Elinor Fondell

Web-based and mailed questionnaires : A comparison of response rates and compliance

Background: We assessed response rates and compliance for a printed questionnaire and a Web questionnaire in a Swedish population-based study and explored the influence of adding personalized feedback to the Web questionnaire. Methods: We assigned 875 subjects to 1 of 3 groups: printed questionnaire, plain Web questionnaire, or Web questionnaire with personalized feedback. The questionnaire had 2 parts, first a general section and then a dietary section. Results: The response rate for the general section was 64% for the printed questionnaire, compared with 50% for the Web questionnaire with feedback. For the dietary questionnaire, the rates were reversed, resulting in a total response rate for the dietary questionnaire that did not differ between printed and web questionnaire with feedback. Conclusions: Interactivity in the Web questionnaire increased compliance in completion of the second section of the questionnaire. Web questionnaires can be useful for research purposes in settings in which Internet access is high.

Physical Activity, Stress, and Self-Reported Upper Respiratory Tract Infection

PURPOSE upper respiratory tract infection (URTI) is the most common reason for seeking primary care in many countries. Still, little is known about potential strategies to reduce susceptibility. We investigated the relationships between physical activity level, perceived stress, and incidence of self-reported URTI. METHODS we conducted a population-based prospective cohort study of 1509 Swedish men and women aged 20-60 yr with a follow-up period of 4 months. We used a Web-based questionnaire to assess disease status and lifestyle factors at the start of the study. We assessed physical activity and inactivity as total MET-hours (MET task) per day and perceived stress by the 14-item Perceived Stress Scale. Participants were contacted every 3 wk via e-mail to assess incidence of URTI. They reported a total of 1181 occurrences of URTI. We used Poisson regression models to control for age, sex, and other potential confounding factors. RESULTS we found that high levels of physical activity (≥ 55 MET·h·d) were associated with an 18% reduced risk (incidence rate ratio (IRR) = 0.82, 95% confidence interval (CI) = 0.69-0.98) of self-reporting URTI compared with low levels of physical activity (<45 MET·h·d). This association was stronger among those reporting high levels of stress (IRR = 0.58, 95% CI = 0.43-0.78), especially among men (IRR = 0.37, 95% CI = 0.24-0.59), but absent in the group with low levels of stress. CONCLUSIONS we found that high physical activity was associated with a lower risk of contracting URTI for both men and women. In addition, we found that highly stressed people, particularly men, appear to benefit more from physical activity than those with lower stress levels.

The effect of dietary guidelines on cancer risk and mortality.

Purpose of review Dietary guidelines are important tools for educating the general public and helping health professionals promote good health and prevent chronic diet-related diseases. However, it is of major public health relevance that the effect of the guidelines per se is evaluated to make sure that they serve their purpose. The aim of this article is to review the current research on dietary guidelines and their effect on cancer risk and mortality. Recent findings Since the last 30–40 years, most industrialized countries have had dietary guidelines. The guidelines are based on thorough reviews of the current scientific evidence regarding dietary intake and health. Potential health benefits associated with good adherence to the guidelines have been evaluated in observational studies during the last 15 years, with an increase in the number of studies during the most recent years. Summary Available data on the potential association between dietary guidelines and cancer are limited and inconclusive. A meta-analysis of studies on overall cancer risk shows no protective effect for good adherence to the dietary guidelines as compared with poor adherence. However, good adherence was associated with a 21% reduced risk of colorectal cancer, and 22% reduced cancer-specific mortality.

Adherence to the Nordic Nutrition Recommendations as a measure of a healthy diet and upper respiratory tract infection.

OBJECTIVE The Nordic countries have published joint dietary recommendations, the Nordic Nutrition Recommendations (NNR), since 1980. We evaluated adherence to the NNR as a measure of a healthy diet and its potential association with self-reported upper respiratory tract infection (URTI). DESIGN A prospective, population-based study with a follow-up period of 4 months. Dietary intake was assessed using a semi-quantitative FFQ with ninety-six items, along with other lifestyle factors, at baseline. URTI was assessed every three weeks. A Poisson regression model was used to control for age, sex and other confounding factors. SETTING A middle-sized county in northern Sweden. SUBJECTS Swedish men and women (n 1509) aged 20-60 years. RESULTS The NNR include recommendations on macronutrient proportions, physical activity and intake of micronutrients, sodium, fibre and alcohol. We found that overall adherence to the NNR was moderately good. In addition, we found that high adherence to the NNR (>5·5 adherence points) was not associated with a lower risk of URTI (incidence rate ratio (IRR) 0·89, 95% CI 0·73, 1·08) compared with low adherence (<4·5 adherence points). When investigating individual components of the NNR, only high physical activity was associated with lower URTI risk (IRR = 0·82, 95% CI 0·69, 0·97) whereas none of the dietary components were associated with risk of URTI. CONCLUSIONS Overall adherence to the NNR was moderately good. Overall adherence to the NNR was not associated with URTI risk in our study. However, when investigating individual components of the NNR, we found that high physical activity was associated with lower URTI risk.

Feedback in web-based questionnaires as incentive to increase compliance in studies on lifestyle factors

OBJECTIVE We explored the use of feedback in interactive web-based questionnaires for collecting data on lifestyle factors in epidemiological studies. DESIGN Here we report from a cohort study on lifestyle factors and upper respiratory tract infections among 1805 men and women. We introduced interactivity in the form of personalized feedback and feedback on a group level regarding dietary intake, physical activity and incidence of infections in web-based questionnaires as incentives for the respondents to continue answering questions and stay in the study. SETTING The study was performed in Sweden. SUBJECTS All participants were randomly selected from the population registry. RESULTS Personalized feedback was offered in the baseline questionnaire and feedback on a group level in the five follow-up questionnaires. In total, 88 % of the participants actively chose to get personalized feedback at least once in the baseline questionnaire. The follow-up questionnaires were sent by email and the overall compliance at each follow-up was 83-84 %, despite only one reminder. In total, 74 % completed all five follow-ups. However, the compliance was higher among those who chose feedback in the baseline questionnaire compared with those who did not choose feedback. CONCLUSIONS The results show that it is possible to use feedback in web questionnaires and that it has the potential to increase compliance. The majority of the participants actively chose to take part in the personalized feedback in the baseline questionnaire and future research should focus on improving the design of the feedback, which may ultimately result in even higher compliance in research studies.

Dietary Intake and Supplement Use of Vitamins C and E and Upper Respiratory Tract Infection

Objective: Antioxidants are regulators of immune function and may play a role in upper respiratory tract infections (URTI). We investigated the potential effects of dietary intake from food and supplement use of vitamins C and E on the risk of self-reported URTI. Methods: We conducted a population-based cohort study of 1509 Swedish men and women ages 20 to 60 with a follow-up period of 4 months. Participants reported a total of 1181 occurrences of URTI. Poisson regression model was used to control for age, sex, and other confounding factors. Results: Among women, we found that the incidence rate ratio (IRR) for high intake of vitamin C (>200 mg/d) from food was 0.69 (95% CI 0.49–0.98) compared with low intake (<100 mg/d). This association was not seen among men, for whom the IRR was 1.16 (95% CI 0.79–1.70) for high intake of vitamin C (>150 mg/d) compared with low intake (<50 mg/d). We saw no protective effect of vitamin E from food among either men or women, but a possible protective effect of vitamin C and E supplement use among men (vitamin C, 0.69 [95% CI 0.47–1.02]; vitamin E, 0.56 [95% CI 0.33–0.95]), although not among women. Conclusion: The present study is the first observational study to suggest that intake of vitamin C from food is sufficient to lower the risk of URTI among women. In addition, it appears that supplement use of vitamin E and vitamin C may reduce the risk of URTI among men, who overall had a lower intake of vitamin C from food than women.

114. The effect of physical activity and chronic stress on self-reported upper respiratory tract infection

adults. We also hypothesized that associations would be patterned by age and gender. Data were from the second wave of the Survey of Midlife in the United States (MIDUS). Participants (N = 507) completed questionnaires focused on lifetime instances of unfair treatment in multiple life domains. Fasting blood samples were obtained during an overnight stay at a General Clinical Research Center (GCRC), and serum levels of fibrinogen were assessed using a semiautomated modification of the Clauss method. Almost half the sample (43%) reported at least one instance of perceived discrimination. Participants under 65 years old reported significantly more instances than those over 65, and women reported more instances than men (P < 0.01 for both). Analyses of variance (ANOVA) that included interaction terms for age and gender showed that perceived discrimination predicted higher serum levels of fibrinogen in young men (P < 0.05), but not in other groups. This association remained statistically significant after adjustment for potential demographic, socioeconomic, health, and health behavior confounds. These results suggest that circulating levels of fibrinogen may be sensitive to perceived discrimination and may play a role in its health consequences. They also suggest that young men may be particularly vulnerable to the adverse impact of perceived discrimination.