Socioeconomic inequalities in attitudes towards cancer: an international cancer benchmarking partnership study.

Socioeconomic status (SES) differences in attitudes towards cancer have been implicated in the differential screening uptake and the timeliness of symptomatic presentation. However, the predominant emphasis of this work has been on cancer fatalism, and many studies focus on specific community subgroups. This study aimed to assess SES differences in positive and negative attitudes towards cancer in UK adults. A population-based sample of UK adults (n=6965, age≥50 years) completed the Awareness and Beliefs about Cancer scale, including six belief items: three positively framed (e.g. 'Cancer can often be cured') and three negatively framed (e.g. 'A cancer diagnosis is a death sentence'). SES was indexed by education. Analyses controlled for sex, ethnicity, marital status, age, self-rated health, and cancer experience. There were few education-level differences for the positive statements, and overall agreement was high (all>90%). In contrast, there were strong differences for negative statements (all Ps<0.001). Among respondents with lower education levels, 57% agreed that 'treatment is worse than cancer', 27% that cancer is 'a death sentence' and 16% 'would not want to know if I have cancer'. Among those with university education, the respective proportions were 34, 17 and 6%. Differences were not explained by cancer experience or health status. In conclusion, positive statements about cancer outcomes attract near-universal agreement. However, this optimistic perspective coexists alongside widespread fears about survival and treatment, especially among less-educated groups. Health education campaigns targeting socioeconomically disadvantaged groups might benefit from a focus on reducing negative attitudes, which is not necessarily achieved by promoting positive attitudes.

Public perceptions of cancer: a qualitative study of the balance of positive and negative beliefs.

OBJECTIVES: Cancer's insidious onset and potentially devastating outcomes have made it one of the most feared diseases of the 20th century. However, advances in early diagnosis and treatment mean that death rates are declining, and there are more than 30 million cancer survivors worldwide. This might be expected to result in more sanguine attitudes to the disease. The present study used a qualitative methodology to provide an in-depth exploration of attitudes to cancer and describes the balance of negative and positive perspectives. DESIGN: A qualitative study using semistructured interviews with thematic analysis. SETTING: A university in London, UK. PARTICIPANTS: 30 participants (23-73 years), never themselves diagnosed with cancer. RESULTS: Accounts of cancer consistently incorporated negative and positive views. In almost all respondents, the first response identified fear, trauma or death. However, this was followed-sometimes within the same sentence-by acknowledgement that improvements in treatment mean that many patients can survive cancer and may even resume a normal life. Some respondents spontaneously reflected on the contradictions, describing their first response as a 'gut feeling' and the second as a more rational appraisal-albeit one they struggled to believe. Others switched perspective without apparent awareness. CONCLUSIONS: People appear to be 'in two minds' about cancer. A rapid, intuitive sense of dread and imminent death coexists with a deliberative, rational recognition that cancer can be a manageable, or even curable, disease. Recognising cancer's public image could help in the design of effective cancer control messages.

Increasing awareness of gynaecological cancer symptoms: a GP perspective.

BACKGROUND: In the UK there has been an effort, through the National Awareness and Early Diagnosis Initiative (NAEDI), to increase early stage diagnoses and ultimately cancer survival. Encouraging early symptom presentation through awareness-raising activities in primary care is one method to achieve this goal. Understanding GPs' views about this type of activity, however, is crucial prior to implementation. AIM: To describe GPs' attitudes to raising public awareness of gynaecological cancers, and their views about the potential impact on primary care services. DESIGN AND SETTING: An online survey with a convenience sample recruited from 1860 UK general practices. METHOD: An invitation was emailed to GPs via practice managers and included a weblink to a draft education leaflet and an online survey about the impact of sending a leaflet giving information about symptoms associated with gynaecological cancers to all women on GPs' lists. Participants could offer additional free text comments which were coded using content analysis. RESULTS: A total of 621 GPs participated. Most (77%, 477) felt that raising awareness of cancers was important. Only half (50%, 308), however, indicated that they would distribute such a leaflet from their practice. Barriers to implementation included concerns about financial costs; emotional impact on patients; increased demand for appointments and diagnostic services, such as ultrasound. CONCLUSIONS: GPs were generally positive about an intervention to improve patients' awareness of gynaecological cancers, but had concerns about increasing rates of presentation. There is a need for research quantifying the benefits of earlier diagnosis against resource costs such as increased consultations, investigations, and referrals.

Ovarian cancer symptom awareness and anticipated delayed presentation in a population sample.

BACKGROUND: While ovarian cancer is recognised as having identifiable early symptoms, understanding of the key determinants of symptom awareness and early presentation is limited. A population-based survey of ovarian cancer awareness and anticipated delayed presentation with symptoms was conducted as part of the International Cancer Benchmarking Partnership (ICBP). METHODS: Women aged over 50 years were recruited using random probability sampling (n = 1043). Computer-assisted telephone interviews were used to administer measures including ovarian cancer symptom recognition, anticipated time to presentation with ovarian symptoms, health beliefs (perceived risk, perceived benefits/barriers to early presentation, confidence in symptom detection, ovarian cancer worry), and demographic variables. Logistic regression analysis was used to identify the contribution of independent variables to anticipated presentation (categorised as < 3 weeks or ≥ 3 weeks). RESULTS: The most well-recognised symptoms of ovarian cancer were post-menopausal bleeding (87.4%), and persistent pelvic (79.0%) and abdominal (85.0%) pain. Symptoms associated with eating difficulties and changes in bladder/bowel habits were recognised by less than half the sample. Lower symptom awareness was significantly associated with older age (p ≤ 0.001), being single (p ≤ 0.001), lower education (p ≤ 0.01), and lack of personal experience of ovarian cancer (p ≤ 0.01). The odds of anticipating a delay in time to presentation of ≥ 3 weeks were significantly increased in women educated to degree level (OR = 2.64, 95% CI 1.61 - 4.33, p ≤ 0.001), women who reported more practical barriers (OR = 1.60, 95% CI 1.34 - 1.91, p ≤ 0.001) and more emotional barriers (OR = 1.21, 95% CI 1.06 - 1.40, p ≤ 0.01), and those less confident in symptom detection (OR = 0.56, 95% CI 0.42 - 0.73, p ≤ 0.001), but not in those who reported lower symptom awareness (OR = 0.99, 95% CI 0.91 - 1.07, p = 0.74). CONCLUSIONS: Many symptoms of ovarian cancer are not well-recognised by women in the general population. Evidence-based interventions are needed not only to improve public awareness but also to overcome the barriers to recognising and acting on ovarian symptoms, if delays in presentation are to be minimised.

Continuing cancer screening later in life: attitudes and intentions among older adults in England.

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.

Ovarian cancer symptom awareness and anticipated time to help-seeking for symptoms among UK women.

OBJECTIVES: To determine levels of awareness of ovarian cancer symptoms and to identify barriers to help-seeking and predictors of a longer time to help-seeking in a UK female population-based sample. METHODS: A UK population-based sample of women [n=1000, including a subsample of women at higher risk due to their age (≥45 years, n=510)] completed the Ovarian Cancer Awareness Measure by telephone interview. Questions measured symptom awareness (using recall and recognition), barriers to medical help-seeking and anticipated time to help-seeking. Regression analyses identified predictors of a higher score on a scale of anticipated time to help-seeking. RESULTS: Most women (58% overall sample; 54% subgroup) were unable to recall any symptoms but 99% recognised at least one. Recognition was lowest for difficulty eating and persistently feeling full. In the sample overall, higher socio-economic status and higher endorsement of practical and service barriers independently predicted a longer anticipated time to help-seeking for more symptoms. White ethnicity was an additional predictor in the older subgroup. CONCLUSIONS: This study suggests awareness of ovarian cancer symptoms is low in the UK, and varies widely between symptoms. It identifies variables that may be involved in a longer time to help-seeking for possible ovarian cancer symptoms and highlights the need for more in-depth research into the factors related to time to help-seeking in real-world situations.

An international measure of awareness and beliefs about cancer: development and testing of the ABC.

OBJECTIVES: To develop an internationally validated measure of cancer awareness and beliefs; the awareness and beliefs about cancer (ABC) measure. DESIGN AND SETTING: Items modified from existing measures were assessed by a working group in six countries (Australia, Canada, Denmark, Norway, Sweden and the UK). Validation studies were completed in the UK, and cross-sectional surveys of the general population were carried out in the six participating countries. PARTICIPANTS: Testing in UK English included cognitive interviewing for face validity (N=10), calculation of content validity indexes (six assessors), and assessment of test-retest reliability (N=97). Conceptual and cultural equivalence of modified (Canadian and Australian) and translated (Danish, Norwegian, Swedish and Canadian French) ABC versions were tested quantitatively for equivalence of meaning (≥4 assessors per country) and in bilingual cognitive interviews (three interviews per translation). Response patterns were assessed in surveys of adults aged 50+ years (N≥2000) in each country. MAIN OUTCOMES: Psychometric properties were evaluated through tests of validity and reliability, conceptual and cultural equivalence and systematic item analysis. Test-retest reliability used weighted-κ and intraclass correlations. Construction and validation of aggregate scores was by factor analysis for (1) beliefs about cancer outcomes, (2) beliefs about barriers to symptomatic presentation, and item summation for (3) awareness of cancer symptoms and (4) awareness of cancer risk factors. RESULTS: The English ABC had acceptable test-retest reliability and content validity. International assessments of equivalence identified a small number of items where wording needed adjustment. Survey response patterns showed that items performed well in terms of difficulty and discrimination across countries except for awareness of cancer outcomes in Australia. Aggregate scores had consistent factor structures across countries. CONCLUSIONS: The ABC is a reliable and valid international measure of cancer awareness and beliefs. The methods used to validate and harmonise the ABC may serve as a methodological guide in international survey research.

Increasing awareness of gynecological cancer symptoms and reducing barriers to medical help seeking: does health literacy play a role?

Health literacy may influence the efficacy of print-based public health interventions. A key part of the U.K. cancer control strategy is to provide information to the public on earlier diagnoses with a view to improving the United Kingdom's relatively poor 1-year cancer survival statistics. This study examined the effect of health literacy on the efficacy of a gynecological cancer information leaflet. Participants (n = 451) were recruited from 17 Cancer Research UK events. Health literacy was assessed with the Newest Vital Sign test. Gynecological cancer symptom awareness and barriers to medical help seeking were assessed before and after participants read the leaflet. Symptom awareness improved, and barriers to medical help seeking were reduced (ps < .001). Symptom awareness was lower in individuals in lower health literacy groups, both at baseline and at follow-up (p < .05, p < .001, respectively), but there were no significant differences in barriers to medical help seeking at either time point (p > .05). As predicted, individuals with lower health literacy benefited less after exposure to the leaflet (ps < .01 for interactions). Despite careful consideration of information design principles in the development of the leaflet, more intensive efforts may be required to ensure that inequalities are not exacerbated by reliance on print-based public health interventions.

What do British women know about cervical cancer symptoms and risk factors?

OBJECTIVE: To identify levels of cervical cancer risk factor and symptom awareness, as well as predictors of higher awareness in a United Kingdom (UK) female population. DESIGN: Population based survey. SETTING: Participants' homes in the UK. SAMPLE: UK representative sample of females aged 16 years and over (n=1392). MATERIALS AND METHODS: Respondents completed the Cervical Cancer Awareness Measure which included questions on awareness of cervical cancer symptoms and risk factors (both recalled and recognised). Linear regression analyses were used to identify predictors of higher symptom and risk factor recognition scores. MAIN OUTCOME MEASURES: Awareness of cervical cancer symptoms and risk factors. RESULTS: Sixty-five percent of respondents were unable to recall any risk factors and 75% were unable to recall any symptoms. Awareness was higher when women were prompted (95% recognised at least one risk factor and 93% at least one symptom). Independent predictors of risk factor recognition were older age and higher education. Symptom recognition was associated with older age, White ethnicity, higher education and having a close experience of cervical cancer. CONCLUSIONS: To reduce inequalities in awareness, interventions should target younger women with lower education and those from ethnic minority groups.

Knowledge of lung cancer symptoms and risk factors in the U.K.: development of a measure and results from a population-based survey.

OBJECTIVES: To develop and validate a lung cancer awareness measure (Lung CAM) and explore the demographical and social predictors of lung cancer awareness in the general population. METHODS STUDY 1: Symptoms and risk factors for lung cancer were identified from the medical literature and health professional expertise in an iterative process. Test-retest reliability, internal reliability, item analyses, construct validity and sensitivity to changes in awareness of the Lung CAM were assessed in three samples (total N=191). RESULTS STUDY 1: The Lung CAM demonstrated good internal (Cronbach's α=0.88) and test-retest reliability (r=0.81, p<0.001). Validity was supported by lung cancer experts scoring higher than equally educated controls (t(106)=8.7, p<0.001), and volunteers randomised to read lung cancer information scoring higher than those reading a control leaflet (t(81)=3.66, p<0.001). METHODS STUDY 2: A population-based sample of 1484 adults completed the Lung CAM in a face-to-face, computer-assisted interview. RESULTS STUDY 2: Symptom awareness was low (average recall of one symptom) and there was little awareness of risk factors other than smoking. Familiarity with cancer, and being from a higher socioeconomic group, were associated with greater awareness. CONCLUSIONS: Using a valid and reliable tool for assessing awareness showed the UK population to have low awareness of lung cancer symptoms and risk factors. Interventions to increase lung cancer awareness are needed to improve early detection behaviour.

Ovarian and cervical cancer awareness: development of two validated measurement tools.

BACKGROUND: The aim of the study was to develop and validate measures of awareness of symptoms and risk factors for ovarian and cervical cancer (Ovarian and Cervical Cancer Awareness Measures). METHODS: Potentially relevant items were extracted from the literature and generated by experts. Four validation studies were carried out to establish reliability and validity. Women aged 21-67 years (n=146) and ovarian and cervical cancer experts (n=32) were included in the studies. Internal reliability was assessed psychometrically. Test-retest reliability was assessed over a 1-week interval. To establish construct validity, Cancer Awareness Measure (CAM) scores of cancer experts were compared with equally well-educated comparison groups. Sensitivity to change was tested by randomly assigning participants to read either a leaflet giving information about ovarian/cervical cancer or a leaflet with control information, and then completing the ovarian/cervical CAM. RESULTS: Internal reliability (Cronbach's α=0.88 for the ovarian CAM and α=0.84 for the cervical CAM) and test-retest reliability (r=0.84 and r=0.77 for the ovarian and cervical CAMs, respectively) were both high. Validity was demonstrated with cancer experts achieving higher scores than controls [ovarian CAM: t(36)= -5.6, p<0.001; cervical CAM: t(38)= -3.7, p=0.001], and volunteers who were randomised to read a cancer leaflet scored higher than those who received a control leaflet [ovarian CAM: t(49)=7.5, p<0.001; cervical CAM: t(48)= -5.5, p<0.001]. CONCLUSIONS: This study demonstrates the psychometric properties of the ovarian and cervical CAMs and supports their utility in assessing ovarian and cervical cancer awareness in the general population.

Cancer fatalism: deterring early presentation and increasing social inequalities?

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

Is it time to change the stereotype of cancer: the expert view.

OBJECTIVES: Negative public attitudes towards cancer may contribute to delays in presentation and present barriers to providing quality care. This study explored the views of cancer experts regarding the content of public health messages to improve public attitudes to cancer. METHODS: Twenty-one healthcare professionals (HCPs) from a range of backgrounds took part took part in interviews. Interview transcripts were evaluated using thematic analysis focusing on the HCPs views of the prevailing negative stereotype of cancer patients and their recommendations for cancer awareness campaigns that could redress this view. RESULTS: HCPs contrasted the progress that had been made in the effective management of cancer with popular stereotypes and media representations. Information quality and supply were identified as barriers to changing the cancer stereotype held by the public. CONCLUSIONS: HCPs believe there is a need for more information about cancer in the public domain and it should focus on providing more balanced messages that include information about the improvements that have been achieved in preventing and treating cancer.

Patient delay in presentation of possible cancer symptoms: the contribution of knowledge and attitudes in a population sample from the United kingdom.

BACKGROUND: Qualitative studies implicate knowledge of cancer symptoms and attitudes towards help-seeking as important factors in patient delay. The present study uses quantitative data from a population-based survey to test the hypotheses that (a) a greater knowledge of early cancer symptoms is associated with a higher likelihood of having appraised a symptom as possibly due to cancer, and (b) more negative attitudes towards help-seeking are associated with a lower likelihood of having sought medical advice for that symptom. METHODS: Two thousand and seventy-one adults were asked whether they had experienced a symptom that they worried might be cancer in the past 3 months, and if so, whether they had seen a doctor. Respondents also completed the Cancer Awareness Measure (CAM) assessing symptom knowledge and barriers to help-seeking. RESULTS: Two hundred and thirty-six (11.4%) respondents reported having experienced a possible cancer symptom. In logistic regression analyses controlling for age, sex, and self-rated health, higher CAM symptom knowledge scores were associated with a greater likelihood of having experienced a possible cancer symptom (odds ratio = 1.09; 95% confidence interval, 1.01-1.17). Of those who had experienced a symptom, 75% (177/236) had seen a doctor. Higher scores on the CAM barriers scale were associated with being less likely to have seen a doctor (odds ratio, 0.74; 95% confidence interval, 0.63-0.87). CONCLUSIONS: Better knowledge of the signs and symptoms of cancer might help people recognize possible cancer symptoms and therefore reduce appraisal delay, whereas more positive attitudes towards help-seeking might reduce behavioral delay. IMPACT: Campaigns to educate the public about cancer symptoms and reduce help-seeking barriers could play a role in promoting early diagnosis.

Public perceptions of the harms and benefits of testicular cancer education: a qualitative study.

BACKGROUND: The value of testicular cancer (TC) education, and in particular advice on testicular self-examination (TSE), has been widely debated by health professionals. One concern centres on its potential to cause unnecessary anxiety among the target population. Views outside the health professional community about TC education's potential benefits and harms have not previously been described. The objective of this study was to investigate the range of views expressed by specific groups thought to have an interest in provision of TC education. METHODS: One-to-one, in-depth interviews with 37 men and women were completed. Participants included TC patients, men with no prior diagnosis of TC, and parents and teachers of adolescent boys. Verbatim transcripts were analysed using the Framework approach to produce a thematic description of views expressed. RESULTS: Participants were unanimously in favour of TC education. Key perceived benefits included earlier cancer detection through increasing knowledge of symptoms leading to better treatment outcomes, and motivating help-seeking by reducing emotional barriers such as fear of cancer or embarrassment. Anxiety was acknowledged as a possible harm but was not expected to be widespread or serious. CONCLUSION: TC education is viewed favourably by members of the public likely to be interested in its provision. Education's potential to cause anxiety was not considered a disincentive to promoting disease awareness.

Socioeconomic disparities in optimism and pessimism.

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.

Socioeconomic disparities in psychosocial wellbeing in cancer patients.

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.

Persistent impact of pubertal timing on trends in smoking, food choice, activity, and stress in adolescence.

OBJECTIVES: a) To replicate the established association between early puberty and smoking; b) to see whether differences between early and late maturers narrowed with increasing age and differed by gender; and c) to determine whether other health behaviors (food choice, physical activity, sedentary behavior) and stress showed the same association with pubertal timing. METHODS: The Health and Behaviour in Teenagers Study (HABITS) followed a cohort of 5863 adolescents from ages 11 to 12 years (UK year 7; US grade 6) for 5 years. Puberty was assessed with the Pubertal Development Scale. Three pubertal timing groups were created by identifying adolescents who reached midpuberty relatively early, average, or late, compared with their peers. Longitudinal trends in health behaviors and stress were compared between the three groups. RESULTS: Smoking rates were higher throughout adolescence among early-maturing students, with no evidence that late-maturers "caught up" when they reached puberty, although group differences narrowed over time. Early-maturing students had higher rates of sedentary behaviors but also reported higher rates of vigorous activity than their "on-time" developing counterparts. Patterns in dietary behaviors and stress showed lower rates of daily breakfast and higher stress among early-maturing girls, but not boys. Overall, the effects were largest in early adolescence (ages 11-13 years) and became smaller at older ages (ages 14-16 years). CONCLUSION: Early-maturing adolescents are at increased risk for unhealthy behaviors, especially smoking, and although differences attenuate during adolescence, they remain significant at age 16 years. This suggests that early maturation may be a cause of, or is at least a marker for, differences in lifestyle.

Socioeconomic status differences in coping with a stressful medical procedure.

OBJECTIVE: The objective of this study was to test the hypothesis that socioeconomic disadvantage results in adverse emotional reactions to a novel, stressful, medical examination. METHODS: Sigmoidoscopy screening for colorectal cancer was identified as a potential stressor. A subset of participants (N = 3535) from the U.K. Flexible Sigmoidoscopy Trial completed pre- and postscreening questionnaires regarding psychologic well-being. All trial participants were sent a postscreening questionnaire after 3 months (post-flexible sigmoidoscopy [FS] sample, N = 29,804), including measures of distress (the General Health Questionnaire), anxiety (State-Trait Anxiety Inventory), a single-item measure of bowel cancer worry, and a 6-item measure of positive consequences of screening. Socioeconomic status (SES) was coded from postcodes with the Townsend Index. SES differences in changes in emotional well-being over the course of screening were evaluated in the longitudinal sample. SES differences in postscreening well-being in relation to screening outcome were evaluated in the post-FS sample. RESULTS: Bowel cancer worry and anxiety were higher in lower SES groups before screening. Both reduced after screening, but there were no SES differences in the change. In the post-FS sample, there was an SES gradient in anxiety but not in distress. Lower SES groups indicated more positive reactions. There were no interactions between SES and screening outcome for any indicator of well-being. CONCLUSIONS: Lower SES was associated with worse psychologic well-being before and after screening, but lower SES participants did not show any differentially greater adverse reactions compared with higher SES participants. Moderately stressful experiences in everyday life do not necessarily more unfavorably affect those with fewer educational and economic resources.

Stress and dietary practices in adolescents.

Baseline data from the Health and Behavior in Teenagers Study (HABITS) were used to investigate associations between stress and dietary practices in a socioeconomically and ethnically diverse sample of 4,320 schoolchildren (mean age = 11.83 years). Male (n = 2,578) and female (n = 1,742) pupils completed questionnaire measures of stress and 4 aspects of dietary practice (fatty food intake, fruit and vegetable intake, snacking, and breakfast consumption) and also provided demographic and anthropometric data. Multivariate analyses revealed that greater stress was associated with more fatty food intake, less fruit and vegetable intake, more snacking, and a reduced likelihood of daily breakfast consumption. These effects were independent of individual (gender, weight) and social (socioeconomic status, ethnicity) factors. Stress may contribute to long-term disease risk by steering the diet in a more unhealthy direction.