Sexual distress and associated factors among cervical cancer survivors: A cross-sectional multicenter observational study.

BACKGROUND: To assess whether sexual distress among cervical cancer (CC) survivors is associated with frequently reported vaginal sexual symptoms, other proposed biopsychosocial factors and whether worries about painful intercourse mediate the relation between vaginal sexual symptoms and sexual distress. METHODS: A cross-sectional study was conducted among 194 sexually active partnered CC survivors aged 25 to 69 years. Sexual distress, vaginal sexual symptoms, sexual pain worry, anxiety, depression, body image concerns, and relationship dissatisfaction and the sociodemographic variables age, time since treatment, and relationship duration were assessed by using validated self-administrated questionnaires. RESULTS: In total, 33% (n = 64) of the survivors scored above the cut-off score for sexual distress. Higher levels of sexual distress were shown to be associated with higher levels of vaginal sexual symptoms, sexual pain worry, relationship dissatisfaction, and body image concerns. Furthermore, the results showed that sexual pain worry partly mediated the association between vaginal sexual symptoms and sexual distress, when controlling for relationship dissatisfaction and body image concerns. CONCLUSIONS: Appropriate rehabilitation programs should be developed for CC survivors to prevent and reduce not only vaginal sexual symptoms but also sexual pain worry, relationship dissatisfaction, and body image concerns to reduce sexual distress.

Small, medium, large or supersize? The development and evaluation of interventions targeted at portion size.

In the past decades, portion sizes of high-caloric foods and drinks have increased and can be considered an important environmental obesogenic factor. This paper describes a research project in which the feasibility and effectiveness of environmental interventions targeted at portion size was evaluated. The studies that we conducted revealed that portion size labeling, offering a larger variety of portion sizes, and proportional pricing (that is, a comparable price per unit regardless of the size) were considered feasible to implement according to both consumers and point-of-purchase representatives. Studies into the effectiveness of these interventions demonstrated that the impact of portion size labeling on the (intended) consumption of soft drinks was, at most, modest. Furthermore, the introduction of smaller portion sizes of hot meals in worksite cafeterias in addition to the existing size stimulated a moderate number of consumers to replace their large meals by a small meal. Elaborating on these findings, we advocate further research into communication and marketing strategies related to portion size interventions; the development of environmental portion size interventions as well as educational interventions that improve people's ability to deal with a 'super-sized' environment; the implementation of regulation with respect to portion size labeling, and the use of nudges to stimulate consumers to select healthier portion sizes.

The process evaluation of two interventions aimed at portion size in worksite cafeterias.

BACKGROUND: In a previous study, the effectiveness of introducing a small meal in addition to the existing size and a proportional pricing strategy have been assessed in Dutch worksite cafeterias. To assess the degree of implementation and to inform the design of future interventions, the present study aimed to describe the process evaluation of both interventions. METHODS: Process evaluation components from Baranowski and Stables, and Rogers (i.e. Recruitment, Maintenance, Context, Resources, Implementation, Exposure, Contamination, and Continued use) were chosen as a theoretical basis. The process evaluation involved qualitative (e.g. structured observations, semi-structured interviews) and quantitative data (e.g. consumer questionnaires) collected from 17 intervention and eight control worksite cafeterias. RESULTS: In all intervention cafeterias, two portion sizes were offered. The pricing instructions were followed in 13 intervention cafeterias. The cafeterias managers indicated that they did not consider offering large and small meals as being complex, risky or time-consuming to implement. Some managers perceived the consumer demand as high, others as (too) low. One year after the study had ended, nine of the intervention cafeterias had continued (at least partly) to follow the protocol. CONCLUSIONS: Offering a smaller portion size in addition to the existing size, as well as proportional pricing, was generally implemented as prescribed by the protocol and can be considered promising in terms of continued use. However, additional efforts are needed to make the intervention more effective in motivating consumers to replace their large portion with a small portion.

Small portion sizes in worksite cafeterias: do they help consumers to reduce their food intake?

BACKGROUND: Environmental interventions directed at portion size might help consumers to reduce their food intake. OBJECTIVE: To assess whether offering a smaller hot meal, in addition to the existing size, stimulates people to replace their large meal with a smaller meal. DESIGN: Longitudinal randomized controlled trial assessing the impact of introducing small portion sizes and pricing strategies on consumer choices. SETTING/PARTICIPANTS: In all, 25 worksite cafeterias and a panel consisting of 308 consumers (mean age=39.18 years, 50% women). INTERVENTION: A small portion size of hot meals was offered in addition to the existing size. The meals were either proportionally priced (that is, the price per gram was comparable regardless of the size) or value size pricing was employed. MAIN OUTCOME MEASURES: Daily sales of small and the total number of meals, consumers' self-reported compensation behavior and frequency of purchasing small meals. RESULTS: The ratio of small meals sales in relation to large meals sales was 10.2%. No effect of proportional pricing was found B=-0.11 (0.33), P=0.74, confidence interval (CI): -0.76 to 0.54). The consumer data indicated that 19.5% of the participants who had selected a small meal often-to-always purchased more products than usual in the worksite cafeteria. Small meal purchases were negatively related to being male (B=-0.85 (0.20), P=0.00, CI: -1.24 to -0.46, n=178). CONCLUSION: When offering a small meal in addition to the existing size, a percentage of consumers that is considered reasonable were inclined to replace the large meal with the small meal. Proportional prices did not have an additional effect. The possible occurrence of compensation behavior is an issue that merits further attention.

Two pack king size chocolate bars. Can we manage our consumption?

This questionnaire study assessed people's consumption intentions regarding two pack king size chocolate bars. Results showed that 92.9% of the respondents (n=143) intended to finish the chocolate bar within 1 day. The most important purchase considerations were hunger and not having considered the size. Furthermore, dietary restraint reduced the odds of a respondent intending to finish the two pack king size chocolate bar within 1 day. Based on the results, the availability and visibility of regular chocolate bars and healthier snacks should be increased, and consumers should be educated about the impact of portion sizes of high caloric snacks.