Frances Shiely

Temporal trends in misclassification patterns of measured and self-report based body mass index categories--findings from three population surveys in Ireland.

BackgroundAs the use of self-reported data to classify obesity continues, the temporal change in the accuracy of self-report measurement when compared to clinical measurement remains unclear. The objective of this study was to examine temporal trends in misclassification patterns, as well as sensitivity and specificity, of clinically measured versus self-report based body mass index (BMI) from three national lifestyle surveys over a 10-year period.MethodsThe Surveys of Lifestyle Attitudes and Nutrition (SLÁN) were interview based cross-sectional survey/measurements involving nationally representative samples in 1998, 2002 and 2007. Data from a subsample of both self-reported and measured height and weight were available from 66 men and 142 women in 1998, 147 men and 184 women in 2002 and 909 men and 1128 women in 2007. Respondents were classified into the BMI categories normal (< 25 kg m-2), overweight (25- < 30 kg m-2) and obese (≥ 30 kg m-2).ResultsUnderreporting of BMI increased across the three surveys (14%→21%→24%; p = 0.002). Sensitivity scores for the normal category exceeded 94% in all three surveys but decreased for the overweight (75%→68%→66%) and obese categories (80%→64%→53%). Simultaneously, specificity levels remained high.ConclusionsBMI values based on self-reported determinations of height and weight in population samples are underestimating the true prevalence of the obesity epidemic and this underestimation is increasing with time. The decreased sensitivity and consistently high specificity scores in the obese category across time, highlights the limitation of self-report based BMI classifications and the need for simple, readily comprehensible indicators of obesity.

Sociodemographic, lifestyle, mental health and dietary factors associated with direction of misreporting of energy intake.

OBJECTIVE To estimate the extent of under- and over-reporting, to examine associations with misreporting and sociodemographic and lifestyle characteristics and mental health status and to identify differential reporting in micro- and macronutrient intake and quality of diet. DESIGN A health and lifestyle questionnaire and a semi-quantitative FFQ were completed as part of the 2007 Survey of Lifestyle, Attitudes and Nutrition. Energy intake (EI) and intake of micro- and macronutrients were determined by applying locally adapted conversion software. A dietary score was constructed to identify healthier diets. Accuracy of reported EI was estimated using the Goldberg method. ANOVA, χ2 tests and logistic regression were used to examine associations. SETTING Residential households in Ireland. SUBJECTS A nationally representative sample of 7521 adults aged 18 years or older. RESULTS Overall, 33·2 % of participants were under-reporters while 11·9 % were over-reporters. After adjustment, there was an increased odds of under-reporting among obese men (OR = 2·01, 95 % CI 1·46, 2·77) and women (OR = 1·68, 95 % CI 1·23, 2·30) compared to participants with a healthy BMI. Older age, low socio-economic status and overweight/obesity reduced the odds of over-reporting. Among under-reporters, the percentage of EI from fat was lower and overall diet was healthier compared to accurate and over-reporters. The reported usage of salt, fried food consumption and snacking varied significantly by levels of misreporting. CONCLUSIONS Patterns in differential reporting were evident across sociodemographic, lifestyle and mental health factors and diet quality. Consideration should be given to how misreporting affects nutrient analysis to ensure sound nutritional policy.

Height and Weight Bias: The Influence of Time

Background We have previously identified in a study of both self-reported body mass index (BMI) and clinically measured BMI that the sensitivity score in the obese category has declined over a 10-year period. It is known that self-reported weight is significantly lower that measured weight and that self-reported height is significantly higher than measured height. The purpose of this study is to establish if self-reported height bias or weight bias, or both, is responsible for the declining sensitivity in the obese category between self-reported and clinically measured BMI. Methods We report on self-reported and clinically measured height and weight from three waves of the Surveys of Lifestyle Attitudes and Nutrition (SLÁN) involving a nationally representative sample of Irish adults. Data were available from 66 men and 142 women in 1998, 147 men and 184 women in 2002 and 909 men and 1128 women in 2007. Respondents were classified into BMI categories normal (<25 kg/m2), overweight (25–<30 kg/m2) and obese (≥30 kg/m2). Results Self-reported height bias has remained stable over time regardless of gender, age or clinical BMI category. Self-reported weight bias increases over time for both genders and in all age groups. The increased weight bias is most notable in the obese category. Conclusions BMI underestimation is increasing across time. Knowledge that the widening gap between self-reported BMI and measured BMI is attributable to an increased weight bias brings us one step closer to accurately estimating true obesity levels in the population using self-reported data.

Alcohol consumption among university students in Ireland and the United Kingdom from 2002 to 2014: a systematic review.

BackgroundAlcohol is a leading cause of global suffering. Europe reports the uppermost volume of alcohol consumption in the world, with Ireland and the United Kingdom reporting the highest levels of binge drinking and drunkenness. Levels of consumption are elevated among university students. Thus, this literature review aims to summarise the current research on alcohol consumption among university students in the Republic of Ireland and the United Kingdom.MethodsMEDLINE, CINAHL, EMBASE and PsychInfo were systematically searched for literature from January 2002 until December 2014. Each database was searched using the following search pillars: alcohol, university student, Ireland or the United Kingdom and prevalence studies.ResultsTwo thousand one hundred twenty eight articles were retrieved from electronic database searching. These were title searched for relevance. 113 full texts were retrieved and assessed for eligibility. Of these, 29 articles were deemed to meet inclusion criteria for the review. Almost two thirds of students reported a hazardous alcohol consumption score on the AUDIT scale. Over 20 % reported alcohol problems over their lifetime using CAGE while over 20 % exceed sensible limits each week. Noteworthy is the narrowing of the gender gap throughout the past decade.ConclusionThis is the first review to investigate consumption patterns of university students in Ireland and the United Kingdom. A range of sampling strategies and screening tools are employed in alcohol research which preclude comparability. The current review provides an overview of consumption patterns to guide policy development.

Hazardous alcohol consumption among university students in Ireland: a cross-sectional study

Objective There is considerable evidence of a cultural shift towards heavier alcohol consumption among university students, especially women. The aim of this study is to investigate the prevalence and correlates of hazardous alcohol consumption (HAC) among university students with particular reference to gender and to compare different modes of data collection in this population. Setting A large Irish university. Design A cross-sectional study using a classroom distributed paper questionnaire. Participants A total of 2275 undergraduates completed the classroom survey, 84% of those in class and 51% of those registered for the relevant module. Main outcome measures Prevalence of HAC measured using the Alcohol Use Disorders Identification Test for Consumption (AUDIT-C) and the proportion of university students reporting 1 or more of 13 adverse consequences linked to HAC. HAC was defined as an AUDIT-C score of 6 or more among males and 5 or more among females. Results In the classroom sample, 66.4% (95% CI 64.4 to 68.3) reported HAC (65.2% men and 67.3% women). In women, 57.4% met HAC thresholds for men. Similar patterns of adverse consequences were observed among men and women. Students with a hazardous consumption pattern were more likely to report smoking, illicit drug use and being sexually active. Conclusions The findings highlight the high prevalence of HAC among university students relative to the general population. Public policy measures require review to tackle the short-term and long-term risks to physical, mental and social health and well-being.

Application of the UK Foresight Obesity Model in Ireland: The Health and Economic Consequences of Projected Obesity Trends in Ireland

Background Given the scale of the current obesity epidemic and associated health consequences there has been increasing concern about the economic burden placed on society in terms of direct healthcare costs and indirect societal costs. In the Republic of Ireland these costs were estimated at €1.13 billion for 2009. The total direct healthcare costs for six major obesity related conditions (coronary heart disease & stroke, cancer, hypertension, type 2 diabetes and knee osteoarthritis) in the same year were estimated at €2.55 billion. The aim of this research is to project disease burden and direct healthcare costs for these conditions in Ireland to 2030 using the established model developed by the Health Forum (UK) for the Foresight: Tackling Obesities project. Methodology Routine data sources were used to derive incidence, prevalence, mortality and survival for six conditions as inputs for the model. The model utilises a two stage modelling process to predict future BMI rates, disease prevalence and costs. Stage 1 employs a non-linear multivariate regression model to project BMI trends; stage 2 employs a microsimulation approach to produce longitudinal projections and test the impact of interventions upon future incidence of obesity-related disease. Results Overweight and obesity are projected to reach levels of 89% and 85% in males and females respectively by 2030. This will result in an increase in the obesity related prevalence of CHD & stroke by 97%, cancers by 61% and type 2 diabetes by 21%. The direct healthcare costs associated with these increases will amount to €5.4 billion by 2030. A 5% reduction in population BMI levels by 2030 is projected to result in €495 million less being spent in obesity-related direct healthcare costs over twenty years. Discussion These findings have significant implications for policy, highlighting the need for effective strategies to prevent this avoidable health and economic burden.

Barriers and facilitators to initial and continued attendance at community-based lifestyle programmes among families of overweight and obese children: a systematic review

The success of childhood weight management programmes relies on family engagement. While attendance offers many benefits including the support to make positive lifestyle changes, the majority of families referred to treatment decline. Moreover, for those who do attend, benefits are often compromised by high programme attrition. This systematic review investigated factors influencing attendance at community‐based lifestyle programmes among families of overweight or obese children. A narrative synthesis approach was used to allow for the inclusion of quantitative, qualitative and mixed‐method study designs. Thirteen studies met the inclusion criteria. Results suggest that parents provided the impetus for programme initiation, and this was driven largely by a concern for their childs psychological health and wellbeing. More often than not, children went along without any real reason or interest in attending. Over the course of the programme, however, childrens positive social experiences such as having fun and making friends fostered the desire to continue. The stigma surrounding excess weight and the denial of the issue amongst some parents presented barriers to enrolment and warrant further study. This study provides practical recommendations to guide future policy makers, programme delivery teams and researchers in developing strategies to boost recruitment and minimise attrition.

Positive Mental Health and Well-Being among a Third Level Student Population

Introduction Much research on the health and well-being of third level students is focused on poor mental health leading to a dearth of information on positive mental health and well-being. Recently, the Warwick Edinburgh Mental Well-being scale (WEMWBS) was developed as a measurement of positive mental health and well-being. The aim of this research is to investigate the distribution and determinants of positive mental health and well-being in a large, broadly representative sample of third level students using WEMWBS. Methods Undergraduate students from one large third level institution were sampled using probability proportional to size sampling. Questionnaires were distributed to students attending lectures in the randomly selected degrees. A total of 2,332 self-completed questionnaires were obtained, yielding a response rate of 51% based on students registered to relevant modules and 84% based on attendance. One-way ANOVAs and multivariate logistic regression were utilised to investigate factors associated with positive mental health and well-being. Results The sample was predominantly female (62.66%), in first year (46.9%) and living in their parents’ house (42.4%) or in a rented house or flat (40.8%). In multivariate analysis adjusted for age and stratified by gender, no significant differences in WEMWBS score were observed by area of study, alcohol, smoking or drug use. WEMWBS scores were higher among male students with low levels of physical activity (p=0.04). Men and women reporting one or more sexual partners (p<0.001) were also more likely to report above average mental health and well-being. Conclusion This is the first study to examine positive mental health and well-being scores in a third level student sample using WEMWBS. The findings suggest that students with a relatively adverse health and lifestyle profile have higher than average mental health and well-being. To confirm these results, this work needs to be replicated across other third level institutions.

A typology of alcohol consumption among young people – A narrative synthesis

Abstract Background Currently, alcohol consumption levels are significantly higher among younger age groups. However, previous research has noted the diversity of motivations and patterns. These patterns of drinking have yet to be synthesised into a typology. The aim of the current study was to synthesise information from studies that produced types of alcohol consumption among young people. Method Quantitative and qualitative literature investigating the different types of drinkers among young people [aged 12–24 years], published in peer reviewed journals, were eligible for inclusion in this systematic review. MEDLINE, PsychInfo and CINAHL were systematically searched for relevant articles published between January 1st 2000 and December 31st 2014. Included papers were critically appraised. A narrative synthesis approach was employed based on guidance from the UK Economic and Social Research Council. Results In total, 13 studies were eligible for inclusion: 11 quantitative, one qualitative and one mixed methods. Six classes of drinkers were formed within this typology. Abstainers reported no alcohol consumption. Light drinkers reported drinking small amounts of alcohol infrequently. In comparison, social and hedonistic drinkers drank most in social situations and to have fun. Heavy and harmful consumers reported increased volume and frequency of consumption including harmful consequences. Conclusion Currently, policy makers are attempting to combat the high levels of harmful alcohol consumption among young people. The current typology provides guidance for targeted interventions in addition to a practical analytic tool in future research.

Knowledge, attitudes and beliefs of parents regarding fever in children: a Danish interview study

Fever and febrile illness are some of the most common conditions managed by parents. The aim of this study was to examine the knowledge, attitudes and beliefs of parents around fever in children under five years of age.