Katriina L. Whitaker

Comparing maternal and paternal intergenerational transmission of obesity risk in a large population-based sample

BACKGROUND Previous research showed childhood obesity to be more strongly associated with maternal weight than with paternal weight. However, confidence in this finding is limited by the lack of objectively measured data from both parents. OBJECTIVE We quantified the individual and combined effects of maternal and paternal overweight/obesity on obesity risk in children. DESIGN Data were pooled from the annual Health Surveys for England carried out between 2001 and 2006. Families with < or =2 children aged 2-15 y with anthropometric data available for both parents and children were included (n = 4432 families, n = 7078 children). Weights and heights were measured by a trained nurse. RESULTS Having 2 overweight parents was associated with an increased risk of child obesity [odds ratio (OR): 2.2; 95% CI: 1.3, 3.7; P < 0.001] compared with having 2 normal-weight parents. Having 2 obese (including severely obese) parents was associated with a higher risk of child obesity (OR: 12.0; 95% CI: 7.2, 20.1; P < 0.01), and having 2 severely obese parents was associated with an even higher risk of child obesity (OR: 22.3; 95% CI: 10.3, 48.4; P < 0.01) independent of age, sex, socioeconomic status, and ethnicity. Mother-child associations (r = 0.27) for body mass index were significantly stronger than father-child associations (r = 0.23), even after adjustment for plausible levels (< or =4%) of undisclosed nonpaternity. Associations were the same for sons and daughters but increased with age. CONCLUSIONS There is a strong and graded association between parental weight status and risk of childhood obesity, which is significantly stronger for maternal weight. Parental obesity could be used to target preventive interventions in the preschool years to avoid serious adverse effects on the future health of children.

Stress and Adiposity: A Meta-Analysis of Longitudinal Studies

Psychosocial stress has been strongly implicated in the biology of adiposity but epidemiological studies have produced inconsistent results. The aim of this analysis was to bring together results from published, longitudinal, prospective studies examining associations between psychosocial stress and objectively measured adiposity in a meta‐analysis. Searches were conducted on Medline, PsycINFO, Web of Science, and PubMed (to January 2009) and reference lists from relevant articles were examined. Prospective studies relating psychosocial stress (general life stress (including caregiver stress), work stress) to BMI, body fat, body weight, waist circumference, or waist‐to‐hip ratio were included. Analyses from 14 cohorts were collated and evaluated. There was no significant heterogeneity, no evidence of publication bias, and no association between study quality and outcomes. The majority of analyses found no significant relationship between stress and adiposity (69%), but among those with significant effects, more found positive than negative associations (25 vs. 6%). Combining results in a meta‐analysis showed that stress was associated with increasing adiposity (r = 0.014; confidence interval (CI) = 0.002–0.025, P < 0.05). Effects were stronger for men than women, in analyses with longer rather than shorter follow‐ups, and in better quality studies. We conclude that psychosocial stress is a risk factor for weight gain but effects are very small. Variability across studies indicates there are moderating variables to be elucidated.

Psychosocial Determinants of Socioeconomic Inequalities in Cancer Screening Participation: A Conceptual Framework

Cancer screening participation shows a strong, graded association with socioeconomic status (SES) not only in countries such as the United States, where insurance status can be a barrier for lower income groups, but also in the United Kingdom, where the National Health Service provides all health care to residents, including screening, for free. Traditionally, the literature on socioeconomic inequalities has focused on upstream factors, but more proximal (downstream) influences on screening participation also need to be examined, particularly those that address the graded nature of the association rather than focusing specifically on underserved groups. This review offers a framework that links some of the components and corollaries of SES (life stress, educational opportunities, illness experience) to known psychosocial determinants of screening uptake (beliefs about the value of early detection, fatalistic beliefs about cancer, self-efficacy). The aim is to explain why individuals from lower SES backgrounds perceive cancer screening tests as more threatening, more difficult to accomplish, and less beneficial. A better understanding of the mechanisms through which lower SES causes negative attitudes toward screening could facilitate the development of intervention strategies to reduce screening inequalities.

Cancer Fatalism: Deterring Early Presentation and Increasing Social Inequalities?

Background: Fatalistic beliefs about cancer have been implicated in low uptake of screening and delay in presentation particularly in low socioeconomic status (SES) groups, but no studies have systematically evaluated interrelationships between SES, fatalism, and early detection behaviors. We explored whether (i) fatalism is associated with negative attitudes toward early detection, (ii) lower SES groups are more fatalistic, and (iii) SES differences in fatalism partly explain SES differences in attitudes toward early detection. Methods: In a population-representative sample of adults in Britain using computer-based interviews in the home setting, respondents (N = 2,018) answered two questions to index fatalism (expectations of cancer survival and cure) and two items on early detection attitudes (the perceived value of early detection and fear of symptom reporting). SES was indexed with a social grade classification. Results: Fatalism was associated with being less positive about early detection (β = −0.40, P < 0.001) and more fearful about seeking help for a suspicious symptom (β = 0.24, P < 0.001). Lower SES groups were more fatalistic (β = −0.21, P < 0.001). Path analyses suggest that SES differences in fatalism might explain SES differences in attitudes about early detection. Conclusions: In this population sample, SES differences in fatalism partly explained SES differences in the perceived value of early detection and fear of symptom presentation. Impact: Fatalistic beliefs about cancer should be targeted to promote early presentation of cancer and this may be particularly important for lower SES groups. Cancer Epidemiol Biomarkers Prev; 20(10); 2127–31. ©2011 AACR.

Women's responses to information about overdiagnosis in the UK breast cancer screening programme: a qualitative study

Objectives To explore the influence of overdiagnosis information on womens decisions about mammography. Design A qualitative focus group study with purposive sampling and thematic analysis, in which overdiagnosis information was presented. Setting Community and university settings in London. Participants 40 women within the breast screening age range (50–71 years) including attenders and non-attenders were recruited using a recruitment agency as well as convenience sampling methods. Results Women expressed surprise at the possible extent of overdiagnosis and recognised the information as important, although many struggled to interpret the numerical data. Overdiagnosis was viewed as less-personally relevant than the possibility of ‘under diagnosis’ (false negatives), and often considered to be an issue for follow-up care decisions rather than screening participation. Women also expressed concern that information on overdiagnosis could deter others from attending screening, although they rarely saw it as a deterrent. After discussing overdiagnosis, few women felt that they would make different decisions about breast screening in the future. Conclusions Women regard it as important to be informed about overdiagnosis to get a complete picture of the risks and benefits of mammography, but the results of this study indicate that understanding overdiagnosis may not always influence womens attitudes towards participation in breast screening. The results also highlight the challenge of communicating the individual significance of information derived from population-level modelling.

Do social norms affect intended food choice

OBJECTIVE To evaluate the effect of social norms on intended fruit and vegetable intake. METHODS A two-stage design to i) compare the perceived importance of normative influences vs cost and health on dietary choices, and ii) test the prediction that providing information on social norms will increase intended fruit and vegetable consumption in an experimental study. Home-based interviews (N=1083; 46% men, 54% women) were carried out as part of the Office for National Statistics Omnibus Survey in November 2008. RESULTS The publics perception of the importance of social norms was lower (M=2.1) than the perceived importance of cost (M=2.7) or health (M=3.4) (all ps<0.001) on a scale from 1 (not at all important) to 4 (very important). In contrast, results from the experimental study showed that intentions to eat fruit and vegetables were positively influenced by normative information (p=0.011) in men but not by health or cost information; none of the interventions affected womens intentions. CONCLUSIONS People have little awareness of the influence of social norms but normative information can have a demonstrable impact on dietary intentions. Health promotion might profit from emphasising how many people are attempting to adopt healthy lifestyles rather than how many have poor diets.

Socioeconomic inequalities in colorectal cancer screening uptake: does time perspective play a role?

OBJECTIVE This study examined the role of time perspective in explaining inequalities in colorectal cancer screening attendance. We tested a path model predicting that (a) socioeconomic status (SES) would be associated with consideration of future consequences (CFC), (b) CFC would be associated with perceived benefits/barriers, and (c) barriers and benefits would be associated longitudinally with screening attendance. METHOD Data for these analyses came from the control arm (n = 809) of an intervention to increase screening uptake. Participants between 55 and 64 years were offered screening as part of the U.K. Flexible Sigmoidoscopy (FS) Trial. They completed a questionnaire that included demographic and psychological variables. Subsequent screening attendance was recorded. RESULTS There was clear evidence of SES differences in attendance, with 56% in the most deprived tertile attending their FS appointment, compared with 68% in the middle tertile and 71% in the least deprived tertile (p < .01). Lower SES was associated with lower CFC, higher perceived barriers, and lower perceived benefits (p < .05 for all). Higher CFC, higher perceived benefits, and lower perceived barriers were associated with attendance (p < .01 for all). CFC mediated the association between SES and perceived benefits/barriers, while perceived benefits/barriers mediated the association between CFC and attendance. CONCLUSION SES differences in CFC contribute to SES differences in the perceived barriers and benefits of screening, which, in turn, contribute to differences in attendance. Interventions that take CFC into account, for example, by emphasizing short-term benefits, could promote equality in screening participation.

Help seeking for cancer ‘alarm’ symptoms: a qualitative interview study of primary care patients in the UK

Background Delay in help seeking for cancer ‘alarm’ symptoms has been identified as a contributor to delayed diagnosis. Aim To understand people’s help-seeking decision making for cancer alarm symptoms, without imposing a cancer context. Design and setting Community-based, qualitative interview study in the UK, using purposive sampling by sex, socioeconomic status, and prior help seeking, with framework analysis of transcripts. Method Interviewees (n = 48) were recruited from a community-based sample (n = 1724) of adults aged ≥50 years who completed a health survey that included a list of symptoms. Cancer was not mentioned. Participants reporting any of 10 cancer alarm symptoms (n = 915) and who had consented to contact (n = 482) formed the potential pool from which people were invited to an interview focusing on their symptom experiences. Results Reasons for help seeking included symptom persistence, social influence, awareness/fear of a link with cancer, and ‘just instinct’. Perceiving the symptom as trivial or ‘normal’ was a deterrent, as was stoicism, adopting self-management strategies, and fear of investigations. Negative attitudes to help seeking were common. Participants did not want to be seen as making a fuss, did not want to waste the doctor’s time, and were sometimes not confident that the GP could help. Conclusion Decision making about cancer alarm symptoms was complex. Recognition of cancer risk almost always motivated help seeking (more so than the fear of cancer being a deterrent), assisted by recent public-awareness campaigns. As well as symptom persistence motivating help seeking, it could also have the reverse effect. Negative attitudes to help seeking were significant deterrents.

Intrusive cognitions and anxiety in cancer patients

OBJECTIVE The study aimed to provide information on intrusive cognitions reported by cancer patients and to investigate for the first time whether intrusive imagery is a factor in psychological morbidity. METHODS Matched samples of anxious (n=65) and nonanxious (n=65) patients were assessed for evidence of intrusive cognitions, including memories, images, and thoughts. Patients also completed the Mini-Mental Adjustment to Cancer Scale. RESULTS Twenty-three percent of patients reported intrusive cognitions. Cognitions were frequent, uncontrollable, and associated with significant distress. Anxious patients reported significantly more of each intrusion type than nonanxious patients, and the presence of intrusive cognitions was significantly associated with maladaptive adjustment, including anxious preoccupation and helplessness-hopelessness. CONCLUSION Intrusive cognitions play a significant role in anxiety and adaptation to the experience of cancer. Advancing knowledge in relation to the phenomenology of intrusions and to the manner in which intrusions can be targeted with psychological treatments is an important next stage of research.

Intrusive cognitions and their appraisal in anxious cancer patients

Objective: Previous research found that anxious cancer patients experience uncontrollable negative intrusive cognitions that have an impact on coping and are associated with significant psychological distress. This is the first study to examine the appraisal of intrusive cognitions in an anxious group of cancer patients.