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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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background: The NHS Cancer Screening Programmes in England now operate a policy of 'informed choice' about participation in cancer screening. Engagement with written information about screening is important to facilitate informed choice, although the degree to which the screening-eligible public engages with the available information is unknown. We examined the association between reading of the standard informational booklet ('Bowel Cancer Screening: The Facts') and participation in the nationally organised NHS Bowel Cancer Screening Programme in England.Methods: Face-to-face interviews were conducted with 1307 adults who were age-eligible for nationally organised colorectal cancer (CRC; also called bowel cancer) in a population-based survey in England in 2014. Respondents were shown an image of 'The Facts' booklet and were asked how much of it they had read when they received their screening invitation ('none', 'a little', 'some', 'most', 'almost all', or 'all'). Logistic regression was used to estimate the associations between screening uptake status ('never' vs. 'ever') and self-reported reading of 'The Facts' booklet (dichotomised to 'none vs. 'any'), adjusting for age, sex, ethnicity, educational attainment, and occupation-based social grade.Results: Overall, 69 % of the sample (908/1307) had participated in CRC screening at least once ('ever' screeners). One-fifth of the sample reported that they had read 'none' of 'The Facts' booklet (22 %; 287/1307), while half reported having read 'all' of it (52 %; 680/1307). Reading of the booklet was strongly differential according to screening uptake status: nearly two-thirds of 'never' screeners had read none of 'The Facts' booklet (63 %; 251/399), compared to less than one in twenty 'ever' screeners (4 %; 36/908); adjusted OR = 39.0; 95 % CI: 26.2-58.1 for reading 'none' in 'never' vs. 'ever' screeners.Conclusions: Although 'The Facts' booklet is intended to support informed choices about CRC screening, the majority of unscreened individuals report that they have read none of it. The degree to which public engagement with the decision-making process about cancer screening is socially unequal must be better understood so that comprehensive and equitable public communication strategies can be developed. [ABSTRACT FROM AUTHOR]

Objective: Sexual activity is a central component of intimate relationships, but sexual function may be impaired by coronary heart disease (CHD). There have been few representative population-based comparisons of sexual behaviour and concerns in people with and without CHD. We therefore investigated these issues in a large nationally representative sample of older people.Methods: We analysed cross-sectional data from 2979 men and 3711 women aged 50 and older from the English Longitudinal Study of Ageing. Sexual behaviour and concerns were assessed by validated self-completion questionnaire and analyses were weighted for non-response. Covariates included age, partnerships status and comorbidities.Results: There were 376 men and 279 women with CHD. Men with CHD were less likely to be sexually active (68.7% vs 80.0%, adjusted OR 0.62, 95% CI 0.47 to 0.81), thought less about sex (74.7% vs 81.9%, OR 0.72, CI 0.54 to 0.95), and reported more erectile difficulties (47.4% vs 38.1%, OR 1.46, CI 1.10 to 1.93) than men without CHD. Effects were more pronounced among those diagnosed within the past 4 years. Women diagnosed <4 years ago were also less likely to be sexually active (35.4% vs 55.6%, OR 0.44, CI 0.23 to 0.84). There were few differences in concerns about sexual activity. Cardiovascular medication showed weak associations with erectile dysfunction.Conclusions: There is an association between CHD and sexual activity, particularly among men, but the impact of CHD is limited. More effective advice after diagnosis might reverse the reduction in sexual activity, leading to improved quality of life. [ABSTRACT FROM AUTHOR]

Background: Worrying about wasting GP time is frequently cited as a barrier to help-seeking for cancer symptoms.Aim: To explore the circumstances under which individuals feel that they are wasting GP time.Design and Setting: Community-based, qualitative interview studies that took place in London, the South East and the North West of England.Method: Interviewees (n = 62) were recruited from a sample (n = 2042) of adults aged ≥50 years, who completed a 'health survey' that included a list of cancer 'alarm' symptoms. Individuals who reported symptoms at baseline that were still present at the 3-month follow-up (n = 271), and who had also consented to be contacted (n = 215), constituted the pool of people invited for interview. Analyses focused on accounts of worrying about wasting GP time.Results: Participants were worried about wasting GP time when time constraints were visible, while dismissive interactions with their GP induced a worry of unnecessary help-seeking. Many felt that symptoms that were not persistent, worsening, or life-threatening did not warrant GP attention. Additionally, patients considered it time-wasting when they perceived attention from nurses or pharmacists to be sufficient, or when appointment structures (for example, 'one issue per visit') were not adhered to. Close relationships with GPs eased worries about time-wasting, while some patients saw GPs as fulfilling a service financed by taxpayers.Conclusion: Worrying about wasting GP time is a complex barrier to help-seeking. GP time and resource scarcity, symptom gravity, appointment etiquette, and previous GP interactions contribute to increasing worries. Friendly GP relationships, economic reasoning, and a focus on the GP's responsibilities as a medical professional reduce this worry. [ABSTRACT FROM AUTHOR]

Objective To examine uptake in the first six pilot centres of the English Bowel Scope Screening (BSS) programme, which began in early 2013 and invites adults aged 55 for a one off Flexible Sigmoidoscopy. Methods Between March 2013 and May 2014 the six pilot centres sent 21,187 invitations. Using multivariate logistic regression analysis, we examined variation in uptake by gender, socioeconomic deprivation (using the Index of Multiple Deprivation), area-based ethnic diversity (proportion of non-white residents), screening centre, and appointment time (routine: daytime vs out-of-hours: evening/weekend). Results Uptake was 43.1%. Men were more likely to attend than women (45% vs 42%; OR 1.136, 95% CI 1.076, 1.199, p < 0.001). Combining data across centres, there was a socioeconomic gradient in uptake, ranging from 33% in the most deprived to 53% in the least deprived quintile. Areas with the highest level of ethnic diversity also had lower uptake (39%) than other areas (41–47%) (all p < 0.02), but there was no gradient. Individuals offered a routine appointment were less likely to attend than those offered an out-of-hours appointment (42% vs. 44%; OR 0.931, 95% CI 0.882, 0.983, p = 0.01). Multivariate analyses confirmed independent effects of deprivation, gender, and centre, but not of ethnic diversity or appointment time. Conclusion Early indications of uptake are encouraging. Future efforts should focus on increasing public awareness of the programme and reducing socioeconomic inequalities. [ABSTRACT FROM AUTHOR]

Objective Health policy in the UK is committed to tackling inequalities in cancer screening participation. We examined whether socioeconomic inequalities in breast and cervical cancer screening participation in England have reduced over five years. Methods Cross-sectional analyses compared cervical and breast screening coverage between 2007/8 and 2012/13 in Primary Care Trusts (PCTs) in England in relation to area-level income deprivation. Results At the start and the end of this five year period, there were socioeconomic inequalities in screening coverage for breast and cervical screening. Inequalities were highest for breast screening. Over time, the coverage gap between the highest and lowest quintiles of income deprivation significantly reduced for breast screening (from 12.3 to 8.3 percentage points), but not for cervical screening (5.3 to 4.9 percentage points). Conclusions Efforts to reduce screening inequalities appear to have resulted in a significant improvement in equitable delivery of breast screening, although not of cervical screening. More work is needed to understand the differences, and see whether broader lessons can be learned from the reduction of inequalities in breast screening participation. [ABSTRACT FROM AUTHOR]

Background: Food fussiness (FF) is common in early childhood and is often associated with the rejection of nutrient-dense foods such as vegetables and fruit. FF and liking for vegetables and fruit are likely all heritable phenotypes; the genetic influence underlying FF may explain the observed genetic influence on liking for vegetables and fruit. Twin analyses make it possible to get a broad-based estimate of the extent of the shared genetic influence that underlies these traits. Objective: We quantified the extent of the shared genetic influence that underlies FF and liking for vegetables and fruit in early childhood with the use of a twin design. Design: Data were from the Gemini cohort, which is a populationbased sample of twins born in England and Wales in 2007. Parents of 3-y-old twins (n = 1330 pairs) completed questionnaire measures of their children's food preferences (liking for vegetables and fruit) and the FF scale from the Children's Eating Behavior Questionnaire. Multivariate quantitative genetic modeling was used to estimate common genetic influences that underlie FF and liking for vegetables and fruit. Results: Genetic correlations were significant and moderate to large in size between FF and liking for both vegetables (20.65) and fruit (20.43), which indicated that a substantial proportion of the genes that influence FF also influence liking. Common genes that underlie FF and liking for vegetables and fruit largely explained the observed phenotypic correlations between them (68-70%). Conclusions: FF and liking for fruit and vegetables in young children share a large proportion of common genetic factors. The genetic influence on FF may determine why fussy children typically reject fruit and vegetables. [ABSTRACT FROM AUTHOR]

Objective To compare self-reported with objectively recorded participation in Faecal Occult Blood testing (FOBt) colorectal cancer (CRC) screening in a national programme. Methods Survey respondents living in England who were eligible for screening were asked in face-to-face interviews if they had ever been invited to do a CRC screening test, how many times they had been invited, and how many times they had participated. National Health Service (NHS) Bowel Cancer Screening Programme (BCSP) records were consulted for respondents who had consented to a record check. The outcome measures were ‘ever uptake’ (responded to ≥1 invitation), ‘repeat uptake’ (responded to ≥2 invitations), and ‘consistent uptake’ (responded to all invitations). Results In the verified group, self-reported ever uptake was highly consistent with recorded ever uptake (87.0% vs. 87.8%). Among those who indicated that they had been invited more than once, self-reported repeat uptake was 89.8% compared with 84.8% recorded repeat uptake. Among those with more than one recorded invitation, self-reported repeat uptake was 72.7% compared with 77.2% recorded repeat uptake, and self-reported consistent uptake was 81.6% compared with 65.6% recorded consistent uptake. Conclusion Our results suggest that people can accurately report whether they have ever taken part in CRC screening. The vast majority of those whose records were verified could also accurately report whether they had taken part in screening at least twice. They were somewhat less accurate in reporting whether they had responded to all screening invitations. [ABSTRACT FROM AUTHOR]

Background: Uptake in the national colorectal cancer screening programme in England varies by socioeconomic status. We assessed four interventions aimed at reducing this gradient, with the intention of improving the health benefits of screening.Methods: All people eligible for screening (men and women aged 60-74 years) across England were included in four cluster-randomised trials. Randomisation was based on day of invitation. Each trial compared the standard information with the standard information plus the following supplementary interventions: trial 1 (November, 2012), a supplementary leaflet summarising the gist of the key information; trial 2 (March, 2012), a supplementary narrative leaflet describing people's stories; trial 3 (June, 2013), general practice endorsement of the programme on the invitation letter; and trial 4 (July-August, 2013) an enhanced reminder letter with a banner that reiterated the screening offer. Socioeconomic status was defined by the Index of Multiple Deprivation score for each home address. The primary outcome was the socioeconomic status gradient in uptake across deprivation quintiles. This study is registered, number ISRCTN74121020.Findings: As all four trials were embedded in the screening programme, loss to follow-up was minimal (less than 0·5%). Trials 1 (n=163,525) and 2 (n=150,417) showed no effects on the socioeconomic gradient of uptake or overall uptake. Trial 3 (n=265 434) showed no effect on the socioeconomic gradient but was associated with increased overall uptake (adjusted odds ratio [OR] 1·07, 95% CI 1·04-1·10, p<0·0001). In trial 4 (n=168 480) a significant interaction was seen with socioeconomic status gradient (p=0·005), with a stronger effect in the most deprived quintile (adjusted OR 1·11, 95% CI 1·04-1·20, p=0·003) than in the least deprived (1·00, 0·94-1·06, p=0·98). Overall uptake was also increased (1·07, 1·03-1·11, p=0·001).Interpretation: Of four evidence-based interventions, the enhanced reminder letter reduced the socioeconomic gradient in screening uptake, but further reducing inequalities in screening uptake through written materials alone will be challenging.Funding: National Institute for Health Research. [ABSTRACT FROM AUTHOR]

Background: There is a socioeconomic gradient in the uptake of screening in the English NHS Bowel Cancer Screening Programme (BCSP), potentially leading to inequalities in outcomes. We tested whether endorsement of bowel cancer screening by an individual's general practice (GP endorsement; GPE) reduced this gradient.Methods: A cluster-randomised controlled trial. Over 20 days, individuals eligible for screening in England from 6480 participating general practices were randomly allocated to receive a GP-endorsed or the standard invitation letter. The primary outcome was the proportion of people adequately screened and its variation by quintile of Index of Multiple Deprivation.Results: We enrolled 265,434 individuals. Uptake was 58.2% in the intervention arm and 57.5% in the control arm. After adjusting for age, sex, hub and screening episode, GPE increased the overall odds of uptake (OR=1.07, 95% CI 1.04-1.10), but did not affect its socioeconomic gradient. We estimated that implementing GPE could result in up to 165 more people with high or intermediate risk colorectal adenomas and 61 cancers detected, and a small one-off cost to modify the standard invitation (£78,000).Conclusions: Although GPE did not improve its socioeconomic gradient, it offers a low-cost approach to enhancing overall screening uptake within the NHS BCSP. [ABSTRACT FROM AUTHOR]

Background: Ethnic minority women are less likely to attend cervical screening.Aim: To explore self-perceived barriers to cervical screening attendance among ethnic minority women compared to white British women.Design: Qualitative interview study.Setting: Community groups in ethnically diverse London boroughs.Methods: Interviews were carried out with 43 women from a range of ethnic minority backgrounds (Indian, Pakistani, Bangladeshi, Caribbean, African, Black British, Black other, White other) and 11 White British women. Interviews were recorded, transcribed verbatim and analysed using Framework analysis.Results: Fifteen women had delayed screening/had never been screened. Ethnic minority women felt that there was a lack of awareness about cervical cancer in their community, and several did not recognise the terms 'cervical screening' or 'smear test'. Barriers to cervical screening raised by all women were emotional (fear, embarrassment, shame), practical (lack of time) and cognitive (low perceived risk, absence of symptoms). Emotional barriers seemed to be more prominent among Asian women. Low perceived risk of cervical cancer was influenced by beliefs about having sex outside of marriage and some women felt a diagnosis of cervical cancer might be considered shameful. Negative experiences were well remembered by all women and could be a barrier to repeat attendance.Conclusions: Emotional barriers (fear, embarrassment and anticipated shame) and low perceived risk might contribute to explaining lower cervical screening coverage for some ethnic groups. Interventions to improve knowledge and understanding of cervical cancer are needed in ethnic minority communities, and investment in training for health professionals may improve experiences and encourage repeat attendance for all women. [ABSTRACT FROM AUTHOR]

Background: Uptake of colorectal cancer screening programmes needs to be improved or at least maintained in order to achieve projected reductions in mortality and morbidity. Understanding the origins of non‐participation in screening is therefore important. Objective: To explore the beliefs and experiences of individuals who had not responded either to their screening invitation or reminder. Design: A qualitative study using in‐depth interviews with non‐participants from England's population‐based colorectal cancer screening programme. Data collection and analysis were carried out using a grounded theory approach, with an emphasis on the constant comparison method, and continued until saturation (27 interviews). Findings: The interviews provided an in‐depth understanding of a range of reasons and circumstances surrounding non‐participation in screening, including contextual and environmental influences as well as factors specific to the screening test. Non‐participation in screening was not necessarily associated with negative attitudes towards screening or a decision to not return a kit. Reasons for non‐participation in screening included not feeling that participation is personally necessary, avoiding or delaying decision making, and having some degree of intention to take part but failing to do so because of practicalities, conflicting priorities or external circumstances. Beliefs, awareness and intention change over time. Discussion and conclusions: A range of approaches may be required to improve screening uptake. Some non‐participants may already have a degree of intention to take part in screening in the future, and this group may be more responsive to interventions based on professional endorsement, repeat invitations, reminders and aids to making the test more practical. [ABSTRACT FROM AUTHOR]

Background The English NHS Bowel Cancer Screening Programme has offered biennial faecal occult blood testing to people aged 60-69 years since 2006, and to those aged 60-74 years since 2010. Analysis of the first 2.6 million screening invitations found that 54% of eligible people took up the invitation. The reasons for this low uptake are unclear. We investigated whether participation in screening varies according to cognitive ability and personality. Methods Participants were members of The English Longitudinal Study of Ageing. In 2010-2011, respondents were asked about participation in bowel cancer screening, and cognitive ability and the ‘Big Five’ personality traits were assessed. Logistic regression was used to examine the cross-sectional relationships between cognitive ability and personality and screening participation in 2681 people aged 60-75 years who were eligible to have been invited to take part in the UK national screening programme for bowel cancer. Results In age-adjusted and sex-adjusted analyses, better cognition and higher conscientiousness were associated with increased participation in cancer screening. ORs (95% CIs) per SD increase were 1.10 (1.03 to 1.18) for cognitive ability and 1.10 (1.01 to 1.19) for conscientiousness. After further adjustment for household wealth and health literacy—shown previously to be associated with participation—these associations were attenuated (ORs were 1.07 (1.00 to 1.15) and 1.07 (0.97 to 1.18), respectively). Conclusions We found some indication that better cognitive function and greater conscientiousness may be linked with a slightly increased likelihood of participation in bowel cancer screening. These relationships need investigation in other cohorts of older people. [ABSTRACT FROM AUTHOR]

Objective To examine whether the adverse effect of obesity on psychological well-being can be explained by weight discrimination. Methods The study sample included 5056 older (≥50 y) men and women living in England and participating in the English Longitudinal Study of Ageing. Participants reported experiences of weight discrimination in everyday life and completed measures of quality of life (CASP-19 scale), life satisfaction (Satisfaction With Life Scale), and depressive symptoms (eight-item CES-D scale). Height and weight were objectively measured, with obesity defined as BMI ≥30 kg/m2. Mediation analyses were used to test the role of perceived weight discrimination in the relationship between obesity and each psychological factor. Results Obesity, weight discrimination, and psychological well-being were all significantly inter-related. Mediation models revealed significant indirect effects of obesity through perceived weight discrimination on quality of life (β = −0.072, SE = 0.008), life satisfaction (β = −0.038, SE = 0.008), and depressive symptoms (β = 0.057, SE = 0.008), with perceived weight discrimination explaining approximately 40% (range: 39.5-44.1%) of the total association between obesity and psychological well-being. Conclusions Perceived weight discrimination explains a substantial proportion of the association between obesity and psychological well-being in English older adults. Efforts to reduce weight stigma in society could help to reduce the psychological burden of obesity. [ABSTRACT FROM AUTHOR]

Background Health literacy skills tend to decline during ageing, which is often attributed to age-related cognitive decline. Whether health literacy skills may be influenced by technological and social factors during ageing is unknown. Methods We investigated whether internet use and social engagement protect against health literacy decline during ageing, independent of cognitive decline. We used prospective data from 4368 men and women aged ≥52 years in the English Longitudinal Study of Ageing from 2004 to 2011. Health literacy was measured at baseline (2004–2005) and at follow-up (2010–2011) using a reading comprehension test of a fictitious medicine label. The influences of consistent internet use and engagement in each of the civic, leisure and cultural activities on health literacy decline over the follow-up were estimated. Results After adjusting for cognitive decline and other covariates, consistent internet use (1379/4368; 32%) was protectively associated with health literacy decline (OR=0.77; 95% CI 0.60 to 0.99), as was consistent engagement in cultural activities (1715/4368; 39%; OR=0.73; 95% CI 0.56 to 0.93). As the number of activities engaged in increased, the likelihood of health literacy decline steadily decreased (ptrend<0.0001), with OR=0.51 (95% CI 0.33 to 0.79) for engaging in all four of the internet use and civic, leisure and cultural activities versus none. Conclusions Internet use and social engagement, particularly in cultural activities (eg, attending the cinema, art galleries, museums and the theatre), may help older adults to maintain health literacy during ageing. Support for older adults to maintain socially engaged lives and to access the internet should help promote the maintenance of functional literacy skills during ageing. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To determine the association between health literacy and participation in publicly available colorectal cancer (CRC) screening in England using data from the English Longitudinal Study of Ageing (ELSA). Methods: ELSA is a population-based study of English adults aged ≥50years. Health literacy, participation in the national CRC screening programme, and covariates were interview-assessed in 2010–11. All those age-eligible for screening from 2006 to 11 were included in the present analysis (n=3087). The association between health literacy and screening was estimated using multivariable-adjusted logistic regression. Results: 73% of participants had adequate health literacy skills. Screening uptake was 58% among those with adequate and 48% among those with limited health literacy skills. Having adequate health literacy was associated with greater odds of CRC screening (multivariable adjusted OR=1.20; 95% CI: 1.00–1.44), independent of other predictors of screening: age (OR=0.92; 95% CI: 0.91–0.94 per one year increase), female sex (OR=1.31; 95% CI: 1.11–1.54), and being in a higher wealth quintile (OR=1.88; 95% CI: 1.43–2.49). Conclusions: Limited health literacy is a barrier to participation in England's national, publicly available CRC screening programme. Interventions should include appropriate design of information materials, provision of alternative support, and increased one-on-one interaction with health care professionals. [Copyright &y& Elsevier]

Background: the rise in life expectancy, together with age-related increase in the incidence of most cancers, has led to mounting interest in cancer screening in older people. In England, routine invitations stop and an ‘opt-in’ (individual request) process is available from ages 71 to 76 years for breast and colorectal screening respectively. Little is known about public attitudes towards age-stoppage policy.Objective: this study examined public attitudes to current stoppage policy, information preferences and intentions to request screening beyond the age of routine invitations.Sample: participants (n = 927; age 60–74 years) were recruited as part of a TNS Research International survey and took part in home-based, computer-assisted interviews.Methods: measures included: (i) attitudes towards current stoppage policy, (ii) preference for communications about screening after the end of the routine invitation period and (iii) intention to opt-in.Results: the majority of respondents (78%) did not agree with age-based stoppage policies. Most (83%) wanted a strong recommendation to opt-in after this age, although the number who thought they would follow such a recommendation was much lower (27%). A majority of participants (54%) thought information on screening at older ages should come from their general practitioner (GP).Conclusion: this survey indicates that older people in England wish to continue to be actively invited for cancer screening, although only a minority think that they would ultimately take up the offer. Primary care may play a role in negotiating a shared decision that is based on individual circumstances. [ABSTRACT FROM AUTHOR]

The article focuses on examining the attitudes of individuals towards faecal immunochemical test (FIT) for haemoglobin in place of colonoscopy as a method for screening for the risk of colorectal cancer (CRC). It states that colonoscopy and FIT were performed with individuals at different risk levels of CRC. It mentions that the screening methodology was introduced by the National Health Service (NHS) Cancer Screening Programmes in England in 2006 to reduce mortality rates.

The article presents a study that compared the barriers to colorectal cancer (CRC) screening with the barriers to breast and cervical cancer screening in Great Britain. The researchers surveyed the middle-aged women on the factors and barriers of cancer screening tests. The study indicated many shared barriers in cancer screening tests but suggested to improve CRC screening by addressing the unpleasantness of stool sampling.

Background Colorectal cancer (CRC) screening participation is low despite its effectiveness in reducing CRC mortality. Identifying benefits and barriers requires consideration of specific characteristics of screening modalities. Aims and Research Questions To monitor the impact of providing information about CRC screening via faecal occult blood testing (FOBt) on intentions to participate. To investigate moderation by individual differences in consideration of future consequences (CFC). Design, setting and participants A total of 211 healthy adults (aged 45-59) with no experience of CRC screening were presented with eight consecutive statements about FOBt-based screening in a web survey. Participants completed measures of i) intention (after each statement), ii) CFC and iii) the importance of screening practicalities (e.g. unpleasantness of completing the test) and benefits (e.g. early detection of cancer). Results An 8 (information) × 2 (CFC) mixed ancova showed that intentions varied across the eight statements. ( P < 0.001): increasing after information about FOBt being completed at home ( P < 0.001) before subsequently decreasing after information about the requirement to collect faecal samples ( P < 0.001) in a plastic tub ( P < 0.01) on three occasions ( P < 0.01) with the low CFC group generally being less inclined to complete the test ( P < 0.01). Two between-group anovas demonstrated that the low CFC group attributed greater importance to practicalities of screening than the high CFC group while the opposite was found for the importance of benefits (both P's < 0.001). Conclusion Deconstructing FOBt-based screening pointed to specific benefits and barriers which can advance research into public preferences of screening and educational materials. [ABSTRACT FROM AUTHOR]

Links between positive affect (PA) and health have predominantly been investigated by using measures of recollected emotional states. Ecological momentary assessment is regarded as a more precise measure of experienced well-being. We analyzed data from the English Longitudinal Study of Aging, a representative cohort of older men and women living in England. PA was assessed by aggregating momentary assessments over a single day in 3,853 individuals aged 52 to 79 y who were followed up for an average of 5 y. Respondents in the lowest third of PA had a death rate of 7.3%, compared with 4.6% in the medium-PA group and 3.6% in the high-PA group. Cox proportional-hazards regression showed a hazard ratio of 0.498 (95% confidence interval, 0.345-0.721) in the high-PA compared with the low-PA group, adjusted for age and sex. This was attenuated to 0.646 (95% confidence interval, 0.436-0.958) after controlling for demographic factors, negative affect, depressed mood, health indicators, and health behaviors. Negative affect and depressed mood were not related to survival after adjustment for covariates. These findings indicate that experienced PA, even over a single day, has a graded relationship with survival that is not caused by baseline health status or other covariates. Momentary PA may be causally related to survival, or may be a marker of underlying biological, behavioral, or temperamental factors, although reverse causality cannot be conclusively ruled out. The results endorse the value of assessing experienced affect, and the importance of evaluating interventions that promote happiness in older populations. [ABSTRACT FROM AUTHOR]

Background: An organized, population-based, colorectal cancer screening programme was initiated in England in 2006 offering biennial faecal occult blood testing (FOBT) to adults aged 60-69 years. Organized screening programmes with no associated financial costs to the individual should minimize barriers to access for lower socio-economic status (SES) groups. However, SES differences in uptake were observed in the pilot centres of the UK programme, so the aim of this analysis was to identify the extent of inequalities in uptake by SES, ethnic diversity, gender and age in the first 28 months of the programme. Design Cross-sectional analysis of colorectal cancer screening uptake data.Methods: Between October 2006 and January 2009, over 2.6 million adults aged 60-69 years were mailed a first FOBT kit by the five regional screening hubs. Uptake was defined as return of a test kit within 13 weeks. We used multivariate generalized linear regression to examine variation by area-based socioeconomic deprivation, area-based ethnicity, gender and age.Results: Uptake was 54%, but showed a gradient across quintiles of deprivation, ranging from 35% in the most deprived quintile to 61% in the least deprived. Multivariate analyses confirmed an independent effect of deprivation, with stronger effects in women and older people. The most ethnically diverse areas also had lower uptake (38%) than other areas (52-58%) independent of SES, age, gender and regional screening hub. Ethnic disparities were more pronounced in men but equivalent across age groups. More women than men returned a kit (56 vs 51%), but there was also an interaction with age, with uptake increasing with age in men (49% at 60-64 years; 53% at 65-69 years) but not women (57 vs 56%).Conclusions: Overall uptake rates in this organized screening programme were encouraging, but nonetheless there was low uptake in the most ethnically diverse areas and a striking gradient by SES. Action to promote equality of uptake is needed to avoid widening inequalities in cancer mortality. [ABSTRACT FROM AUTHOR]

Background: A large proportion of UK children do not reach the recommended levels of physical activity (PA) required for optimum health. Few studies have investigated the psychosocial correlates of objectively measured PA in preadolescents. This study examined child attitudes and parental behaviours as correlates of children’s activity. Methods: In total, 278 children (138 boys and 140 girls) aged 7–9 years were recruited as part of the Physical Exercise and Appetite in Children Study (PEACHES). Activity was objectively measured using the Actigraph GT1M accelerometer; the variables were total PA (mean accelerometer counts min−1) and moderate and vigorous PA (MVPA) >2000 counts min−1. Child-focussed variables were self-efficacy (Physical Activity Self-Efficacy scale), physical performance self-concept (Self-Perception Profile for Children), positive and negative outcome expectancies and liking for PA. Parental variables were PA and support for child activity. Results: Significant sex-by-psychosocial outcome interactions were observed for total PA and MVPA, so data from boys and girls were analysed separately. No psychosocial or parental outcomes were correlated with activity in girls. Significant correlates of activity in boys (self-efficacy, self-concept and parental support) were entered in to a hierarchical regression using both total PA and MVPA and, controlling for BMI SD, SES and ethnicity. PA self-efficacy and self-concept were significantly independently associated with total PA, explaining around 12% of the variance. Self-efficacy was significantly associated with time spent in MVPA, also explaining around 12% of the variance in this behaviour. Parental support was not significant in the regression model. Conclusion: PA self-efficacy and self-concept are significant correlates of objectively measured PA in UK boys. [ABSTRACT FROM AUTHOR]

Gemini is a cohort study of young twins in the United Kingdom designed to assess genetic and environmental influences on early childhood weight trajectories with a focus on infant appetite and the family environment. A total of 2402 families with twins born in England and Wales between March and December 2007 agreed to participate and returned completed baseline questionnaires. The sample includes 1586 same-sex and 816 opposite-sex twins. The study is currently funded for 5 years of follow-up, but is planned to continue into early adolescence and beyond, pending funding. With current funding of the study, families will be followed up when twins are: 8 months old (baseline), and then at 15, 20, 24, 36 and 48 months of age. Gemini is in its early stages, with baseline and first follow-up data collection completed. This is the first twin cohort to focus on childhood weight gain with detailed and repeated measures of children's appetite, food preferences, activity behavior and parental feeding styles, alongside detailed and repeated collection of anthropometrics. This article reviews the rationale for the Gemini study, its representativeness and the main measures. [ABSTRACT FROM AUTHOR]

Objectives To explore barriers to cervical screening attendance in a population-based sample, and to compare barriers endorsed by women who were up-to-date with screening versus those who were overdue. We also tested the hypothesis that women who were overdue for screening would be more generally disillusioned with public services, as indexed by reported voting behaviour in elections. Setting A population-based survey of women in England. Methods Face-to-face interviews were carried out with 580 women aged 26-64 years, and recruited using stratified random probability sampling as part of an omnibus survey. Questions assessed self-reported cervical screening attendance, barriers to screening, voting behaviour and demographic characteristics. Results Eighty-five per cent of women were up-to-date with screening and 15% were overdue, including 2.6% who had never had a smear test. The most commonly endorsed barriers were embarrassment (29%), intending to go but not getting round to it (21%), fear of pain (14%) and worry about what the test might find (12%). Only four barriers showed significant independent associations with screening status: difficulty making an appointment, not getting round to going, not being sexually active and not trusting the test. We found support for our hypothesis that women who do not attend for screening are less likely to vote in elections, even when controlling for barrier endorsement and demographic factors. Conclusions Practical barriers were more predictive of screening uptake than emotional factors such as embarrassment. This has clear implications for service provision and future interventions to increase uptake. The association between voting behaviour and screening uptake lends support to the hypothesis that falling screening coverage may be indicative of a broader phenomenon of disillusionment, and further research in this area is warranted. [ABSTRACT FROM AUTHOR]

Aim To assess the effect of smoking uptake on body mass index (BMI), waist circumference and height during adolescence. Design Five-year longitudinal study. Setting Thirty-six schools in South London, England, selected by a stratified random sampling procedure designed to ensure ethnic and socio-economic diversity. Participants A total of 5863 students took part in the HABITS (Health and Behaviour in Teenagers) Study between 1999 and 2003. Measurements Self-reported smoking behaviour, saliva cotinine concentrations and measured weight, waist circumference and height were obtained, along with information on gender, ethnicity, socio-economic deprivation, pubertal status, self-reported exercise and dieting. Students were examined annually from school year 7 (ages 11–12) to year 11 (ages 15–16), with response rates ranging from 74 to 84%. A total of 2665 never smokers at year 7 with complete data for years 7 and 11 were included in the analyses. Findings Adjusting for year 7 BMI and other potential confounders, regular smokers (more than six cigarettes a week) at year 11 had significantly lower BMI ( P = 0.002) than other students. Smokers defined by a cotinine above 15 ng/ml also had lower BMI ( P < 0.0001). Waist circumferences were lower in regular smokers ( P = 0.014) and cotinine-defined smokers ( P < 0.011). No consistent association was found between smoking and height. The adjusted difference in weight between regular smokers and other students amounted to 1.8 kg (95% CI, 0.52–3.17) for an average-height student. Conclusion Taking up regular smoking during adolescence may result in a lower BMI, but the effect is small and of uncertain significance. [ABSTRACT FROM AUTHOR]

Objective: To assess uptake of once-only flexible sigmoidoscopy (FS) in a community sample to determine whether FS would be viable as a method of population-based screening for colorectal cancer. Methods: All adults aged 60–64 years registered at three General Practices in North West London, UK (510 men and women) were sent a letter of invitation to attend FS screening carried out by an experienced nurse, followed by a reminder if they did not make contact to confirm or decline the invitation. The primary outcome was attendance at the endoscopy unit for a FS test. Results: Of the 510 people invited to attend, 280 (55%) underwent FS. Among non-attenders, 91 (18%) were ineligible for screening or did not receive the invitation, 19 (4%) accepted the offer of screening but were unable to attend during the study period, 52 (10%) declined the offer, 41 (8%) did not respond to the invitation, and 27 (5%) accepted the offer of screening but did not attend. Attendance among those eligible to be screened, who had received the invitation, was 67%. People from more socioeconomically deprived neighbourhoods were less likely to attend (odds ratio [OR] = 0.90; confidence interval [CI] = 0.84–0.96; P = 0.003). Women were more likely to attend than men (OR = 1.44; CI = 1.01–2.05; P = 0.041). Conclusions: Attendance rates in this pilot for nurse-led, population-based FS screening were higher than those reported in other FS studies, and comparable with adherence to fecal occult blood testing (FOBT) in the UK FOBT pilot. Having a female nurse endoscopist may have been responsible for increasing female uptake rates but this warrants confirmation in a larger study. [ABSTRACT FROM AUTHOR]

To examine the psychosocial impact of testing positive for high risk human papillomavirus (HPV) among women attending primary cervical screening.Cross sectional survey. Measures were taken at baseline and one week after the receipt of HPV and cytology screening results.Well women's clinic in London, UK.Four hundred and twenty-eight women aged 20–64 years.Postal questionnaire survey.Psychosocial and psychosexual outcomes were anxiety, distress and feelings about current, past and future sexual relationships.Women with normal cytology who tested positive for HPV (HPV+) were significantly more anxious and distressed than women who were negative (HPV−) using both a state anxiety measure [F(1,267)= 29,P<0.0001] and a screening specific measure of psychological distress [F(1,267)= 69,P<0.0001]. Women with an abnormal or unsatisfactory smear result, who tested HPV+, were significantly more distressed than HPV− women with the same smear result [F(1,267)= 8.8,P= 0.002], but there was no significant difference in state anxiety. Irrespective of cytology result, HPV+ women reported feeling significantly worse about their sexual relationships. Approximately one-third of women who tested positive reported feeling worse about past and future sexual relationships compared with less than 2% of HPV− women.The findings suggest that testing positive for HPV may have an adverse psychosocial impact, with increased anxiety, distress and concern about sexual relationships. Psychosocial outcomes of HPV testing need further investigation and must be considered alongside clinical and economic decisions to include HPV testing in routine cervical screening. [ABSTRACT FROM AUTHOR]

Objectives. This study investigated socioeconomic predictors of obesity in men and women. Methods. Data from the 1996 Health Survey for England were used to compare odds ratios for obesity by education, occupation, and 2 economic markers after control for age, marital status, and ethnicity. Results. Obesity risk was greater among men and women with fewer years of education and poorer economic circumstances and among women, but not men, of lower occupational status. Conclusions. Higher educational attainment and higher socioeconomic status were associated with a lower risk of obesity in both men and women, whereas higher occupational status was associated with a lower risk only for women. The implications of these findings for understanding causes and prevention of obesity are discussed. (Am J Public Health. 2002;92:1299-1304) [ABSTRACT FROM AUTHOR]

Assesses the influence of stress of academic examinations on the eating behavior and lipid profiles among university students in London, England. Deterioration in emotional well-being during examinations; Increase in the perceived stress at the examination sessions; Reduction of energy intake on individuals with low trait anxiety and high social support.

Abstract Objective: To quantify the prevalence and characteristics of hardcore smokers in England. Design: Cross sectional survey. Setting: Interview in respondents' household. Participants: 7766 adult cigarette smokers. Main outcome measures: Hardcore smoking defined by four criteria (less than a day without cigarettes in the past five years; no attempt to quit in the past year; no desire to quit; no intention to quit), all of which had to be satisfied. Results: Some 16% of all smokers were categorised as hardcore. Hardcore smoking was associated with nicotine dependence, socioeconomic deprivation, and age, rising from 5% in young adults aged 16-24 to 30% in those aged ≥65 years. Hardcore smokers displayed distinctive attitudes towards and beliefs about smoking. In particular they were likely to deny that smoking affected their health or would do so in the future. Prevalence of hardcore smoking was almost four times higher than in California. Conclusion: Hardcore smoking presents a serious challenge to public health efforts to reduce the prevalence of smoking, but the proportion of hardcore smokers does not necessarily increase as overall prevalence in a population declines. More hardcore smokers could be persuaded to quit, but this will require interventions that are targeted to the particular needs and perceptions of both socially disadvantaged and older smokers. [ABSTRACT FROM AUTHOR]

Abstract: Background: Repeated taste exposure, in combination with small rewards, has been shown to increase children's acceptance of disliked foods. However, previous studies have used direct contact with researchers or professionals for the implementation of the repeated exposure procedure. If mailed taste exposure instructions to parents produced comparable outcomes, this could be a cost-effective and easily disseminable strategy to promote healthier diets in children. Objective: Our randomized controlled study aimed to test the efficacy and acceptability of mailed materials giving instructions on taste exposure as a means of increasing acceptance of vegetables in preschool-aged children. Design: Participants were families of 3-year-old twins from the Gemini cohort who took part between March 2011 and April 2012. Families were randomized to a mailed intervention or a no treatment control condition. The intervention involved offering each child 14 daily tastes of a disliked (target) vegetable with a small reward (a sticker) if the child complied. Main outcome measures: Outcomes were the child's intake of the target vegetable (number of pieces) and parent reports of the child's liking at two baseline (T1 and T2) and one postintervention (T3) behavior assessment. Results: Record sheets with intake and liking data from T1, T2, and T3 were returned for 472 children, of which 442 were complete (94%). Over the intervention period (T2 to T3) intake and liking of the target vegetable increased significantly more in the intervention group than in the control group (intake: odds ratio 12.05, 95% CI 8.05 to 18.03, P<0.001; liking: odds ratio 12.34, CI 7.97 to 19.12, P<0.001). Acceptability of the procedure was very high among parents who completed the protocol. Conclusions: Mailed instructions for taste exposure were effective in increasing children's acceptance of an initially disliked vegetable. These results support the value of parent-administered exposure to increase children's vegetable acceptance, and suggest that it can be carried out without direct health professional contact. [Copyright &y& Elsevier]

Abstract: Background and purpose: The United States’ Centers for Disease Control and Prevention recommends that boys aged 11–12 be vaccinated against HPV to reduce the risk of genital warts and HPV-related cancers. No recommendation has been made in England although there have been calls to widen access to the vaccine. This study aimed to assess boys’ willingness to have HPV vaccination, eliciting reasons for their decisions. Methods: 528 boys aged 16–18 years completed a questionnaire in school. Measures included demographic characteristics, HPV awareness, willingness to have the vaccine, and reasons for the vaccine decision. Coding of open responses was informed by social cognition model constructs. Results: A large proportion of the sample (41%) intended to have the vaccine, however, slightly more were unsure (49%) and a small number (10%) would not get vaccinated. Uncertainty was associated with lack of previous awareness of HPV and perceived lack of adequate information. Boys who would not have the vaccine did not feel at risk or did not see the need for it. Conclusion: These preliminary data suggest that HPV vaccination may be acceptable to boys, and confirm previous findings that information is vital in the decision-making process. [Copyright &y& Elsevier]

Colorectal cancer (CRC) is the second largest cause of cancer death in the UK. Since 2010, CRC screening based on Faecal Occult Blood testing has been offered by the NHS in England biennially to all persons age 60–69 years. Several studies have demonstrated a gradient in uptake using area-level markers of socio-economic status (SES), but few have examined the individual-level contributors to the gradient. We aimed to quantify the extent of SES inequality in CRC screening uptake in England using individual-level data, and to identify individual factors associated with this inequality. We used data from 1833 participants (aged 61–69) in Wave 5 (collected in years 2010/11) of the English Longitudinal Study of Ageing (ELSA) eligible for having been sent at least one CRC screening invitation. Uptake was defined by self-report of ever having been screened as part of the National Screening Programme. We assessed socio-economic inequality using the corrected concentration index of uptake against SES rank, which was derived by regressing a range of SES markers against net non-pension household wealth. Other demographic and health-related variables were included in the analysis. Factors associated with inequality were measured using concentration index decomposition. There was a significant pro-rich gradient in screening uptake (concentration index: 0.16, 95% CI:0.11–0.22), mostly explained within our model by differences in non-pension wealth (38.7%), partner screening status (15.9%), sickness/disability (13.5%), and health literacy (8.5%). Interventions aimed at reducing inequalities in CRC screening uptake should focus on improving acceptability of screening in populations with low levels of education and literacy barriers. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To examine whether HPV vaccination influences sexual behaviour in adolescent girls, either by giving them a ‘green light’ to have sex, or because perceived protection afforded by the vaccine permits compensatory risky sexual behaviour. Design: Cross-sectional and longitudinal surveys. Setting: Seven English schools. Main outcome measures: Self-reported sexual behaviour. Participants: The cross-sectional survey included 1053 girls (mean age 17.1 years) who had (n =433 recruited in March 2010) or had not (n =620 recruited in March 2009) been offered the HPV vaccine. The longitudinal survey included 407 girls (mean age 17.5 years) who had been offered HPV vaccination and had either received at least one dose (n =148) or had not received any doses (n =259). Results: In the cross-sectional survey, the group of girls who had been offered the HPV vaccine were no more likely to be sexually active than the group of girls who had not been offered the HPV vaccine. In the longitudinal survey, the vaccinated group were no more likely to have changed their condom use or increased their total number of sexual partners than the unvaccinated group. Conclusions: Neither being offered the HPV vaccine nor receiving it affected sexual behaviour. [Copyright &y& Elsevier]

Objective: The screening context may provide a "teachable moment" for promoting health behaviours. The present study examined the impact on diet, alcohol and physical activity of providing individually-tailored advice in the context of flexible sigmoidoscopy (FS) screening.Method: Adults (n=365) aged 58-59 years who attended FS screening between 2006 and 2008 and had no abnormalities detected were randomised to one of three groups: (i) control (usual care); (ii) standard leaflet on healthy lifestyle; or (iii) standard leaflet plus brief, tailored feedback based on information from the pre-screening questionnaire. A 6-month follow-up questionnaire assessed group differences in fruit and vegetable consumption, alcohol intake and physical activity.Results: More people in the tailored group were meeting the 5-a-day fruit and vegetable recommendation at 6 months (OR: 2.28, CI[1.09, 4.76]). For physical activity there was a non-significant trend towards meeting current activity guidelines in the tailored group (OR: 1.26, CI[0.62, 2.55]). Alcohol intake was low overall and did not change in any group.Conclusion: Tailored advice given in the context of cancer screening may provide an opportunity to improve dietary behaviours. Further research is needed to determine whether screening provides a unique "teachable moment" or if similar effects can be achieved in other health settings. [ABSTRACT FROM AUTHOR]

This study explored associations between child eating behaviors and maternal feeding practices, specifically testing the hypotheses that maternal “restriction” is associated with having a child with stronger food approach tendencies (eg, overresponsiveness to food), and maternal pressure to eat is associated with having a child with food avoidant tendencies (eg, satiety responsiveness). Five-hundred thirty-one families with 7- to 9-year-old children from schools in London, UK, were invited to take part in the Physical Exercise and Appetite in Children Study (PEACHES). Results are from baseline data of this longitudinal study. Of those invited, 405 gave consent for their child to participate (51.6% male; 48% female). Just over half of the mothers (n=213, 53%) completed the Child Eating Behavior Questionnaire and the Child Feeding Questionnaire for the index child (mean age: 8.3±0.62 years) during the 2006-2007 school year. Children were weighed and measured at school by trained researchers. As predicted, maternal restriction was associated with child food responsiveness (P<0.001), and maternal pressure to eat was associated with child satiety responsiveness (P<0.001), slowness (P=0.03), and fussiness (P=0.01). Child enjoyment of food was associated with lower maternal pressure to eat (P=0.01). All effects were independent of the child''s body mass index standard deviation score and sociodemographic factors. Practitioners may find it useful to take an interactional perspective, acknowledging that children both influence and are influenced by their parents'' feeding practices. This will allow the development of targeted interventions and better parental guidance on managing obesogenic eating behaviors in young children. [Copyright &y& Elsevier]

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.

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., (© The Author 2016. Published by Oxford University Press on behalf of the British Geriatrics Society)

Objectives: Reducing cancer screening inequalities in England is a major focus of the 2011 Department of Health cancer outcome strategy. Screening coverage requires regular monitoring in order to implement targeted interventions where coverage is low. This study aimed to characterise districts with atypical coverage levels for cervical or breast screening., Design: Observational study of district-level coverage in the English Cervical and Breast screening programmes in 2012., Setting: England, UK., Participants: All English women invited to participate in the cervical (age group 25-49 and 50-64) and breast (age group 50-64) screening programmes., Outcomes: Risk adjustment models for coverage were developed based on district-level characteristics. Funnel plots of adjusted coverage were constructed, and atypical districts examined by correlation analysis., Results: Variability in coverage was primarily explained by population factors, whereas general practice characteristics had little independent effect. Deprivation and ethnicity other than white, Asian, black or mixed were independently associated with poorer coverage in both screening programmes, with ethnicity having the strongest effect; by comparison, the influence of Asian, black or mixed ethnic minority was limited. Deprivation, ethnicity and urbanisation largely accounted for the lower cervical screening coverage in London. However, for breast screening, being located in London remained a strong negative predictor. A subset of districts was identified as having atypical coverage across programmes. Correlates of deprivation in districts with relatively low adjusted coverage were substantially different from overall correlates of deprivation., Discussion: These results inform the continuing drive to reduce avoidable cancer deaths in England, and encourage implementation of targeted interventions in communities residing in districts identified as having atypically low coverage. Sequential implementation to monitor the impact of local interventions would help accrue evidence on 'what works'., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)

Background: Low health literacy is common among aging patients and is a risk factor for morbidity and mortality. We aimed to describe health literacy decline during aging and to investigate the roles of cognitive function and decline in determining health literacy decline., Methods: Data were from 5,256 non-cognitively impaired adults aged ≥ 52 years in the English Longitudinal Study of Ageing. Health literacy was assessed using a four-item reading comprehension assessment of a fictitious medicine label, and cognitive function was assessed in a battery administered in-person at baseline (2004-2005) and at follow-up (2010-2011)., Results: Overall, 19.6% (1,032/5,256) of participants declined in health literacy score over the follow-up. Among adults aged ≥ 80 years at baseline, this proportion was 38.2% (102/267), compared to 14.8% (78/526) among adults aged 52-54 years (OR = 3.21; 95% CI: 2.26-4.57). Other sociodemographic predictors of health literacy decline were: male sex (OR = 1.20; 95% CI: 1.04-1.38), non-white ethnicity (OR = 2.42; 95% CI: 1.51-3.89), low educational attainment (OR = 1.58; 95% CI: 1.29-1.95 for no qualifications vs. degree education), and low occupational class (OR = 1.67; 95% CI: 1.39-2.01 for routine vs. managerial occupations). Higher baseline cognitive function scores protected against health literacy decline, while cognitive decline (yes vs. no) predicted decline in health literacy score (OR = 1.59; 95% CI: 1.35-1.87 for memory decline and OR = 1.56; 95% CI: 1.32-1.85 for executive function decline)., Conclusions: Health literacy decline appeared to increase with age, and was associated with even subtle cognitive decline in older non-impaired adults. Striking social inequalities were evident, whereby men and those from minority and deprived backgrounds were particularly vulnerable to literacy decline. Health practitioners must be able to recognize limited health literacy to ensure that clinical demands match the literacy skills of diverse patients.

Objective: To design and user-test a 'gist-based' colorectal cancer screening information leaflet, which promotes comprehension of the screening offer., Methods: Twenty-eight individuals approaching screening age were recruited from organisations in deprived areas of England. Using a between-subjects design, we tested iterations of a newly-designed gist-based information leaflet. Participants read the leaflet and answered 8 'true' or 'false' comprehension statements. For the leaflet to be considered fit-for-purpose, all statements had to be answered correctly by at least 80% of participants in each round. Alterations were made if this threshold was not met and additional rounds of testing were undertaken., Results: At round 1, answers to 2/8 statements did not meet the threshold. After changes, answers in round 2 did not reach the threshold for 1/8 statements. In round 3, all answers were adequate and the leaflet was deemed fit-for-purpose. Qualitative data offered solutions such as language and layout changes which led to improved comprehension of the leaflet., Conclusion: User-testing substantially improved the design and subsequent comprehensibility of a theory-driven gist-based colorectal cancer screening information leaflet., Practical Implications: This leaflet will be evaluated as part of a large national randomised controlled trial designed to reduce socioeconomic inequalities in colorectal cancer screening participation., (Copyright © 2013 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.)

Background: Social marketing campaigns offer a promising approach to the prevention of childhood obesity. Change4Life (C4L) is a national obesity prevention campaign in England. It included mass media coverage aiming to reframe obesity into a health issue relevant to all and provided the opportunity for parents to complete a brief questionnaire ('How are the Kids') and receive personalised feedback about their children's eating and activity. Print and online C4L resources were available with guidance about healthy eating and physical activity. The study aims were to examine the impact of personalised feedback and print material from the C4L campaign on parents' attitudes and behaviours about their children's eating and activity in a community-based cluster-randomised controlled trial., Methods: Parents of 5-11 year old children were recruited from 40 primary schools across England. Schools were randomised to intervention or control ('usual care'). Basic demographic data and brief information about their attitudes to their children's health were collected. Families in intervention schools were mailed the C4L print materials and the 'How are the Kids' questionnaire; those returning the questionnaire were sent personalised feedback and others received generic materials. Outcomes included awareness of C4L, attitudes to the behaviours recommended in C4L, parenting behaviours (monitoring and modelling), and child health behaviours (diet, physical activity and television viewing). Follow-up data were collected from parents by postal questionnaire after six months. Qualitative interviews were carried out with a subset of parents (n = 12)., Results: 3,774 families completed baseline questionnaires and follow-up data were obtained from 1,419 families (37.6%). Awareness was high in both groups at baseline (75%), but increased significantly in the intervention group by follow-up (96% vs. 87%). Few parents (5.2% of the intervention group) returned the questionnaire to get personalised feedback. There were few significant group differences in parental attitudes or parenting and child health behaviours at follow-up. Physical activity was rated as less important in the intervention group, but a significant group-by-socioeconomic status (SES) interaction indicated that this effect was confined to higher SES families. Similar interactions were also seen for physical activity monitoring and child television time; with adverse effects in higher SES families and no change in the lower SES families. Effects were little better in families that completed the questionnaire and received personalised feedback. At interview, acceptability of the intervention was modest, although higher in lower SES families., Conclusions: The C4L campaign materials achieved increases in awareness of the campaign, but in this sample had little impact on attitudes or behaviour. Low engagement with the intervention appeared a key issue., Trial Registration Number: Current Controlled Trials ISRCTN00791709.

Objective: Positive psychological well-being is associated with reduced risk of chronic illnesses. Biological risk factors may contribute to these effects, although sex differences may be present. Two aspects of well-being can be distinguished: affective well-being (happiness and pleasure) and eudaemonia (sense of autonomy and purposeful engagement with life). We evaluated relationships between both affective and eudaemonic well-being and biological measures in a large sample of older people., Methods: This cross-sectional study analyzed the English Longitudinal Study of Ageing, a nationally representative cohort aged 50 years or older. In this study, 7795 participants completed positive well-being and depressive symptom measures. Waist circumference, dehydroepiandosterone sulfate, C-reactive protein, fibrinogen, high-density lipoprotein cholesterol, plasma triglycerides, and peak expiratory flow were assessed., Results: In men, affective well-being was associated with smaller waist circumference (B = -0.206, p < .001) and greater levels of dehydroepiandosterone sulfate (B = 0.072, p = .003). Affective well-being in women was related to lower concentrations of inflammatory markers (C-reactive protein and fibrinogen, B = -0.242 and -0.024, respectively, p < .001) and greater high-density lipoprotein cholesterol (B = 0.011, p = .017). Both men and women showed associations between well-being and lower levels of plasma triglycerides (B = -0.032, p < .001) and better lung function (B = 3.594, p < .001). Associations were independent of age, marital status, socioeconomic circumstances, body mass, smoking, limiting long-standing illnesses, health indicators, and depressive symptoms. Similar results were obtained for eudaemonic well-being., Conclusions: Positive psychological well-being has biological correlates that may be health protective, with distinctive patterns for men and women.

Objectives: To examine intergenerational associations for thinness and to compare maternal and paternal effects., Design: Population-based, cross-sectional design using data from the Health Survey for England from January 1, 2001, through December 31, 2006., Setting: The Health Survey for England, an annual, national survey representative of the population living in private households in England., Participants: Families with children and adolescents aged 2 to 15 years with anthropometric data available for children and adolescents and 2 parents (N = 4423 families, N = 7078 children and adolescents)., Main Exposure: Trained interviewers collected height and weight measurements., Main Outcome Measure: Child/adolescent thinness, categorized using International Obesity Task Force criteria., Results: Of 7078 children and adolescents, 402 (5.7%) were categorized as being thin. Thinness was more common in 2- to 5-year-olds (odds ratio, 1.61; 95% confidence interval, 1.22-2.13) than in 11- to 15-year-olds and in children and adolescents from ethnic minority (black: 2.28; 1.22-4.26; and Asian: 3.65; 2.76-4.83) than white backgrounds, but no differences were observed by sex or socioeconomic status. The strongest predictor of child/adolescent thinness was parental weight status. The prevalence of thinness was highest (16.2%) when both parents were thinner and progressively lower when both parents were in the upper half of the healthy-weight range (7.8%) or were overweight (5.3%) or obese (2.5%), with no differences in the magnitude of maternal and paternal influences., Conclusions: These results are consistent with the idea that many cases of thinness are likely to represent the low end of the healthy distribution of weight and, as such, are likely to have a primarily genetic origin.

Background: A strong genetic influence on appetitive traits has been shown in children and adults, but no studies have examined appetite in early infancy, even though avidity of appetite has been linked with a higher risk of obesity., Objective: The objective was to investigate the heritability in early infancy of 4 appetitive traits that have been shown to be heritable later in childhood., Design: Data are from the Gemini Study, a population-based sample of twins (n = 2402 pairs) born in England and Wales in 2007. To describe their children's eating behavior during the first 3 mo of life while they were still exclusively milk fed, the parents of the twins completed 4 subscales of the Baby Eating Behavior Questionnaire: "enjoyment of food," "food responsiveness," "slowness in eating," and "satiety responsiveness." Heritability was estimated by using quantitative genetic model fitting., Results: Heritability was high for slowness in eating (84%; 95% CI: 83%, 86%) and satiety responsiveness (72%; 95% CI: 65%, 80%) and moderate for food responsiveness (59%; 95% CI: 52%, 65%) and enjoyment of food (53%; 95% CI: 43%, 63%)., Conclusions: Genetically determined variability in appetitive traits may be one of the pathways through which genes influence the growth rate in infancy. Early identification of infants with avid appetites may make it possible to implement strategies to attenuate the expression of these traits before excessive weight gain occurs.

Background: Socioeconomic status (SES) exhibits a graded relationship with health. Dispositional optimism represents a potential mediator and has been strongly linked to health, but few studies have assessed its association with SES., Purpose: To assess the relationship between SES and trait optimism and pessimism in a representative community sample of older British adults., Method: Community samples of adults (55-64 years) from Scotland (N = 10,650) and England (N = 5,099) registered with Primary Care Practices were mailed self-report questionnaires. Optimism was measured by the Life Orientation Test (LOT), which generates a total score and positive (optimism) and negative (pessimism) subscale scores. SES was assessed with an individual-level index of socioeconomic deprivation based on education, housing tenure, and car ownership., Results: In both samples, there was a strong SES gradient in the total LOT score, with higher SES being associated with higher scores. However, when pessimism and optimism subscales were analyzed separately, the gradient was strong for pessimism, but minimal for optimism., Conclusion: The results suggest that lower SES is associated with viewing the future as containing more negative events, but there was little SES difference for positive events. It will be important to distinguish the roles of pessimism and optimism in other determinants of health.

This study tested the hypothesis that cancer patients from lower socioeconomic status (SES) backgrounds have poorer adjustment to cancer. In a longitudinal study of 352 patients with breast, prostate or colorectal cancer, SES was indexed as a composite of educational level, car and home ownership. Patients were classified as higher (3 markers: car, home and higher education) or lower (up to 2 markers) SES. Patients completed measures of depression, anxiety, quality-of-life, social difficulties and benefit-finding at 2 months (Time 1) and 10 months (Time 2) after diagnosis. Data on disease stage, treatment and co-morbid illness were also collected. At Time 1, lower SES patients were more anxious and depressed and had worse quality-of-life and more social difficulties. Psychological wellbeing improved on all measures by follow-up, and although not significant, the trend was towards diminishing, rather than increasing, differences in wellbeing between higher and lower SES groups. Acute psychosocial reactions to a cancer diagnosis appeared to be greater amongst patients with fewer educational and material resources, but longer-term adjustment did not appear to be any worse in lower SES patients.