App-based food Go/No-Go training: User engagement and dietary intake in an opportunistic observational study.

Food Go/No-Go training aims to alter implicit food biases by creating associations between perceiving unhealthy foods and withholding a dominant response. Asking participants to repeatedly inhibit an impulse to approach unhealthy foods can decrease unhealthy food intake in laboratory settings. Less is known about how people engage with app-based Go/No-Go training in real-world settings and how this might relate to dietary outcomes. This pragmatic observational study investigated associations between the number of completed app-based food Go/No-Go training trials and changes in food intake (Food Frequency Questionnaire; FFQ) for different healthy and unhealthy food categories from baseline to one-month follow-up. In total, 1234 participants (m(BMI) = 29 kg/m2, m(age) = 43years, 69% female) downloaded the FoodT app and completed food-Go/No-Go training at their own discretion (mean number of completed sessions = 10.7, sd = 10.3, range: 1-122). In pre-registered analyses, random-intercept linear models predicting intake of different foods, and controlled for baseline consumption, BMI, age, sex, smoking, metabolic syndrome, and dieting status, revealed small, significant associations between the number of completed training trials and reductions in unhealthy food intake (b = -0.0005, CI95= [-0.0007;-0.0003]) and increases in healthy food intake (b = 0.0003, CI95 = [0.0000; 0.0006]). These relationships varied by food category, and exploratory analyses suggest that more temporally spaced training was associated with greater changes in dietary intake. Taken together, these results imply a positive association between the amount of training completed and beneficial changes in food intake. However, the results of this pragmatic study should be interpreted cautiously, as self-selection biases, motivation and other engagement-related factors that could underlie these associations were not accounted for. Experimental research is needed to rule out these possible confounds and establish causal dose-response relationships between patterns of engagement with food Go/No-Go training and changes in dietary intake.

Association between educational level and smoking cessation in an 11-year follow-up study of a national health survey.

Aims: There is a lack of longitudinal, population-based studies on the association between education and smoking cessation. A more thorough examination of this association is needed to address inequalities in smoking. Methods: The longitudinal Health 2000 Survey and Health 2011 Survey, representing the Finnish population aged ⩾30 years, were analysed. Of the 1352 baseline daily smokers, 945 (70%) provided a smoking status at the follow-up. The analytic sample size was 884 (excluding the follow-up occasional smokers). Self-reported questionnaire data and measurements (e.g. plasma cotinine) from the baseline were utilised. The outcome variable was smoking cessation at the follow-up, and the main explanatory variable was education. Logistic regression was the main method for statistical analyses. All of the analyses accounted for the sampling design. Results: At the follow-up, 28% of the baseline daily smokers had quit smoking. An adjusted regression model showed that highly educated respondents had a higher likelihood of quitting smoking compared with those with basic education. Controlling for demographic and health-related variables had a modest effect on this association. Higher scores for plasma cotinine, symptoms of depression and heavy alcohol use were associated with a lower likelihood of quitting smoking. The association between education and smoking cessation was weaker for women than it was for men. Conclusions: High education is associated with smoking cessation among the general adult population, especially among men. A higher plasma cotinine level is strongly associated with continued smoking among both sexes. Background variables only modestly affected the association between education and smoking cessation.

Association of snus experimentation in late adolescence with daily cigarette smoking in early adulthood: A longitudinal study among Finnish men.

Aims: Swedish smokeless tobacco (snus) is a lower-risk tobacco product than cigarette smoking for individuals. However, the public health impact of snus use is less well studied. Critically, it is uncertain whether use of snus leads to the onset of smoking. This study aimed to investigate prospectively the association between snus experimentation in late adolescence and daily cigarette smoking in early adulthood among Finnish young men. Methods: Data were obtained from 1090 young men within the population-based FinnTwin12 cohort. At baseline (mean age 17 years), we assessed lifetime use of cigarettes and snus, plus other potential predictors of cigarette smoking. At follow-up (mean age 24 years), participants were categorized according to their current smoking status. The final analyses were conducted among 375 young men who were never smokers at baseline with adequate data on follow-up smoking status and other potential predictors of cigarette smoking. Results: Age-adjusted logistic regressions showed an increased risk of becoming a daily smoker at follow-up among those participants who had at least tried snus but had never smoked cigarettes at baseline (odds ratio (OR) 6.48, 95% confidence interval (CI) 2.02-20.7), compared with those who had never used snus. When additionally adjusted for monthly alcohol intoxication, maternal smoking, and peer drug use, the association between snus experimentation and later daily cigarette smoking was attenuated, but remained significant (OR 3.94, 95% CI 1.22-12.7). Conclusions: Our data support the proposition that snus experimentation during late adolescence is longitudinally associated with daily cigarette smoking in early adulthood. Although a causal association cannot be inferred with certainty, snus experimentation might constitute an indicator of the propensity to proceed to regular snus use and initiation of use of other tobacco or nicotine products.

Implicit process interventions in eating behaviour: a meta-analysis examining mediators and moderators.

Dual-process models integrate deliberative and impulsive mental systems and predict dietary behaviours better than deliberative processes alone. Computerised tasks such as the Go/No-Go, Stop-Signal, Approach-Avoidance, and Evaluative Conditioning have been used as interventions to directly alter implicit biases. This meta-analysis examines the effects of these tasks on dietary behaviours, explores potential moderators of effectiveness, and examines implicit bias change as a proposed mechanism. Thirty randomised controlled trials testing implicit bias interventions (47 comparisons) were included in a random-effects meta-analysis, which indicated small cumulative effects on eating-related behavioural outcomes (g = -0.17, CI95 = [-0.29; -0.05], p = .01) and implicit biases (g = -0.18, CI95 = [-0.34; -0.02], p = .02). Task type moderated these effects, with Go/No-Go tasks producing larger effects than other tasks. Effects of interventions on implicit biases were positively related to effects on eating behaviour (B = 0.42, CI95 = [0.02; 0.81], p = .03). Go/No-Go tasks seem to have most potential for altering dietary behaviours through implicit processes. While changes in implicit biases seem related to the effects of these interventions on dietary outcomes, more research should explore whether repeated exposure to implicit bias interventions may have any practical intervention value in real world settings.

Randomised controlled feasibility study of a school-based multi-level intervention to increase physical activity and decrease sedentary behaviour among vocational school students.

BACKGROUND: No school-based physical activity (PA) interventions among older adolescents have demonstrated long-term effectiveness, and few of them so far have addressed sedentary behaviour (SB). Based on behavioural theories and evidence, we designed a multi-level intervention to increase PA and decrease SB among vocational school students. This study investigates feasibility and acceptability of two main intervention components and research procedures. We also examine uptake of behaviour change techniques (BCTs) by the participants. METHODS: Design was an outcome assessor blinded, cluster-randomised controlled trial. Four classes of students (matched pairs) were randomised into one intervention and one control arm. The intervention consisted of (1) a 6-h group-based intervention for students, (2) two 2-h training workshops to reduce their students' sitting in class for teachers, and (3) provision of light PA equipment in classrooms. At baseline (T1), mid-intervention (T2) at 3 weeks, post-intervention (T3) and 6 months after baseline (T4) we measured hypothesised psychosocial mediators and self-reported PA and sitting. Objective assessment of PA and SB (7-day accelerometry) was conducted at T1, T3 and T4. Body composition (bioimpedance) was measured at T1 and T4. Students and teachers in the intervention arm filled in acceptability questionnaires at T3. RESULTS: Recruitment rate was 64% (students) and 88.9% (teachers), and at T3, all post-intervention measurements were completed by 33 students (retention 76.7%) and 15 teachers (retention 93.8%). Acceptability ratings of sessions were high (students M = 6.29, scale 1-7), and data collection procedures were feasible. Intervention arm students reported increased use of BCTs, but uptake of some key BCTs was suboptimal. BCT use correlated highly with objective measures of PA. Based on both self-report and student evaluation, teachers in the intervention arm increased the use of sitting reduction strategies at post-intervention and T4 follow-up (p < .05). CONCLUSIONS: We detected willingness of the target groups to participate, good response rates to questionnaires, adequate retention, as well as acceptability of the trial protocol. Investigation of BCT use among students helped further enhance intervention procedures to promote BCT use. After making necessary modifications identified, intervention effectiveness can next be tested in a definitive trial. TRIAL REGISTRATION: ISRCTN34534846 . Registered 23 May 2014. Retrospectively registered.

Family history and perceived risk of diabetes, cardiovascular disease, cancer, and depression.

BACKGROUND: Family history is a useful and inexpensive tool to assess risks of multifactorial diseases. Family history enables individualized disease prevention, but its effects on perceived risks of various diseases need to be understood in more detail. We examined how family history relates to perceived risk of diabetes mellitus, cardiovascular disease (CVD), cancer, and depression, and whether these associations are independent of or moderated by sociodemographic factors, health behavior/weight status (smoking, alcohol consumption, physical activity, BMI [kg/m(2)]), or depressive symptoms. METHODS: Participants were Finnish 25-74-year-olds (N=6258) from a population-based FINRISK 2007 study. Perceived absolute lifetime risks (Brewer et al., 2004; Becker, 1974; Weinstein and Nicolich, 1993; Guttmacher et al., 2004; Yoon et al., 2002) and first-degree family history of CVD, diabetes, cancer and depression, and health behaviors were self-reported. Weight and height were measured in a health examination. RESULTS: Family history was most prevalent for cancer (36.7%), least for depression (19.6%). Perceived risk mean was highest for CVD (2.8), lowest for depression (2.0). Association between family history and perceived risk was strongest for diabetes (ß=0.34, P<0.001), weakest for depression (ß=0.19, P<0.001). Adjusting for sociodemographics, health behavior, and depressive symptoms did not change these associations. The association between family history and perceived risk tended to be stronger among younger than among older adults, but similar regardless of health behaviors or depressive symptoms. DISCUSSION: Association between family history and perceived risk varies across diseases. People's current understandings on heritability need to be acknowledged in risk communication practices. Future research should seek to identify effective strategies to combine familial and genetic risk communication in disease prevention.

Self-esteem growth trajectory from adolescence to mid-adulthood and its predictors in adolescence.

The present study examined the trajectory of self-esteem from adolescence to mid-adulthood and its predictors in adolescence in a prospective cohort sample with a 26-year follow-up. Participants of a Finnish cohort study in 1983 at 16 years (N = 2194) were followed up at ages 22 (N = 1656), 32 (N = 1471) and 42 (N = 1334) years. Self-esteem development was analyzed using latent growth curve models with parental socioeconomic status (SES), parental divorce, school achievement, daily smoking, and heavy drinking as time invariant covariates. Self-esteem grew linearly from 16 to 32 years, but stabilized after that with no growth between 32 and 42 years. Males had significantly higher self-esteem throughout the follow-up, although females had a faster growth rate. Better school performance and higher parental SES were associated with a higher initial level of self-esteem among both genders, while parental divorce among females and daily smoking among males were associated with a lower initial level of self-esteem. Among females the growth rate of self-esteem was practically unaffected by the studied covariates. Among males, however, the initial differences in self-esteem favouring those from a higher SES background were indicated to diminish, while the differences between non-smokers and smokers were indicated to increase. The studied adolescent covariates combined had only limited predictive value for the later self-esteem development. However, the effects of any covariate on the level and slope of the self-esteem trajectory, even if small, should be assessed in combination in order to identify whether they lead to converging, diverging or constantly equidistant self-esteem trajectories. The findings highlight the variety of roles that adolescent behaviours and social environments may have in the developmental process of self-esteem from adolescence into mid-adulthood.

Genetic causal beliefs about morbidity: associations with health behaviors and health outcome beliefs about behavior changes between 1982-2002 in the Finnish population.

BACKGROUND: The role and meaning of genetic information has grown considerably in the recent decades. We examined changes in causal beliefs about morbidity as well as the associations between causal beliefs, health behaviors and obesity, and health outcome beliefs from 1982 to 2002. METHODS: In five population-based risk-factor surveys (the FINRISK Studies) of individuals aged 25 to 64 years conducted from 1982 to 2002 (n = 37,503), respondents chose the most important cause of morbidity from a list of ten alternatives. Health outcome beliefs were assessed with two items. Physical inactivity and smoking status were based on self-reports and obesity was based on measured height and weight. RESULTS: The prevalence of those who endorse genetic factors as the most important cause of morbidity increased from 4% in 1982 to 10% in 1992 and remained at that level until 2002. During the study period, lack of exercise and overweight increased, whereas inappropriate diet and stress diminished as causal beliefs about morbidity. Smokers and physically inactive were more likely to endorse genetic than behavioral causes of morbidity, whereas obese respondents were more likely to choose overweight over genetic causes of morbidity. Those who endorse genetic factors as the most important cause had more pessimistic outcome beliefs about health behavior changes, but these outcome beliefs became more positive in all causal belief groups during the study period. CONCLUSION: Despite increased public discussion of genomics, the relative proportion of those who endorse genetic factors as the most important cause of morbidity has remained low. However, within this group beliefs about benefits of health behavior changes have become more positive. This could indicate that increase in genomic health information does not lead to more negative appraisals of efficacy of lifestyle changes.

Associations of Weight Concerns With Self-Efficacy and Motivation to Quit Smoking: A Population-Based Study Among Finnish Daily Smokers.

INTRODUCTION: Concerns about weight gain occurring after smoking cessation may affect motivation and self-efficacy towards quitting smoking. We examined associations of smoking-specific weight concerns with smoking cessation motivation and self-efficacy in a population-based cross-sectional sample of daily smokers. METHODS: Six-hundred biochemically verified (blood cotinine) current daily smokers comprising 318 men and 282 women aged 25-74 years, were studied as part of the National FINRISK (Finnish Population Survey on Risk Factors on Chronic, Noncommunicable Diseases) study and its DIetary, Lifestyle and Genetic factors in the development of Obesity and Metabolic syndrome (DILGOM) sub-study that was conducted in Finland in 2007. Self-reported scales were used to assess weight concerns, motivation and self-efficacy regarding the cessation of smoking. Multiple regression analyses of concerns about weight in relation to motivation and self-efficacy were conducted with adjustments for sex, age (years), body mass index (BMI, [kg/m(2)]), physical activity (times per week), and further controlled for nicotine dependence (Fagerström Test for Nicotine Dependence). RESULTS: Higher levels of weight concerns were associated with lower self-efficacy (ß = -0.07, p < .001) after adjusting for sex and age. The association remained after additional adjustment for BMI and physical activity (ß = -0.07, p < .001). After further controlling for nicotine dependence the association became weaker but remained significant (ß = -0.04, p = .02). There were no statistically significant associations between concerns about weight and motivation for smoking cessation (ß = 0.02, p = 0.16). CONCLUSIONS: These cross-sectional population-based data do not support earlier findings that suggest that smokers with high levels of weight concerns are less motivated to quit smoking. Our data suggest that daily smokers who are highly concerned about weight may have lower self-efficacy for cessation of smoking.

Smoking, nicotine dependence and nicotine intake by socio-economic status and marital status.

INTRODUCTION: Low socio-economic status (SES) is strongly related to smoking, but studies examining the association of SES with nicotine dependence (ND) are scarce. The aim of this study was to examine the associations of SES and marital status with smoking, multiple measures of ND, and cotinine as a nicotine intake biomarker. METHODS: The sample comprised 1746 ever smokers, sampled from the National FINRISK 2007 Study, who had completed a tobacco specific questionnaire in addition to the standard clinical examination. The Fagerström Test for Nicotine Dependence (FTND), the Heaviness of Smoking Index (HSI), the Nicotine Dependence Syndrome Scale (NDSS), and the Hooked On Nicotine Checklist (HONC) were assessed, while plasma cotinine was measured as a biomarker of nicotine exposure in daily smokers. Univariate and multivariate associations were assessed by linear regression and multinomial logistic regression. RESULTS: In multivariate models, lower education was associated with higher FTND and HSI, income with HSI, and occupation with HSI (men only), FTND, HONC and NDSS scores. Lower education was related to higher cotinine levels among daily smokers, although the association diminished slightly after adjusting for daily smoking amount. Living without a spouse was associated with daily smoking and higher ND. CONCLUSION: In this cross-sectional study low SES was linked with higher ND among current smokers, while low SES was associated with higher cotinine levels among daily smokers. Living alone was linked with higher ND. Longitudinal studies are warranted to further explore these associations. As lower SES smokers are more addicted they may need more targeted cessation services to succeed in quitting smoking.

Weight concerns among Finnish ever-smokers: a population-based study.

INTRODUCTION: Concern over weight gain after smoking cessation has been hypothesized to discourage quit attempts and consequently reduce smoking cessation rates. The aim of this study was to examine the association between smoking status and weight concerns among a population-based sample of Finnish ever-smokers. METHODS: Data were collected in conjunction with the National FINRISK 2007 Study from a population-based sample of 25- to 74-yearold Finns. These analyses were based on a subsample of 1,614 ever-smokers. Participants were divided into 4 groups (daily smokers, occasional smokers, recent quitters, and former smokers) based on the self-reported smoking status. Weight concerns were analyzed as a sum score including 6 items (range 0-24). Regression analyses were used to examine the association between smoking status and weight concerns, while adjusting for multiple confounders. RESULTS: Smoking status was significantly associated with weight concerns, current daily smokers reporting the highest levels of weight concerns. After adjusting for potential confounders (age, gender, body mass index, socioeconomic status, and health behavior), the weight concerns of daily smokers remained significantly higher in comparison with all other groups. Although women were more concerned about their weight than men, no gender-specific associations were found between weight concerns and smoking status. CONCLUSIONS: Current daily smokers are more concerned about their weight than recent quitters, as well as former and occasional smokers. Weight concerns should be taken into account in tobacco dependence treatment.

Sense of coherence, depressive symptoms, cardiovascular diseases, and all-cause mortality.

OBJECTIVE: There is increasing interest in whether positive and negative psychological constructs are bipolar opposites of the same phenomenon. We examine whether a positive construct--sense of coherence (SOC)--has independent predictive power over and above depressive symptoms for cardiovascular disease (CVD) and all-cause mortality. METHODS: Participants included 3850 men and 4083 women aged 25 to 74 years who had participated in risk factor surveys conducted in 1992 or 1997. Antonovsky's 13-item SOC scale was used to measure SOC, and had a correlation of -0.60 with the Beck Depression Inventory. RESULTS: During a mean follow-up time of 14.2 years, there were 670 deaths and 487 nonfatal and fatal CVD events. Higher SOC scores were associated with a lower risk of all-cause mortality (relative risk [RR] = 0.90, 95% confidence interval [CI] = 0.84-0.97 per unit), especially among men, but this association became nonsignificant after adjustment for depressive symptoms (RR = 0.99, 95% CI = 0.90-1.08). Among participants without a history of CVD, higher SOC scores were related to a lower risk for CVD (RR = 0.90, 95% CI = 0.83-0.98), but this association disappeared after adjustment for cardiovascular risk factors. Depressive symptoms remained significant predictors of CVD among women in a model including also SOC (RR = 1.24, 95% CI = 1.06-1.46). CONCLUSIONS: SOC was related to all-cause mortality among men; the association with CVD events was modest. Measures for SOC and depressive symptoms were significantly correlated, which might result in overlap in their associations with adverse disease and mortality outcomes.

Psychosocial consequences of predictive genetic testing for Lynch syndrome and associations to surveillance behaviour in a 7-year follow-up study.

We evaluated long-term psychosocial consequences of predictive genetic testing, and surveillance behaviour in Lynch syndrome (LS). We conducted a longitudinal study of 208 participants (62 LS mutation carriers and 146 non-carriers) who provided information on general anxiety (State-Trait Anxiety Inventory), fear of cancer and dying, satisfaction with life, risk and test perceptions, and surveillance behaviour in the baseline questionnaire before testing, and 1 month, 1 year and 7 years post-test. At 7 years, most of the psychosocial variables remained unchanged, regardless of mutation status. Carriers tended to underestimate their colorectal cancer risk but were more worried about their cancer risk than their counterparts. Non-carriers reported a higher degree of satisfaction with their testing decisions (P < 0.05), but had more doubts concerning test result validity than carriers (P < 0.05). All carriers attended a post-test colonoscopy surveillance, while 16% of non-carriers reported colonoscopy examinations. Those non-carriers with doubts about test validity were more likely (P = 0.019) to report post-test colonoscopy. Of the carriers, 17% had an interval longer than 3 years between their colonoscopies. Fear of dying soon, measured at 1-month post-test follow-up was the only psychosocial variable predicting non-compliance in recommended surveillance. No adverse psychosocial consequences were detected, and respondents were satisfied with their decision to testing 7 years post-test. Among the carriers, solely fear of dying soon predicted non-compliance in recommended surveillance. Some non-carriers were still worried about their risk and had doubts about the validity of their genetic testing results predicting post-test colonoscopy.

Toward identifying a broader range of social cognitive determinants of dietary intentions and behaviors.

BACKGROUND: Measurement of social cognitive variables is often restricted to long-term and health-related outcomes. A more comprehensive measurement of cognitive determinants would enable evidence-based design of health behavior interventions with a focus on the most relevant targets. The purpose of this study was to examine the relative impact of different social cognitive determinants on fruit and vegetable (FV) and fast food consumption. METHODS: Finnish male conscripts (N = 855, age M = 20) filled in questionnaires on social cognitive factors when entering the military service, and on food consumption frequency after two months. The data were analysed using structural equation modeling. RESULTS: Physical well-being expectation and bad taste expectation were most strongly related to both FV and fat avoidance intentions. Perceived weight gain risk predicted fat avoidance intention, whereas perceived risk for other health problems predicted FV intention. Social self-efficacy was associated with FV intention only. Consumption of both FV and fast food was predicted by action planning and intention. CONCLUSIONS: A more careful evaluation of subtypes of social cognitions sheds light on the specific content behind motivation. Such understanding might help in designing more effective intervention messages.

Diurnal Evening Type is Associated with Current Smoking, Nicotine Dependence and Nicotine Intake in the Population Based National FINRISK 2007 Study.

AIMS: To examine whether smoking habits, nicotine dependence (ND) and plasma cotinine levels differ by diurnal type. DESIGN: Data originated from the national FINRISK 2007 survey. Regression analyses were calculated to examine the association between diurnal type and smoking status, ND, and nicotine intake. PARTICIPANTS: 7091 FINRISK participants with smoking and diurnal type information and a subset of 1746 ever smokers with detailed smoking, and ND assessments. MEASUREMENTS: Diurnal type assessed with a six-item sum scale was categorized as morning, intermediate and evening type. Smoking status was determined as current (daily or occasional), former, and never smokers. ND was measured with the Fagerström Test for Nicotine Dependence (FTND), the Hooked on Nicotine Checklist (HONC), and the Nicotine Dependence Syndrome Scale (NDSS). For current smokers, plasma cotinine was analyzed as biochemical measurement of nicotine intake. FINDINGS: Evening type was associated with current smoking (OR=1.66, 95% CI 1.40, 1.97). A significant association with diurnal type was seen for FTND among men (beta= -0.46, 95% CI -0.72, -0.21), sexes combined for HONC (beta= -0.31, 95% CI -0.52, -0.11) and NDSS (beta= -0.86, 95% CI -1.43, -0.29) and for cotinine among men (beta= -0.73, 95% CI -1.16, -0.29). Adjustment for depressive symptoms attenuated the association of diurnal type with NDSS to be non-significant. CONCLUSIONS: Diurnal type was associated with multiple ND measures and nicotine intake, interestingly more so among men. Evening type persons are at higher risk of dependence, but depressive symptoms attenuates this association clearly.

Academic achievement and smoking: is self-efficacy an important factor in understanding social inequalities in Finnish adolescents?

AIMS: Poor academic achievement is strongly related to smoking but studies that examine the mechanism between academic achievement and smoking are lacking. The aim of this study, therefore, was to examine the smoking-related cognitions (i.e. attitude, social influence, self-efficacy and intention to smoke) in relation to academic achievement and determine whether these cognitions explain different patterns of smoking. METHODS: The study uses the data of a longitudinal study that was carried out in Finland, and the sample comprised 1,096 students in grades seven to nine. RESULTS: During the seventh-grade students with poor academic achievement reported more positive attitudes to smoking and a greater social influence of their peers regarding smoking, weaker self-efficacy to refuse smoking and more intentions to smoke in the future compared to students with high academic achievement. Moreover, the follow-up analyses after a 24-month interval revealed that self-efficacy to refuse smoking of students with poor grades had become weaker compared to students with high grades. Furthermore, the influence of seventh-grade academic achievement predicting ninth-grade weekly smoking was partially mediated through the self-efficacy beliefs and the intention to smoke. CONCLUSIONS: Differences in academic achievement may have an impact on adolescents' self-efficacy beliefs and the intention to smoke in the future. To reduce health inequalities a strong input on continuing research to improve smoking prevention methods, especially for students with low academic achievement, is needed.

Longitudinal study of relations between school achievement and smoking behavior among secondary school students in Finland: results of the ESFA study.

The aim of this study was to explore a longitudinal bi-directional relationship between school achievement and smoking behavior. The sample consists of 2,188 Finnish students in grades 7-9. Data were collected at three separate occasions between the years 1998 and 2000. Three hypothesized conceptual models were developed and tested using path analyses by structural equation modeling (SEM). Students that performed poorly at school smoked weekly six times more than those who achieved the highest school grade point averages at the age of 15. Using SEM, the findings suggest that not only does deterioration of school achievement contribute to progression in smoking uptake continuum but also vice versa progression in smoking uptake continuum to deterioration of school achievement over time (CFI = .997). There were no moderating effects of gender or treatment condition in the proposed models. Both deterioration of school achievement and progression in smoking uptake continuum predicted changes in other behavior during the first two years in secondary school in Finland.

Sharing genetic risk with next generation: mutation-positive parents' communication with their offspring in Lynch Syndrome.

Identification of hereditary predisposition to cancer has limited significance if not followed by efficient cancer prevention. The responsibility of informing offspring about genetic risk often falls to the parents. We systematically investigated how parents with Lynch Syndrome share knowledge of genetic risk with their offspring, challenges in the communication process and wish for professional support. Of all known mutation carriers over age 40 (n = 337) in 102 Finnish Lynch Syndrome families, 86% completed a self-reported questionnaire; 248 of them (86%) had children. Of the 248 parents, 87% reported disclosure and 13% nondisclosure. Reasons for nondisclosure were mainly the young age of offspring, socially distant relationships, or feeling of difficulty in discussing the topic. Men reported significantly more often disclosure with a support person (spouse etc.) (P < 0.001). The most difficult communication aspect was discussing children's cancer risk. Of the 191 firstborn adult children informed, 69% had taken the predictive genetic test. Every third parent suggested that health professionals should be involved in passing on the information and that a family appointment at the genetic clinic should be organized at the time of disclosure. Nearly all parents had informed their adult offspring about the genetic risk and possibility of genetic testing, but almost one-third were unsure of how their offspring had used the information. The challenge is to improve the communication processes, so that all offspring would get the information important for their health care, and parents would get the professional support desired at disclosure.

Emotional eating and physical activity self-efficacy as pathways in the association between depressive symptoms and adiposity indicators.

BACKGROUND: There is increasing evidence that depressive symptoms and obesity are positively related, but the mechanisms that explain the association between them are unclear. OBJECTIVE: We examined direct and indirect associations between depressive symptoms, emotional eating, physical activity (PA) self-efficacy (ie, an individual's confidence in his or her ability to overcome barriers to maintain PA behaviors), and adiposity indicators. DESIGN: Structural equation modeling was used to test the hypothesized mediation model in Finnish men (n = 2312) and women (n = 2674) aged 25-74 y from the National Cardiovascular Risk Factor Survey conducted in 2007. The Center for Epidemiologic Studies-Depression Scale, the Three-Factor Eating Questionnaire-R18, and a PA barriers self-efficacy scale were used. Body mass index (BMI), waist circumference (WC), and percentage body fat of participants were measured in a health examination. RESULTS: Depressive symptoms and emotional eating had positive correlations and PA self-efficacy had negative correlations with BMI, WC, and percentage body fat. Elevated depressive symptoms were related to higher emotional eating (ß = 0.38 for men and 0.31 for women) and lower PA self-efficacy (ß = -0.41 for men and -0.31 for women), whereas emotional eating and PA self-efficacy were inversely correlated (r = -0.12 and -0.18, respectively). The positive bivariate associations between depressive symptoms and adiposity indicators became nonsignificant in models that included emotional eating and PA self-efficacy, and both of these factors significantly mediated the effects of depressive symptoms on adiposity indicators. CONCLUSIONS: Psychological factors related to both eating and PA may be relevant in explaining the positive relation between depressive symptoms and adiposity. Interventions that target obesity should take into account the effects of these factors on weight regulation.

Hostility, anger control, and anger expression as predictors of cardiovascular disease.

OBJECTIVE: To examine in a prospective setting whether different hostility measures, including Cynical Distrust, Trait Anger, Anger Out, Anger In, and Anger Control, are related to cardiovascular disease (CVD) and ischemic heart disease (IHD). METHODS: Participants comprised 25- to 74-year-old men (n = 3850) and women (n = 4083), followed up for 10 to 15 years. Trait Anger, Anger Out, Anger In, and Anger Control were assessed with the Spielberger State-Trait Anger Expression Inventory and Cynical Hostility with the Cynical Distrust Scale. Incident CVD and IHD were derived from hospital records/death certificates. Subjects with a history of CVD or IHD at baseline were excluded. RESULTS: Subjects in the lowest Anger Control tertile had a higher risk of first nonfatal and fatal CVD incidence (relative risk [RR], 1.35; 95% confidence interval [CI], 1.06-1.73) than subjects in the highest tertile after adjustment for age, gender, education, marital status, smoking, body mass index, blood pressure, cholesterol, alcohol consumption, and depressive symptoms. Higher Cynical Distrust scores predicted nonfatal and fatal CVD (RR, 1.31; 95% CI, 1.09-1.56) and IHD (RR, 1.37; 95% CI, 1.08-1.74) events after adjustment for age, but these associations disappeared after further adjustment for gender, education, and marital status. Other hostility measures, i.e., Trait Anger, Anger Out, or Anger In, were not related to CVD or IHD outcomes. CONCLUSIONS: This is the first study to show that compared with four other hostility dimensions, low Anger Control predicts CVD events. Further studies should examine whether Anger Control is specific to anger or reflects more general psychosocial factors.