.38) and higher attendance rates at screening (OR = 1.23; 95% CI 1.04–1.45) than non-married people. After adjusting for the marriage effect, inviting partners together (co-invitation) significantly increased screening intentions among women (OR = 1.17; 95% CI 1.04–1.31) but not men (OR = 0.97; 95% CI 0.85–1.10). Co-invitation significantly increased attendance at screening in both genders (OR = 1.34; 95% CI 1.14–1.58). Conclusions In this age group, married adults are more likely to participate in colorectal cancer screening than the non-married, and inviting both members of a couple together further increases screening uptake. The positive effect of marriage was as strong for women as men.
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Affiliation(s)
- Cornelia H M van Jaarsveld
- Cancer Research UK Health Behaviour Unit, Department of Epidemiology and Public Health, University College London, Gower Street, London WC1E 6BT, UK
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Vrinten C, McGregor LM, Heinrich M, von Wagner C, Waller J, Wardle J, Black GB. What do people fear about cancer? A systematic review and meta-synthesis of cancer fears in the general population. Psychooncology 2016; 26:1070-1079. [PMID: 27643482 PMCID: PMC5573953 DOI: 10.1002/pon.4287] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 08/15/2016] [Accepted: 09/15/2016] [Indexed: 12/13/2022]
Abstract
Background Cancer has long inspired fear, but the effect of fear is not well understood; it seems both to facilitate and to deter early diagnosis behaviours. To elucidate fear's behavioural effects, we systematically reviewed and synthesised qualitative literature to explore what people fear about cancer. Methods We searched Medline, Embase, PsycInfo, Web of Science, AnthroSource, and Anthrobase for studies on cancer fear in breast, cervical, and colorectal cancer screening and analysed 102 studies from 26 countries using thematic synthesis. Results Fears of cancer emanated from a core view of cancer as a vicious, unpredictable, and indestructible enemy, evoking fears about its proximity, the (lack of) strategies to keep it at bay, the personal and social implications of succumbing, and fear of dying from cancer. Conclusions This view of cancer as ‘an enemy’ reprises the media's ‘war on cancer’ theme and may affect the acceptance of cancer early detection and prevention messages, since cancer's characteristics influenced whether ‘fight’ or ‘flight’ was considered appropriate.
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Affiliation(s)
| | | | | | | | - Jo Waller
- Department of Epidemiology and Public Health, UCL, London, UK
| | - Jane Wardle
- Department of Epidemiology and Public Health, UCL, London, UK
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Kobayashi LC, Wardle J, Wolf MS, von Wagner C. Health Literacy and Moderate to Vigorous Physical Activity During Aging, 2004-2013. Am J Prev Med 2016; 51:463-72. [PMID: 27140501 DOI: 10.1016/j.amepre.2016.02.034] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Revised: 02/17/2016] [Accepted: 02/17/2016] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Health literacy (the ability to read and understand health information) may help to support sustained participation in moderate to vigorous physical activity (MVPA) during aging; this relationship has never been examined longitudinally. This study aimed to investigate the relationship between health literacy and participation in weekly MVPA over an 8-year period among older adults. METHODS Data were from interviews with 4,345 adults aged 52-79 years in the English Longitudinal Study of Ageing from 2004/2005 to 2012/2013, analyzed in 2015. Health literacy was assessed in 2004/2005 as reading comprehension of a medicine label, defined as "low" (≤2/4 items correct); "medium" (3/4); and "high" (4/4). The outcome was maintaining weekly MVPA at all of five time points from 2004/2005 to 2012/2013. A population-weighted logistic regression model was adjusted for sociodemographic, physical health, and cognitive (memory and verbal fluency) covariates. RESULTS Overall, 72% (3,128/4,345) of the sample had high health literacy; 18% (797/4,345) had medium health literacy; and 10% (420/4,345) had low health literacy. Of those with high health literacy, 59% (1,840/3,128) consistently reported weekly participation in MVPA, compared with 33% (138/420) of those with low health literacy (AOR=1.37, 95% CI=1.04, 1.80). Better memory was weakly positively associated with long-term MVPA (AOR=1.03, 95% CI=1.00, 1.05, per point increase out of 24), as was better verbal fluency (AOR=1.05, 95% CI=1.01, 1.09, per point increase out of 9). CONCLUSIONS High health literacy and good cognitive function are independently associated with participation in weekly MVPA over an 8-year period during aging.
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Affiliation(s)
- Lindsay C Kobayashi
- Department of Epidemiology and Public Health, University College London, London, United Kingdom.
| | - Jane Wardle
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Michael S Wolf
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Christian von Wagner
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
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Smith SG, McGregor LM, Raine R, Wardle J, von Wagner C, Robb KA. Inequalities in cancer screening participation: examining differences in perceived benefits and barriers. Psychooncology 2016; 25:1168-1174. [PMID: 27309861 PMCID: PMC5082500 DOI: 10.1002/pon.4195] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 06/09/2016] [Accepted: 06/10/2016] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Inequalities exist in colorectal cancer (CRC) screening uptake, with people from lower socioeconomic status backgrounds less likely to participate. Identifying the facilitators and barriers to screening uptake is important to addressing screening disparities. We pooled data from 2 trials to examine educational differences in psychological constructs related to guaiac fecal occult blood testing. METHODS Patients (n = 8576) registered at 7 general practices in England, within 15 years of the eligible age range for screening (45-59.5 years), were invited to complete a questionnaire. Measures included perceived barriers (emotional and practical) and benefits of screening, screening intentions, and participant characteristics including education. RESULTS After data pooling, 2181 responses were included. People with high school education or no formal education reported higher emotional and practical barriers and were less likely to definitely intend to participate in screening, compared with university graduates in analyses controlling for study arm and participant characteristics. The belief that one would worry more about CRC after screening and concerns about tempting fate were strongly negatively associated with education. In a model including education and participant characteristics, respondents with low emotional barriers, low practical barriers, and high perceived benefits were more likely to definitely intend to take part in screening. CONCLUSIONS In this analysis of adults approaching the CRC screening age, there was a consistent effect of education on perceived barriers toward guaiac fecal occult blood testing, which could affect screening decision making. Interventions should target specific barriers to reduce educational disparities in screening uptake and avoid exacerbating inequalities in CRC mortality.
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Affiliation(s)
- S G Smith
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK.
- Department of Epidemiology and Public Health, University College London, London, UK.
| | - L M McGregor
- Department of Epidemiology and Public Health, University College London, London, UK
| | - R Raine
- Department of Applied Health Research, University College London, London, UK
| | - J Wardle
- Department of Epidemiology and Public Health, University College London, London, UK
| | - C von Wagner
- Department of Epidemiology and Public Health, University College London, London, UK
| | - K A Robb
- Department of Epidemiology and Public Health, University College London, London, UK
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
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Kliemann N, Wardle J, Johnson F, Croker H. Reliability and validity of a revised version of the General Nutrition Knowledge Questionnaire. Eur J Clin Nutr 2016; 70:1174-1180. [PMID: 27245211 PMCID: PMC5014128 DOI: 10.1038/ejcn.2016.87] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 04/20/2016] [Accepted: 04/27/2016] [Indexed: 11/09/2022]
Abstract
BACKGROUND/OBJECTIVES The General Nutrition Knowledge Questionnaire (GNKQ) was developed in the 1990s and has been widely used. Since then advances in understanding of associations between diet and disease have led to changes in dietary recommendations. This study reports the validity and reliability of an updated version of the GNKQ, bringing it into line with current nutritional advice. METHODS/SUBJECTS Following a review of current recommendations, the revised version of the GNKQ (GNKQ-R) was created, consisting of 88 items and four sections. Reliability and validity of the GNKQ-R were determined in four validation studies: (1) reliability was examined using an online sample (n=266), (2) construct validity was assessed with 96 Dietetics students and 89 english students using the 'known-groups' method, (3) associations between nutrition knowledge and socio-demographic characteristics were examined using the previously described samples and (4) sensitivity to change was tested by measuring GNKQ-R scores pre- and post-exposure to online nutrition information in written (n=65) and video (n=41) formats. RESULTS The reliability was >0.7 in all sections. Dietetics students scored significantly higher than english students. As predicted, GNKQ-R scores were significantly higher among females vs males, people with a degree vs without, and people with very good vs poor or good health status. They were lower in those older than 50 years vs younger adults. GNKQ-R scores were significantly greater after the nutrition interventions in both written and video formats. CONCLUSIONS The GNKQ-R is a valid measure of nutrition knowledge that is consistent, reliable and sensitive to change.
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Affiliation(s)
- N Kliemann
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, London, UK
| | - J Wardle
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, London, UK
| | - F Johnson
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, London, UK
| | - H Croker
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, London, UK
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Bonello B, Ghanouni A, Bowyer HL, MacRae E, Atkin W, Halloran SP, Wardle J, von Wagner C. Using a hypothetical scenario to assess public preferences for colorectal surveillance following screening-detected, intermediate-risk adenomas: annual home-based stool test vs. triennial colonoscopy. BMC Gastroenterol 2016; 16:113. [PMID: 27618798 PMCID: PMC5020544 DOI: 10.1186/s12876-016-0517-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 08/11/2016] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND To assess public preferences for colorectal cancer (CRC) surveillance tests for intermediate-risk adenomas, using a hypothetical scenario. METHODS Adults aged 45-54 years without CRC were identified from three General Practices in England (two in Cumbria, one in London). A postal survey was carried out during a separate study on preferences for different first-line CRC screening modalities (non- or full-laxative computed tomographic colonography, flexible sigmoidoscopy, or colonoscopy). Individuals were allocated at random to receive a pack containing information on one first-line test, and a paragraph describing CRC surveillance recommendations for people who are diagnosed with intermediate-risk adenomas during screening. All participants received a description of two surveillance options: annual single-sample, home-based stool testing (consistent with Faecal Immunochemical Tests; FIT) or triennial colonoscopy. Invitees were asked to imagine they had been diagnosed with intermediate-risk adenomas, and then complete a questionnaire on their surveillance preferences. RESULTS 22.1 % (686/3,100) questionnaires were returned. 491 (15.8 %) were eligible for analysis. The majority of participants stated a surveillance preference for the stool test over colonoscopy (60.8 % vs 31.0 %; no preference: 8.1 %; no surveillance: 0.2 %). Women were more likely to prefer the stool test than men (66.7 % vs. 53.6 %; p = .011). The primary reason for preferring the stool test was that it would be done more frequently. The main reason to prefer colonoscopy was its superiority at finding polyps. CONCLUSIONS A majority of participants stated a preference for a surveillance test resembling FIT over colonoscopy. Future research should test whether this translates to greater adherence in a real surveillance setting. TRIAL REGISTRATION International Standard Randomised Controlled Trial Number registry, ISRCTN85697880 , prospectively registered on 25/04/2013.
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Affiliation(s)
- Bernardette Bonello
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London, WC1E 7HB UK
| | - Alex Ghanouni
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London, WC1E 7HB UK
| | - Harriet L. Bowyer
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London, WC1E 7HB UK
| | - Eilidh MacRae
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Wendy Atkin
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Stephen P. Halloran
- NHS Bowel Cancer Screening Southern Programme Hub, Guildford, Surrey UK
- Royal Surrey County Hospital NHS Foundation Trust & University of Surrey, Guildford, Surrey UK
| | - Jane Wardle
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London, WC1E 7HB UK
| | - Christian von Wagner
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London, WC1E 7HB UK
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Beeken RJ, Williams K, Wardle J, Croker H. "What about diet?" A qualitative study of cancer survivors' views on diet and cancer and their sources of information. Eur J Cancer Care (Engl) 2016; 25:774-83. [PMID: 27349812 PMCID: PMC4995727 DOI: 10.1111/ecc.12529] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2016] [Indexed: 12/28/2022]
Abstract
Given the abundance of misreporting about diet and cancer in the media and online, cancer survivors are at risk of misinformation. The aim of this study was to explore cancer survivors' beliefs about diet quality and cancer, the impact on their behaviour and sources of information. Semi-structured interviews were conducted with adult cancer survivors in the United Kingdom who had been diagnosed with any cancer in adulthood and were not currently receiving treatment (n = 19). Interviews were analysed using Thematic Analysis. Emergent themes highlighted that participants were aware of diet affecting risk for the development of cancer, but were less clear about its role in recurrence. Nonetheless, their cancer diagnosis appeared to be a prompt for dietary change; predominantly to promote general health. Changes were generally consistent with healthy eating recommendations, although dietary supplements and other non-evidence-based actions were mentioned. Participants reported that they had not generally received professional advice about diet and were keen to know more, but were often unsure about information from other sources. The views of our participants suggest cancer survivors would welcome guidance from health professionals. Advice that provides clear recommendations, and which emphasises the benefits of healthy eating for overall well-being, may be particularly well-received.
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Affiliation(s)
- R J Beeken
- Department of Epidemiology and Public Health, Health Behaviour Research Centre, University College London, London, UK
| | - K Williams
- Department of Epidemiology and Public Health, Health Behaviour Research Centre, University College London, London, UK
| | - J Wardle
- Department of Epidemiology and Public Health, Health Behaviour Research Centre, University College London, London, UK
| | - H Croker
- Department of Epidemiology and Public Health, Health Behaviour Research Centre, University College London, London, UK
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Jackson SE, Wardle J, Steptoe A, Fisher A. Sexuality after a cancer diagnosis: A population-based study. Cancer 2016; 122:3883-3891. [PMID: 27531631 PMCID: PMC5157756 DOI: 10.1002/cncr.30263] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 07/12/2016] [Accepted: 07/27/2016] [Indexed: 01/19/2023]
Abstract
BACKGROUND This study explored differences in sexual activity, function, and concerns between cancer survivors and cancer-free controls in a population-based study. METHODS The data were from 2982 men and 3708 women who were 50 years old or older and were participating in the English Longitudinal Study of Ageing. Sexual well-being was assessed with the Sexual Relationships and Activities Questionnaire, and cancer diagnoses were self-reported. RESULTS There were no differences between cancer survivors and controls in levels of sexual activity (76.0% vs 78.5% for men and 58.2% vs 55.5% for women) or sexual function. Men and women with cancer diagnoses were more dissatisfied with their sex lives than controls (age-adjusted percentages: 30.9% vs 19.8% for men [P = .023] and 18.2% vs 11.8% for women [P = .034]), and women with cancer were more concerned about levels of sexual desire (10.2% vs 7.1%; P = .006). Women diagnosed < 5 years ago were more likely to report difficulty with becoming aroused (55.4% vs 31.8%; P = .016) and achieving orgasm (60.6% vs 28.3%; P < .001) and were more concerned about sexual desire (14.8% vs 7.1%; P = .007) and orgasmic experience (17.6% vs 7.1%; P = .042) than controls, but there were no differences in men. CONCLUSIONS Self-reports of sexual activity and functioning in older people with cancer are broadly comparable to age-matched, cancer-free controls. There is a need to identify the causes of sexual dissatisfaction among long-term cancer survivors despite apparently normal levels of sexual activity and function for their age. The development of interventions addressing low sexual desire and problems with sexual functioning in women is also important and may be particularly relevant for cancer survivors after treatment. Cancer 2016;122:3883-3891. © 2016 American Cancer Society.
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Affiliation(s)
- Sarah E Jackson
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Jane Wardle
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Andrew Steptoe
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Abigail Fisher
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
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Kliemann N, Beeken RJ, Wardle J, Johnson F. Development and validation of the Self-Regulation of Eating Behaviour Questionnaire for adults. Int J Behav Nutr Phys Act 2016; 13:87. [PMID: 27484457 PMCID: PMC4969721 DOI: 10.1186/s12966-016-0414-6] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 07/25/2016] [Indexed: 12/19/2022] Open
Abstract
Background Eating self-regulatory capacity can help individuals to cope with the obesogenic environment and achieve, as well as maintain, a healthy weight and diet. At present, there is no comprehensive, reliable and valid questionnaire for assessing this capacity and measuring change in response to self-regulation interventions in adults. This paper reports the development of the Self-regulation of Eating Behaviour Questionnaire (SREBQ) for use in UK adults, and presents evidence for its reliability and construct validity. The development of the SREBQ involved generation of an item pool, followed by two pilot studies (Samples 1 and 2) and a test of the questionnaire’s underlying factor structure (Sample 3). The final version of the SREBQ was then assessed for reliability and construct validity (Sample 4). Results Development of the SREBQ resulted in a 5-item questionnaire. The face validity was satisfactory, as assessed by the pilot studies. The factor structure analysis (Sample 3) suggested that it has a single underlying factor, which was confirmed in a second sample (Sample 4). The SREBQ had strong construct validity, showing a positive correlation with general measures of self-regulation. It was also positively correlated with motivation and behavioural automaticity, and negatively correlated with food responsiveness and emotional over-eating (p < 0.001). It showed good discriminant validity, as it was only weakly associated with satiety responsiveness, food fussiness and slowness in eating. Conclusions The SREBQ is a reliable and valid measure for assessment of eating self-regulatory capacity in the general UK adult population. Electronic supplementary material The online version of this article (doi:10.1186/s12966-016-0414-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Nathalie Kliemann
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, Gower Street, London, WC1E 6BT, UK
| | - Rebecca J Beeken
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, Gower Street, London, WC1E 6BT, UK
| | - Jane Wardle
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, Gower Street, London, WC1E 6BT, UK
| | - Fiona Johnson
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, Gower Street, London, WC1E 6BT, UK.
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