Perceived effects of stress on food choice

Self-reported effects of stress on eating behaviour and food were assessed in a brief questionnaire in 212 students. Snacking behaviour was reportedly increased by stress in the majority of respondents (73%) regardless of gender or dieting status. The overall increase in snacking during stress was reflected by reports of increased intake of "snack-type" foods in all respondents, regardless of dieting status. In contrast, intake of "meal-type" foods (fruit and vegetables, meat and fish) was reported to decrease during stressful periods. The majority of the respondents reported an effect of stress on overall amount eaten, but while snacking, roughly equal numbers reporting decreased intake (42%) and increased intake (38%). The direction of change in intake could be predicted in part by dieting status, with dieters being more likely to report stress hyperphagia and nondieters being more likely to report stress hypophagia.

Development of a general nutrition knowledge questionnaire for adults

OBJECTIVE

This paper describes the development of a reliable and valid questionnaire to provide a comprehensive measure of the nutritional knowledge of UK adults. The instrument will help to identify areas of weakness in people's understanding of healthy eating and will also provide useful data for examining the relationship between nutrition knowledge and dietary behaviour which, up until now, has been far from clear.

DESIGN

Items were generated paying particular attention to content validity. The initial version of the questionnaire was piloted and assessed on psychometric criteria. Items which did not reach acceptable validity were excluded, and the final 50 item version was administered to two groups differing in nutritional expertise on two occasions to assess the construct validity and test-retest reliability.

SETTING

The questionnaire was developed in 1994 in the UK.

SUBJECTS

Three hundred and ninety-one members of the general public, recruited via their places of work, completed the questionnaire at the piloting stage. The final version was administered to 168 dietetics and computer science students following a university lecture.

RESULTS

The internal consistency of each section was high (Cronbach's alpha = 0.70-0.97) and the test-retest reliability was also well above the minimum requirement of 0.7. Nutrition experts scored significantly better than computer experts [F(1167) = 200.5, P<0.001], suggesting good construct validity.

CONCLUSIONS

The findings demonstrate that the instrument meets psychometric criteria for reliability and construct validity. It should provide a useful scale with which to reassess the relationship between knowledge and dietary behaviour.

Increased salivary cortisol reliably induced by a protein-rich midday meal

OBJECTIVE

This study was conducted to determine whether an increase in salivary free cortisol would be reliably elicited by a midday meal, thus providing a convenient physiological challenge to the hypothalamic-pituitary-adrenal (HPA) axis, and whether this cortisol release depended on the protein content of the meal.

METHOD

In healthy men, free cortisol was measured in saliva samples taken before and after two identical protein-rich midday meals (39% energy as protein) and compared with a day on which no meal was eaten. Next, in healthy women in a nonclinical setting, salivary cortisol was measured before and after a protein-rich meal (32% energy as protein) on one day and a low-protein meal (5% energy as protein) on another day. Measures of mood, appetite, and psychological well-being were also taken.

RESULTS

An acute meal-dependent increase in salivary cortisol occurred, which was reliable over 2 test days. This increase in cortisol depended on the proportion of protein in the meal, increasing after the high-protein but not the low-protein meal. The extent of this increase in cortisol correlated significantly with poor psychological well-being in women. Some postmeal improvement of mood (positive affect) was associated with the high- but not the low-protein meal.

CONCLUSIONS

The cortisol response to meals may have implications for the effects of meal composition on mood, cognitive function, and food choice. The measurement of free cortisol in saliva provides a psychologically stress-free and reliable technique to assess the cortisol response to a standard protein-rich meal, ie, a physiological challenge to the HPA axis in men and women that could be investigated in naturalistic settings outside the laboratory.

A longitudinal study of work load and variations in psychological well-being, cortisol, smoking, and alcohol consumption

The effects of variations in work load (indexed by paid work hours) on psychological well-being, cortisol, smoking, and alcohol consumption were examined in a sample of 71 workers (44 women, 27 men) in the retail industry. Measures were obtained on four occasions over a six-month period, and assessments were ranked individually according to hours of work over the past seven days. Job strain (demand/control) and job social support were evaluated as potential moderators of responses. Paid work hours ranged from a mean of 32.6 to 48.0 hours per week, and ratings of work-home conflict and perceived stress varied across assessments. Salivary cortisol was inversely associated with job strain and did not vary across sessions. Female but not male smokers consumed more cigarettes during periods of long work hours, and self-reported smoking and cotinine concentrations were greater among smokers with higher nicotine dependency scores. Men but not women with poor social supports consumed more alcohol as work hours lengthened. These data indicate that health behaviors are affected only to a limited extent by variations in work load. Results are discussed in the context of adaptation to work and the pathways linking stressful experience with health risk.

Mood and drinking: a naturalistic diary study of alcohol, coffee and tea

Understanding the pattern of associations between mood and consumption of alcohol, coffee and tea may provide information about the factors governing beverage drinking. The associations between mood and the consumption of alcohol, coffee and tea during everyday life were assessed. A naturalistic study was carried out with 18 male and 31 female volunteers from two working groups (psychiatric nursing and school teaching). Participants completed daily records of drink consumption, together with ratings of anxious and positive moods for 8 weeks. Potential moderators of associations were self-reported drinking to cope, high perceived job demands and social support at work. Day-by-day associations were analysed using Spearman correlations. There were substantial individual-differences in associations between mood and daily alcohol, coffee and tea consumption. Overall, alcohol intake was associated with high positive and low anxious mood. This effect was not present among participants with high drinking to cope ratings. Coffee and tea drinking were not consistently related to mood across the entire sample. However, job demands influenced the association between coffee consumption and anxious mood in men, and those who experienced high job demands drank more coffee on days on which they felt anxious. In contrast, women but not men who enjoyed high social support at work felt more relaxed on days on which they drank more tea. These results indicate that people vary widely in the extent to which mood is related to the drinking of alcohol, coffee and tea. The strength of associations is influenced by gender, motivational factors, and by stress and coping resources.

Fruit and vegetable consumption, nutritional knowledge and beliefs in mothers and children

Increasing fruit and vegetable consumption is an important health behaviour. Parental and other psychosocial influences on children's fruit and vegetable consumption are poorly understood. The contribution of a variety of psychosocial and environmental factors to consumption of fruit and vegetables by children aged 9-11 years was explored. Ninety-two mothers and children (48 girls and 44 boys) were recruited via urban primary health-care practices. Socio-economic and educational level, nutritional knowledge and health- and diet-related beliefs and attitudes were assessed in mothers and children by questionnaires and semistructured interviews. Mothers>> diets were measured by a food frequency questionnaire, while children's diets were assessed by 3-day diaries (N=80). The pattern of influence of the various measures on fruit and vegetable consumption was compared with that on children's confectionery intake. The children's intakes of macronutrients were typical for the U.K. (37% fat, 50% carbohydrate and 13% protein by energy; 12 g/day fibre), while median fruit, fruit juice and vegetable intake amounted to about 2.5 servings/day. Univariate correlations and subsequent multiple regression analyses revealed quite different influences on the three food types. Independent predictors of children's fruit intake included mothers>> nutritional knowledge (beta=0.37), mothers>> frequency of fruit consumption (beta=0.30) and mothers>> attitudinal conviction that increasing fruit and vegetable consumption by their children could reduce their risk of developing cancer (beta=0.27; multiple r2=0.37,p<0.0001). Children's vegetable consumption was independently explained by the child's liking for commonly eaten vegetables (beta=0.36) and the mother's belief in the importance of disease prevention when choosing her child's food (beta=-0.27 r2=0.20,p<0.001). Children's confectionery consumption was predicted by the mother's liking for confectionery (beta=0.32) and the children's concern for health in choosing what to eat (beta=-0.26 r2=0.16, p<0.005). Children's consumption of fruit and vegetables are related to different psychosocial and environmental factors. Promotion of this behaviour may require attention to nutritional education and child feeding strategies of parents.

Uptake, yield of neoplasia, and adverse effects of flexible sigmoidoscopy screening

BACKGROUND

A multicentre randomised controlled trial to evaluate screening by "once only" flexible sigmoidoscopy (FS) for prevention of bowel cancer is in progress.

AIMS

To pilot the trial protocol examining rates of attendance, yield of neoplasia, and adverse effects.

SUBJECTS

A total of 3540 subjects aged 55-64 years in Welwyn Garden City (WGC) and 19,706 in Leicester (LE).

METHODS

Subjects responding positively to an "interest in screening" questionnaire were randomised to invitation for screening or control arms. Small polyps were removed during screening. Colonoscopy was undertaken for high risk polyps (more than two adenomas, size at least 1 cm, villous histology, severe dysplasia, or malignancy). The remainder were discharged.

RESULTS

In WGC and LE respectively, 59% and 61% indicated an interest in screening, of which 74% and 75% attended. Adenomas were detected in 10% and 9%, respectively, and cancers in 7 per 1000 (in both centres), 55% at Dukes's stage A. The colonoscopy referral rate was 6% in both centres. Mild, short lived bleeding occurred in 3%. One person died following surgery.

CONCLUSIONS

Compliance rates, yield of adenomas, and referral rate for colonoscopy were as expected, but cancer detection rates were higher. Adverse effects following sigmoidoscopy or colonoscopy were mild and transient, but there was one postoperative death. A randomised trial is necessary to evaluate fully the risks and benefits of this intervention.

Motives underlying healthy eating: using the Food Choice Questionnaire to explain variation in dietary intake

The Food Choice Questionnaire (FCQ), which measures the reported importance to a given individual of nine factors underlying food choice, and a food frequency questionnaire, were administered to 241 participants, who were also required to classify their diet as either 'standard', 'low in red meat' or 'vegetarian'. Respondents describing their diet as low in red meat attributed greater importance to health, natural content, weight control and ethical concern in their food choice than did those who described their diets as standard, whereas vegetarians differed significantly from those with a standard diet only on the score for ethical concern. Differences between men and women and between students and non-students in the frequency of consumption of a number of foods were shown to be mediated by differences in the importance attached to FCQ factors. Thus the generally healthier diets of women compared to men appeared to be accounted for by the greater importance attributed by women to weight control, natural content and ethical concerns.

The list heuristic for studying personality correlates of food choice behaviour: a review and results from two samples

Over the past half century, a methodology has been used to investigate predictors of eating behaviour which involves the use of a list of foods, with subjects answering some preference question(s) about each food. For each person, the number of foods which elicit a particular response, usually of rejection, is used as a psychometric measure of their eating behaviour. We refer to this as the list heuristic. There has been great variability in the exact design used and comparing across studies is difficult. We tackle this issue by comparing "sublists" within one study. Previous list heuristic studies have found a link between behaviour and both anxiety and sensation seeking. Food choice behaviours can also be studied through psychometric questionnaires of more traditional design. Such studies have produced similar results and suggest a distinction between neophobia and general "pickiness". The list heuristic is used here in two studies. Our results are notably different, finding no relationships with anxiety and only weak relationships with sensation seeking. Further, results concerning food neophobia measures (list heuristic and questionnaire) suggest problems in differentiating food neophobia from more general food rejection behavior.

Leisure-time physical exercise: prevalence, attitudinal correlates, and behavioral correlates among young Europeans from 21 countries

BACKGROUND

Increasing leisure time physical exercise is a major target of public health programs throughout the developed world, but few international comparisons of exercise habits among people from diverse cultures have been published. The objectives of this study were to assess the prevalence of exercise among young adults from 21 European countries, to analyze associations with health beliefs and risk awareness, and to investigate relationships among exercise, other health-related behaviors, and emotional well-being.

METHODS

The European Health and Behaviour Survey, a questionnaire survey of 7,302 male and 9,181 female university students ages 18-30 years from 21 countries, was analyzed.

RESULTS

Age-adjusted prevalence of physical exercise in the past 2 weeks averaged 73.2% among men and 68.3% among women, but varied markedly from more than 80% to less than 60% across country samples. Beliefs in the health benefits of exercise were consistently associated with physical exercise, as was desire to lose weight. Awareness of the influence of exercise on heart disease averaged 52% among men and 54% among women, but was not strongly associated with engagement in exercise. Associations among exercise, lack of smoking, and sleep time were observed, but results for alcohol consumption were inconsistent. Social support and depression were independently associated with physical exercise.

CONCLUSIONS

Physical exercise levels are highly variable across samples of relatively privileged young Europeans from different countries. Associations with other health behaviors and with emotional well-being suggest that regular physical exercise is consistent with a healthy lifestyle. Links with health beliefs are consistent despite sociocultural differences, but deficient knowledge of the health consequences of a sedentary lifestyle remains a cause for concern.

Healthy dietary practices among European students

Predictors of 5 healthy dietary habits were examined in data from the European Health and Behaviour Survey (A. Steptoe & J. Wardle, 1996), a study of over 16,000 students from 21 European countries. The level of practice of these healthy dietary habits was low. Significant univariate associations with healthy dietary habits were identified for gender, weight, dieting status, dietary health beliefs, nutrition knowledge, and health locus of control. In multivariate analyses, only gender, dieting status, and dietary health beliefs were significant predictors of healthy dietary habits. The practical implications of these results for dietary health promotion are discussed.

Cause and effect beliefs and self-esteem of overweight children

In this study, beliefs of the cause and effect of weight were examined in a sample of 9- to 11-year-old clinically overweight children. Lower self-esteem was found in the children who believed they are responsible for their overweight as compared to those who attributed their overweight to an external cause. Lower self-esteem was also found in the children who believed that their overweight hinders their social interaction. Other evidence gathered here lends some support to the view that the overweight child is more vulnerable to low self-esteem. The negative experiences in school and at home that the children reported and the premise that childhood obesity is a stigmatising condition is discussed.

Healthy dietary practices among European students

Predictors of 5 healthy dietary habits were examined in data from the European Health and Behaviour Survey (A. Steptoe & J. Wardle, 1996), a study of over 16,000 students from 21 European countries. The level of practice of these healthy dietary habits was low. Significant univariate associations with healthy dietary habits were identified for gender, weight, dieting status, dietary health beliefs, nutrition knowledge, and health locus of control. In multivariate analyses, only gender, dieting status, and dietary health beliefs were significant predictors of healthy dietary habits. The practical implications of these results for dietary health promotion are discussed.

Cultural variation in health locus of control

OBJECTIVE

To compare health locus of control scores in women from different ethnic backgrounds.

METHOD

One-hundred and twenty-eight caucasian, South Asian and Afro-Caribbean women completed written or orally presented versions of the multidimensional health locus of control scale, as well as ratings of religiousness, health status and occupational status.

RESULTS

South Asian women scored higher on 'chance' and 'powerful others' locus of control as predicted. They also had higher scores on internality. The ethnic differences persisted after controlling for occupation and health status. High religiousness among the South Asians appeared to explain some, but not all, of their higher scores.

CONCLUSION

South Asians may differ from British caucasians in relation to their beliefs about internal and external influences on health.

Influence of relative fat content information on responses to three foods

Thirty-six normal-weight participants each tasted and rated three cheeses, three yogurts and three "koerrtas" (a novel, tofu-based food) on several hedonic, intention and sensory dimensions. Each sample was labelled as either "Higher" (than normal fat content), "Normal", or "Lower" (than normal fat content) while the actual fat content remained virtually constant. Cheese and yoghurt were chosen as consumers thought them to be high and low fat foods respectively in pre-testing. The presence of significant and predictable label effects on dimensions such as perceived healthiness and amount of fat demonstrated the efficacy of the manipulation. The Lower labelled foods were rated slightly less pleasant than the Normal but there was no interaction with type of food. However, there was an interaction with food type for rated likelihood of buying: participants were more likely to buy the Lower labelled yoghurt than the Normal or Higher yogurts. Participant characteristics were important moderators of the effect of the dietary fat-related labels. Those participants who reported a greater perceived influence of general health concerns on food choice, for example, rated the higher fat labelled foods as less pleasant and tended to be less likely to buy the higher labelled yogurts and cheeses than those who reported a lower perceived influence.

Stress, social support and health-related behavior: a study of smoking, alcohol consumption and physical exercise

The effects of academic examination stress on health behavior was assessed in university students. It was hypothesized that the anticipation of examinations would lead to increases in cigarette smoking and alcohol consumption, and to decreases in physical activity, and that effects would be particularly salient in students with low social supports. One hundred eighty students were divided into exam-stress (51 women, 64 men) and control (49 women, 16 men) groups, and were assessed at baseline and then within 2 weeks of exams, or an equivalent point for the control group. Perceived stress, emotional well-being and health behaviors were assessed by questionnaire and interview. The exam-stress group reported significant increases in perceived stress and emotional distress between baseline and exam sessions, but responses were not affected by social support availability. The controls showed no systematic changes in health behaviors. In the exam-stress group, smoking increased by an average of 54.7% between sessions in women with few social supports, but remained stable in men. There was a decrease in alcohol consumption of 17.5% in students with high social support between sessions, while those with low social supports showed an average increase of 18.5%. Physical activity decreased between baseline and exam sessions in the exam-stress group, but was not affected by social support. The results are discussed in relation to the effects of naturally occurring episodic stress on health behaviors, and the role of social support in moderating responses.

Randomised placebo controlled trial of effect on mood of lowering cholesterol concentration. Oxford Cholesterol Study Group

OBJECTIVE

To evaluate the effects on mood of a substantial and prolonged reduction in total cholesterol concentration.

DESIGN

Randomised placebo controlled comparison of patients who had been allocated to receive simvastatin 20 mg or 40 mg daily versus those allocated matching placebo in a ratio of 2:1. Follow up at an average of 152 weeks after randomisation.

SUBJECTS

Men and women aged between 40 and 75 years at entry with blood total cholesterol of 3.5 mmol/l or greater, who were considered to be at higher than average risk of coronary heart disease based on medical history.

MAIN OUTCOME MEASURES

The shortened profile of mood states questionnaire, reported use of psychotropic medication, and symptoms possibly related to mood.

RESULTS

Simvastatin reduced total cholesterol by 1.9 mmol/l (26.7%) at the time of follow up. Among all 621 patients randomised to simvastatin (414 patients) or placebo (207 patients) there were no significant differences in the use of psychotropic medication or in reports of symptoms possibly related to mood. Of these patients, 491 (334 simvastatin, 157 placebo) completed the mood questionnaire, and there were no significant differences between the treatment groups in total or subscale scores, even when patients with low baseline cholesterol concentrations or elderly subjects were considered separately.

CONCLUSION

These results do not support the hypothesis that treatment to lower cholesterol concentration causes mood disturbance.

Changes in "withdrawal symptoms" following discontinuation of low-dose diazepam

The intensity of putative benzodiazepine withdrawal symptoms was evaluated as part of a double blind placebo-controlled study of benzodiazepines and behaviour therapy in the management of agoraphobia. During the first phase of that study, some subjects were switched from low dose diazepam to placebo, and others remained on diazepam. Symptoms were evaluated in long-term benzodiazepine users (n = 30) and non-users n = 32) when they first entered the study and 4 weeks later, after both groups had been randomized to either diazepam or placebo, using eight analog rating scales measuring commonly reported withdrawal symptoms. At baseline, both users and non-users reported a substantial number of symptoms, with higher levels in the more anxious patients, but no differences between groups. After the transition to either diazepam or placebo, the users switched to placebo reported significantly higher levels of symptoms than users switched to diazepam and non-users combined. Multiple regression analysis suggested that the increase in symptoms was associated with the increase in anxiety, which was higher in the withdrawing group than the other three groups. These results raise questions concerning the extent to which withdrawal symptoms uniquely characterize benzodiazepine withdrawal. They confirm the common assumption that an increase in symptoms often accompanies withdrawal from benzodiazepines, but suggest that such symptoms are not so intense as to make withdrawal excessively difficult, at least in low-dose users.

Body fat distribution in South Asian women and children

OBJECTIVE

To compare levels of abdominal fatness in South Asian and European mothers and children.

SUBJECTS

49 mothers and children from South Asian backgrounds and 63 mothers and children from European backgrounds who took part in a study on family health behaviours.

MEASUREMENTS

Anthropometric measures and abdominal fatness indices, including WHR and conicity.

RESULTS

Asian mothers were shorter, and lighter than European mothers, but had a higher WHR and a higher conicity. Among children, boys had a higher WHR and conicity than girls but there were no ethnic differences in fat distribution.

CONCLUSION

Different patterns of fat distribution were observed in South Asian and European women, with South Asian women having a relatively large waist circumference, relative either to hip circumference (WHR) or to overall size (conicity). Sex differences in fat distribution, but not ethnic differences, were observed in the children. This suggests that the adult patterns of fat distribution may not be established at this stage.

Body size, parental appraisal, and self-esteem in blind children

This study of self-esteem, body size, and parental views in 9-11-year-old blind children found positive views about self-presentation with no sex or weight differences. Lower self-esteem emerged in children who thought they were judged by parents as too thin but being fat, being appraised as fat, or believing they are thought of as fat by parents, showed no effect on self-esteem. Their responses to questions about the causes, characteristics, and psychosocial functioning of obesity suggest an innate desire and possible need for a more robust stature, a bigger presence, and a feeling of weight which appeared to supercede any acquired negative attitudes to fatness.

Development of a measure of the motives underlying the selection of food: the food choice questionnaire

A number of factors are thought to influence people's dietary choices, including health, cost, convenience and taste, but there are no measures that address health-related and non-health-related factors in a systematic fashion. This paper describes the development of a multidimensional measure of motives related to food choice. The Food Choice Questionnaire (FCQ) was developed through factor analysis of responses from a sample of 358 adults ranging in age from 18 to 87 years. Nine factors emerged, and were labelled health, mood, convenience, sensory appeal, natural content, price, weight control, familiarity and ethical concern. The questionnaire structure was verified using confirmatory factor analysis in a second sample (n = 358), and test-retest reliability over a 2- to 3-week period was satisfactory. Convergent validity was investigated by testing associations between FCQ scales and measures of dietary restraint, eating style, the value of health, health locus of control and personality factors. Differences in motives for food choice associated with sex, age and income were found. The potential uses of this measure in health psychology and other areas are discussed.