The Immunisation Beliefs and Intentions Measure (IBIM): Predicting parents’ intentions to immunise preschool children

In England, uptake of the second dose of MMR (against measles, mumps, rubella), and dTaP/IPV or DTaP/IPV booster (against diphtheria, tetanus, pertussis, polio), is lower than that of the primary course. The Immunisation Beliefs and Intentions Measure (IBIM), based on the theory of planned behaviour (TPB) and qualitative interviews, was used to predict parents’ intentions to take preschoolers for these recommended vaccinations. Parents from 43 child groups in southern England were randomised to receiving questions about either MMR (N = 193) or dTaP/IPV (N = 159). Overall, 255 parents fully completed TPB-based items. Regression analyses revealed that parental attitudes about the protective benefits of immunising and perceived behavioural control were strong, reliable predictors of intention to immunise with MMR. For dTaP/IPV, perceived protective benefits and number of children reliably predicted intention to immunise. Differences between parents with ‘maximum immunisation intentions’ and those with ‘less than maximum intentions’ are described. The IBIM appears to be a useful measure for predicting parents’ intentions to immunise preschoolers. Implications for improving uptake are discussed.     

Physical activity, cardiorespiratory fitness, and obesity among Chinese children

Objective

To investigate the relationships of cardiorespiratory fitness (CRF) and physical activity (PA) with the risk of overweight/obesity in Chinese schoolchildren.

Methods

A total of 1795 children aged 8-13 years at baseline were followed-up for 18 months from 2006 to 2008 in Guangzhou, China. Children were categorized as “normal weight”, “overweight”, and “obese” using Chinese obesity cut-off points. Data on self-reported PA were obtained. CRF was determined by the 20-meter multistage fitness test, and the sex-specific median values were set as the cut-off points for the classification of high and low CRF.

Results

Significantly higher CRF was found in children with normal weight (from 6.55 to 8.65 ml/kg/min) or physically active children (from 0.42 to 1.22 ml/kg/min) compared with the reference group. CRF was inversely associated with the kg/m² change in BMI during the follow-up period (β = − 0.63 kg/m² and − 0.64 kg/m² for boys and girls, respectively, both p < 0.001). Significant association of baseline CRF with overweight/obesity was found in boys (odds ratio (OR) 8.71; 95% confidence interval (CI) 2.59-29.26, p < 0.001), whereas the association was marginally insignificant in girls (OR 6.87; 95% CI 0.96-49.09, p = 0.055).

Conclusions

The results showed a strong negative association between CRF levels and children's BMI and weight gain.     

Prefrontal cortex transcranial direct current stimulation associated with aerobic exercise change aspects of appetite sensation in overweight adults

This study investigated whether transcranial direct current stimulation (tDCS) on dorsolateral prefrontal cortex (DLPFC) isolated or combined with aerobic exercise influenced the desire to eat, hunger, and satiety in overweight subjects. Nine volunteers underwent anodal or sham tDCS (2 mA; 20 min) over DLPFC and isocaloric exercise bouts (70%VO₂R; ∼200 kcal). The appetite sensations were evaluated by visual analogue scales at four moments: I - Baseline; II - After tDCS; III - Post-Exercise and IV - 30-min Post-Exercise. The tDCS on left DLPFC decreased the desire to eat at baseline (tDCS −26% vs. −14% Sham). The tDCS associated with exercise had greater suppressing effect in desire to eat compared to either tDCS or exercise alone (tDCS −39% vs. −27% Sham). Moreover, the tDCS associated with exercise decreased hunger (tDCS −48% vs. 36% Sham) and increased satiety (tDCS 28% vs. 7% Sham) immediately after exercise. The post-exercise 30-min recovery elicited an overall increase in appetite. However the increase in desire to eat and hunger after recovery was lower after tDCS (29% and 13%, respectively) compared to sham stimulation (77% and 113%, respectively). These findings in overweight subjects indicate that the combination of tDCS over DLPFC and aerobic exercise induced greater decrease in appetite sensations compared to anodal tDCS or exercise alone.     

Incidence of obesity during childhood and adolescence in a large contemporary cohort

Background and Aims

Timing of obesity development during childhood and adolescence is unclear, hindering preventive strategies. The primary aim of the present study was to quantify the incidence of overweight and obesity throughout childhood and adolescence in a large contemporary cohort of English children (the Avon Longitudinal Study of Parents and Children, ALSPAC; children born 1991-1992). A secondary aim was to examine the persistence of overweight and obesity.

Methods

Longitudinal data on weight and height were collected annually from age 7-15 years in the entire ALSPAC cohort (n = 4283), and from 3 to 15 years in a randomly selected subsample of the cohort (n = 549; ‘Children in Focus’ CiF). Incidence of overweight and obesity (BMI (Body mass index) at or above the 85th and 95th centiles relative to UK reference data) was calculated. Risk ratios (RR) for overweight and obesity at 15 years based on weight status at 3, 7, and 11 years were also calculated.

Results

In the entire cohort, four-year incidence of obesity was higher between ages 7 and 11 years than between 11 and 15 years (5.0% vs 1.4% respectively). In the CiF sub-sample, four-year incidence of obesity was also highest during mid-childhood (age 7-11 years, 6.7%), slightly lower during early childhood (3-7 years, 5.1%) and lowest during adolescence (11-15 years 1.6%). Overweight and obesity at all ages had a strong tendency to persist to age 15 years as indicated by risk ratios (95% CI (Confidence interval)) for overweight and obesity at 15 years from overweight and obesity (relative to healthy weight status) at 3 years (2.4, 1.8-3.1), 7 years (4.6, 3.6-5.8), and 11 years (9.3, 6.5-13.2).

Conclusion

Mid-late childhood (around age 7-11 years) may merit greater attention in future obesity prevention interventions.     

Participation and cardiovascular risk reduction in a voluntary worksite nutrition and physical activity program

Objective

In a cohort of employees participating in a worksite nutrition and physical activity program, we compared program completion and changes in cardiovascular risk factors by baseline body mass index.

Methods

In 2007, 774 employees enrolled in a 10 week program at a hospital in Boston, Massachusetts. Program completion and change in weight, cholesterol, and blood pressure were compared between obese (body mass index ≥ 30), overweight (body mass index = 25-29.9), and normal weight (body mass index < 25) participants.

Results

At baseline, 63% were obese or overweight and had higher blood pressure and cholesterol compared to normal weight participants. Program completion was 82% and did not differ by body mass index. Mean weight loss was 1.9 kg at end of program (p < 0.001) and 0.4 kg at 1 year (p = 0.002). At end of program, participants with body mass index ≥ 30 lost 3.0% body weight vs. 2.7% for body mass index = 25-29.9 and 1.7% for body mass index < 25 (p < 0.001), but weight loss at 1 year did not differ by body mass index. Mean cholesterol and blood pressure were lower at end of program and 1 year (all, p < 0.005) but did not differ by body mass index.

Conclusions

Worksite programs can successfully initiate cardiovascular risk reduction among employees, but more intensive interventions are needed to make significant improvements in the health of higher risk obese employees.     

Bone Mineral Density Changes during Weight Regain following Weight Loss with and without Exercise

The purpose of this study was to compare changes in bone mineral density (BMD) over a 6 month follow up (period of weight regain) in overweight, postmenopausal women having previously completed a 6 month weight loss (WL) intervention with and without aerobic exercise (AEX). Women (BMI > 25 kg/m²) underwent VO₂max and DEXA scans at baseline, after 6 months of WL or AEX + WL, and at 12 months ad libitum follow up. Both groups lost ~9% body weight from 0 to 6 months and regained ~2% from 6 to 12 months, while losing ~4% of appendicular lean mass (ALM) across the 12-month study duration. VO₂max increased 10% from 0 to 6 months and declined 12% from 6 to 12 months for AEX + WL, with no changes for WL. Total body (p < 0.01) and total femur (p = 0.03) BMD decreased similar between groups across time (combined groups: 0–6 months: total body: −1.2% and total femur: −1.2%; 6–12 months: total body: −0.26% and total femur: −0.09%). Less ALM loss and greater VO₂max increases during the WL phase were associated with attenuated BMD loss at various anatomical sites during periods of weight regain (6–12 months) p’s < 0.05). Results suggest that BMD loss may continue following WL, despite weight regain. Further, this study adds to the literature by suggesting that preventing declines in muscle quality and function during WL may attenuate the loss of BMD during weight regain. Future studies are needed to identify mechanisms underlying WL-induced bone loss so that effective practices can be designed to minimize the loss of BMD during WL and weight maintenance in older women.     

Parental practices perceived by children using a French version of the Kids' Child Feeding Questionnaire

About 18% of 6-11-year-old French children are overweight, of whom 3.3% are obese. Parental feeding practices, especially restriction and pressure-to-eat, seem to promote overeating in children. Since no tool was available for the perception of parental feeding practices of French children, our aim was to validate a French version of the Kids’ Child Feeding Questionnaire (KCFQ, Carper, Orlet Fischer, & Birch, 2000), and to determine the relationship between KCFQ's dimensions and children's standardised body mass index (BMI z-scores). The questionnaire was completed by 240 normal-weighted or overweight children between the age of 9 and 11. The validation was based on a confirmatory factor analysis. The internal consistency of factors was confirmed using Cronbach's coefficients. After deleting some items (3 for the pressure-to-eat subscale and 3 for the restriction subscale), the two-factor model (pressure-to-eat, restriction) provided an acceptable fit (χ² (34) = 64; RMSEA = .06; CFI = 0.93; NNFI = .90), and satisfactory internal consistency. Children's perception of restriction was significantly and positively correlated with BMI z-scores (r = 36, p < .001), whereas their perception of pressure-to-eat was not significantly associated with BMI z-scores (r = −.09, p = .24). This scale appears to be a sound tool for highlighting children's perceptions of parental feeding practices, and their links to weight status.     

Exercise and diet determinants of overweight women participating in an exercise and diet program: a prospective examination of the theory of planned behavior

The purpose of this study was to examine prospectively the ability of direct and belief-based measures of the theory of planned behavior (TPB) constructs to predict exercise and diet intention and behavior of overweight women. Participants were 117 overweight, community-dwelling women and university students enrolled in a 4-week exercise and diet program. Participants completed baseline measures of demographic characteristics and the TPB constructs. Their exercise and diet adherence were also recorded. We found that: (1) the direct measure of perceived behavioral control (PBC) predicted exercise intention, (2) the direct measures of instrumental attitude, subjective norm, and PBC predicted diet intention, and (3) none of the direct or belief-based measures of the TPB constructs predicted 4-week exercise or diet behavior. Furthermore, several beliefs were associated with the direct measures of attitude, subjective norm, PBC, and intention. Implications of these results for designing exercise and diet interventions with overweight women are discussed.     

Phone and e-mail counselling are effective for weight management in an overweight working population: a randomized controlled trial

Background  

The work setting provides an opportunity to introduce overweight (i.e., Body Mass Index ≥ 25 kg/m²) adults to a weight management programme, but new approaches are needed in this setting. The main purpose of this study was to investigate the effectiveness of lifestyle counselling by phone or e-mail on body weight, in an overweight working population. Secondary purposes were to establish effects on waist circumference and lifestyle behaviours, and to assess which communication method is the most effective.     

Psycho-markers of weight loss. The roles of TFEQ Disinhibition and Restraint in exercise-induced weight management

Eating behaviour traits, namely Disinhibition and Restraint, have the potential to exert an effect on food intake and energy balance. The effectiveness of exercise as a method of weight management could be influenced by these traits. Fifty eight overweight and obese participants completed 12-weeks of supervised exercise. Each participant was prescribed supervised exercise based on an expenditure of 500 kcal/session, 5 d/week for 12-weeks. Following 12-weeks of exercise there was a significant reduction in mean body weight (−3.26 ± 3.63 kg), fat mass (FM: −3.26 ± 2.64 kg), BMI (−1.16 ± 1.17 kg/m²) and waist circumference (WC: −5.0 ± 3.23 cm). Regression analyses revealed a higher baseline Disinhibition score was associated with a greater reduction in BMI and WC, while Internal Disinhibition was associated with a larger decrease in weight, %FM and WC. Neither baseline Restraint or Hunger were associated with any of the anthropometric markers at baseline or after 12-weeks. Furthermore, after 12-weeks of exercise, a decrease in Disinhibition and increase in Restraint were associated with a greater reduction in WC, whereas only Restraint was associated with a decrease in weight. Post-hoc analysis of the sub-factors revealed a decrease in External Disinhibition and increase in Flexible Restraint were associated with weight loss. However, an increase in Rigid Restraint was associated with a reduction in %FM and WC. These findings suggest that exercise-induced weight loss is more marked in individuals with a high level of Disinhibition. These data demonstrate the important roles that Disinhibition and Restraint play in the relationship between exercise and energy balance.     

Canadian paediatricians' opinions on rotavirus vaccination

Rotavirus is the leading cause of dehydration and hospitalization due to gastroenteritis (GE) in young children. Almost all children are affected by the age of 5 years. Two safe and effective rotavirus vaccines are available for clinical use in Canada. In the context where rotavirus vaccination is recommended, but not publicly funded, we have assessed paediatricians’ knowledge, attitudes and beliefs (KAB) regarding rotavirus disease and its prevention by vaccination. A self-administered anonymous questionnaire based upon the Health Belief Model and the Analytical framework for immunization programs was mailed to all 1852 Canadian paediatricians. The response rate was 50%. The majority of respondents rated consequences of rotavirus infection for young patients as moderate. Sixty-six percent considered that rotavirus disease occur frequently without vaccination and 62% estimated that the disease generates a significant economic burden. Sixty-nine percent of respondents considered rotavirus vaccines to be safe and 61%, to be effective. The reduction of severe GE cases was seen as the main benefit of rotavirus vaccination, while the risk of adverse events was the principal perceived barrier. Fifty-three percent (53%) indicated a strong intention to recommend rotavirus vaccines. In multivariate analysis, main determinant of paediatricians’ intention to recommend rotavirus vaccines was the perceived health and economic burden of rotavirus diseases (partial R² = 0.49, p < 0.0001). More than half of surveyed paediatricians were willing to recommend rotavirus vaccines to their patients, but the proportion of respondents who had a strong intention to do so remains low when compared to several other new vaccines. As with other new vaccines, rotavirus vaccine uptake risks to remain low in Canada as long as it is not publicly funded.     

Development and factor structure of the Baby Eating Behaviour Questionnaire in the Gemini birth cohort

The objective of this study was to develop a parent-report psychometric measure of infant appetite during the period of exclusive milk-feeding. Constructs and items for the Baby Eating Behaviour Questionnaire (BEBQ) were derived from an existing psychometric measure validated for older ages, the Children's Eating Behaviour Questionnaire, supplemented by a review of the literature on milk-feeding behaviours. Cognitive interviewing with a sample of mothers (n = 10) was used to refine the questions. The factor structure of the 18-item BEBQ was assessed in infants (one per family) from the Gemini twin birth cohort (n = 2402 families). Principal Component Analysis identified four distinct appetitive constructs, all of which had good internal reliability: ‘enjoyment of food’ (Cronbach's α = 0.81), ‘food responsiveness’ (α = 0.79), ‘slowness in eating’ (α = 0.76), and ‘satiety responsiveness’ (α = 0.73). A single item assessing ‘general appetite’ correlated with all of the constructs. The BEBQ is the first standardised measure of infant appetite designed to characterise appetitive traits that might confer susceptibility to excess weight gain.     

Predicting physical activity promotion in health care settings.

PURPOSE: To test the ability of the theory of planned behavior (TPB) in predicting the stage of change for physical activity promotion by mental health professionals. DESIGN: Six-month prospective questionnaire study. SETTING: One mental health trust in the East Midlands, United Kingdom. SUBJECTS: Three hundred ninety-four mental health professionals (men, n = 131; women, n = 263) of an initial sample of 477 participated in the study (83% response rate). MEASURES: Attitudes, subjective norms, intentions, perceived behavioral control, and stage of change were measured at the first wave of data collection. Stage of change was also assessed 6 months later. Data were analyzed using structural equation modeling. RESULTS: Intention and stage of change were successfully predicted from TPB variables. Overall, 27% of the variance in self-reported stage of promoting physical activity was explained by the model. Sixty-one percent of the variance in intention to promote physical activity was explained. When included, past behavior was the strongest predictor of both intention and stage of change and attenuated all other path coefficients. Past behavior improved the predicted variance in intention by 11% and stage by 6%. CONCLUSIONS: The TPB variables of attitude, subjective norms, perceived behavioral control, and intention predict stage of change of physical activity promotion in a health care setting. However, promoting physical activity in the past had a sizable effect on predicting subsequent promotion. Due to unequal distribution across stages, the stage model's application to understanding the behavior of health professionals may be limited.     

Understanding the potential and challenges of adenoma treatment as a prevention opportunity: insights from the BeWEL formative study

Objectives

To explore prevention opportunities presented by colorectal adenoma diagnosis and inform engagement strategies for the BeWEL study (body weight and physical activity lifestyle intervention for colorectal cancer screening participants who have undergone adenoma removal).

Methods

Qualitative study comprising 4 purposively sampled focus groups conducted in urban and rural areas in Tayside, Scotland, with different deprivation levels. Participants were men and women (n = 17) aged 50-74 with BMI > 25 kg/m² with removal of adenoma detected by colorectal cancer screening.

Results

Adenoma diagnosis presents both opportunities and challenges for prevention. Some patients perceived adenoma as minor and not sufficiently motivating to act as a ‘teachable moment’. Patients had low awareness of the relationship between adenoma and lifestyle factors, and received little information on prevention during screening and treatment. Consequently they interpreted post-treatment ‘all clear’ messages as validation of existing lifestyles, and did not see the relevance of prevention advice. Receptiveness increased when the association between lifestyle, adenoma recurrence and other illness was explained.

Conclusion

The study illustrates the value of exploratory research into patient understanding to improve communications and health services. Without unduly worrying patients, professionals should explain how to reduce risk of adenoma, cancer and other diseases, particularly through diet, physical activity and weight reduction.     

Body composition changes during the first two years of university

Objective

Changes in body weight, composition, and shape were investigated in male and female college students between the freshman and sophomore years.

Methods

Changes in weight, body mass index (BMI), percent and absolute body fat and fat-free mass (via bioelectrical impedance), and waist circumference (via body scans) were assessed over the freshman and sophomore years (2007-2009) among 120 students attending a Southern public university.

Results

Weight (2.5 and 1.7 lbs) and BMI gains (0.3 and 0.3 kg/m²) did not significantly differ between the freshman and sophomore years, respectively. Significantly more percent body fat and fat mass were gained during the freshman (1.9% and 3.3 lbs, respectively) than the sophomore year (0.0% and 0.6 lbs, respectively). Females lost significantly more fat-free mass during the freshman (−0.8 lb) than during the sophomore year (1.0 lb). Changes in waist circumference and weight were significantly correlated. Increases in the percentages of females classified as overweight and with unhealthy body fat amounts and waist circumferences were observed.

Conclusion

While the sophomore year was characterized by slightly healthier body composition changes than the freshman year, the gains in weight, fat mass, and waist circumference measurements suggest increased health risks for many college females.     

Occupational exposure to particulate matter and endotoxin for California dairy workers

Occupational exposure of dairy workers to particulate matter (PM) and endotoxin has been considered by some to be of potential concern. This paper reports personal exposure concentrations of PM (μg/m³) and endotoxin (EU/m³) for 226 workers from 13 California dairies. Arithmetic mean personal concentrations for PM_2.5, inhalable PM and endotoxin were 48 μg/m³ (N = 222), 987 μg/m³ (N = 225) and 453 EU/m³ (N = 225), respectively. Using mixed effects models, time spent re-bedding of freestall barns versus any other job conducted on a dairy led to the highest exposure for PM_2.5, inhalable PM, and endotoxin. Personal exposure concentrations were found to be greater than those reported for ambient area based concentrations at the same dairies. A pseudo R-square approach revealed that one area based measure combined with time spent performing tasks explained a significant portion of variation in personal exposure concentrations.     

Predicting physical activity intention and behaviour among children in a longitudinal sample

We examined predictors of leisure-time physical activity intention and behaviour in children, and the potential direct and moderating effects of gender and ethnicity. Participants were 364 (230 Asian; 134 Caucasian) 9-11-year-old children who completed measures of the theory of planned behaviour (TPB) and physical activity behaviour (Physical Activity Questionnaire for Children) across three, 3-month intervals (i.e., two prediction time-periods) in Canada. The TPB explained 35-50% of the variance in physical activity behaviour and 74-76% of the variance in intention using structural equation modelling. An autoregressive longitudinal path model showed that the TPB predicted changes in physical activity and physical activity predicted changes in TPB constructs (p<.05). Overall, intention and perceived behavioural control were significant (p<.05) contributors to the direct prediction of behaviour and subjective norm and perceived behavioural control were significant (p<.05) predictors of intention. Gender did not show a robust relationship with physical activity or intention, but the effect of ethnicity on physical activity was mediated through perceived behavioural control (Asians less active than Caucasians). Finally, gender and ethnicity did not moderate TPB and physical activity relations (p<.05). These data suggest that childhood may be a formative stage for the development of physical activity cognitions and that promoting physical activity in children may require normative and control-based intervention.     

Psychosocial predictors of eating habits among adults in their mid-30s: The Oslo Youth Study follow-up 1991–1999

Background  

The predictive value of the psychosocial constructs of Theory of Planned Behaviour (TPB) on subsequent dietary habits has not been previously investigated in a multivariate approach that includes demographic factors and past dietary behaviour among adults. The aim of this study was to investigate to what extent TPB constructs, including intention, attitudes, subjective norms, perceived behavioural control, and perceived social norms, measured at age 25 predicted four eating behaviours (intake of fruits and vegetables, whole grains, total fat and added sugar) eight years later.     

The effect of timing of maternal tetanus,diphtheria, and acellular pertussis (Tdap) immunization during pregnancy on newborn pertussis antibody levels – A prospective study

Background

The Centers for Disease Control and Prevention recommend Tdap immunization during pregnancy, preferably at 27–36 weeks.

Aim

To ascertain whether there is a preferential period of maternal Tdap immunization during pregnancy that provides the highest concentration of pertussis-specific antibodies to the newborn.

Methods

This prospective study measured pertussis-specific antibodies in paired maternal-cord sera of women immunized with Tdap after the 20th week of their pregnancy (n = 61).

Results

The geometric mean concentrations (GMCs) of Immunoglobulin G (IgG) to pertussis toxin (PT) were higher in the newborns’ cord sera when women were immunized at 27–30⁺⁶ weeks (n = 21) compared with 31–36 weeks (n = 30) and >36 weeks (n = 7), 46.04 international units/milliliter (IU/mL) (95% CI, 24.29–87.30) vs. 8.69 IU/mL (95% CI, 3.66–20.63) and 21.12 IU/mL (95% CI, 7.93–56.22), p < 0.02, respectively. The umbilical cord GMCs of IgG to filamentous hemagglutinin (FHA) were higher in the newborns’ cord sera when women were immunized at 27–30⁺⁶ weeks compared with 31–36 weeks and >36 weeks, 225.86 IU/mL (95% CI, 182.34–279.76) vs. 178.31 IU/mL (95% CI, 134.59–237.03) and 138.03 IU/mL (95% CI, 97.61–195.16), p < 0.02, respectively.

Conclusions

Immunization of pregnant women with Tdap between 27–30⁺⁶ weeks was associated with the highest umbilical cord GMCs of IgG to PT and FHA compared with immunization beyond 31 weeks gestation. Further research should be conducted to reaffirm these finding in order to promote an optimal pertussis controlling policy.