Simon Griffin

Publications of Simon Griffin

• An explanatory randomised controlled trial of a nurse-led, consultation-based intervention to support patients with adherence to taking glucose lowering medication for type 2 diabetes.

  Authors: Andrew Farmer, Wendy Hardeman, Dyfrig Hughes, A Toby Prevost, Youngsuk Kim, Anthea Craven, Jason Oke, Sue Boase, Mary Selwood, Ian Kellar, Jonathan Graffy, Simon Griffin, Stephen Sutton, Ann Louise Kinmonth

  BMC family practice. 04/2012; 13(1):30.

  ABSTRACT: BACKGROUND: Failure to take medication reduces the effectiveness of treatment leading to increased morbidity and mortality. We evaluated the efficacy of a consultation-based intervention toABSTRACT: BACKGROUND: Failure to take medication reduces the effectiveness of treatment leading to increased morbidity and mortality. We evaluated the efficacy of a consultation-based intervention to support objectively-assessed adherence to oral glucose lowering medication (OGLM) compared to usual care among people with type 2 diabetes. METHODS: This was a parallel group randomised trial in adult patients with type 2 diabetes and HbA1c[greater than or equal to]7.5% (58 mmol/mol), prescribed at least one OGLM. Participants were allocated to a clinic nurse delivered, innovative consultation-based intervention to strengthen patient motivation to take OGLM regularly and support medicine taking through action-plans, or to usual care. The primary outcome was the percentage of days on which the prescribed dose of medication was taken, measured objectively over 12 weeks with an electronic medicationmonitoring device (TrackCap, Aardex, Switzerland). The primary analysis was intention-totreat. RESULTS: 211 patients were randomised between July 1, 2006 and November 30, 2008 in 13 British general practices (primary care clinics). Primary outcome data were available for 194 participants (91.9%). Mean (sd) percentage of adherent days was 77.4% (26.3) in the intervention group and 69.0% (30.8) in standard care (mean difference between groups 8.4%, 95% confidence interval 0.2% to 16.7%, p = 0.044). There was no significant adverse impact on functional status or treatment satisfaction. CONCLUSIONS: This well-specified, theory based intervention delivered in a single session of 30 min in primary care increased objectively measured medication adherence, with no adverse effect on treatment satisfaction. These findings justify a definitive trial of this approach to improving medication adherence over a longer period of time, with clinical and cost-effectiveness outcomes to inform clinical practice. Trial registration Current Controlled Trials ISRCTN30522359.

• Predictors of suboptimal glycaemic control in type 2 diabetes patients: The role of medication adherence and body mass index in the relationship between glycaemia and age.

  Authors: Alexander Nagrebetsky, Simon Griffin, Ann Louise Kinmonth, Stephen Sutton, Anthea Craven, Andrew Farmer

  Diabetes research and clinical practice. 01/2012;

  AIMS: To analyse predictors of glycaemic control including medication adherence and body mass index (BMI) in UK general practice patients with sub-optimally controlled type 2 diabetes. METHODS:AIMS: To analyse predictors of glycaemic control including medication adherence and body mass index (BMI) in UK general practice patients with sub-optimally controlled type 2 diabetes. METHODS: Baseline demographic, health- and treatment-related measures were evaluated as predictors of one year glycaemic control defined separately as HbA(1c)≤7.5% and a continuous measure of HbA(1c) concentration, using multivariate regression models. Significant predictors were adjusted for objectively assessed medication adherence and BMI. RESULTS: One-year HbA(1c) concentration was associated with baseline HbA(1c) (p<0.001), BMI (p=0.02), and inversely associated with age (p=0.007) and objectively assessed adherence. Adherent patients had one-year (adjusted) HbA(1c) concentration 0.65% (95% CI -1.04, -0.25; p=0.001) lower than nonadherent. Odds ratios (95% CI) of HbA(1c)≤7.5% for 10-year higher age were 1.63 (1.08, 2.45); for adherent compared to non-adherent patients 1.89 (0.84, 4.25); for patients receiving >5 compared to ≤5 medications 0.32 (0.13, 0.76); and for each 1% increment in baseline HbA(1c) 0.48 (0.31, 0.73). CONCLUSIONS: The lower HbA(1c) achieved from greater adherence to glucose lowering treatment is comparable to that achieved with additional medication. Relationships between older age and better glycaemic control are not explained by better adherence, but may partly relate to lower BMI.

• Correlates of time spent walking and cycling to and from work: baseline results from the commuting and health in Cambridge study.

  Authors: Jenna Panter, Simon Griffin, Andrew Jones, Roger Mackett, David Ogilvie

  The international journal of behavioral nutrition and physical activity. 11/2011; 8:124.

  Environmental perceptions and psychological measures appear to be associated with walking and cycling behaviour; however, their influence is still unclear. We assessed these associations usingEnvironmental perceptions and psychological measures appear to be associated with walking and cycling behaviour; however, their influence is still unclear. We assessed these associations using baseline data from a quasi-experimental cohort study of the effects of major transport infrastructural developments in Cambridge, UK. Postal surveys were sent to adults who travel to work in Cambridge (n = 1582). Questions asked about travel modes and time spent travelling to and from work in the last week, perceptions of the route, psychological measures regarding car use and socio-demographic characteristics. Participants were classified into one of two categories according to time spent walking for commuting ('no walking' or 'some walking') and one of three categories for cycling ('no cycling', '1-149 min/wk' and ' ≥ 150 min/wk'). Of the 1164 respondents (68% female, mean (SD) age: 42.3 (11.4) years) 30% reported any walking and 53% reported any cycling to or from work. In multiple regression models, short distance to work and not having access to a car showed strong positive associations with both walking and cycling. Furthermore, those who reported that it was pleasant to walk were more likely to walk to or from work (OR = 4.18, 95% CI 3.02 to 5.78) and those who reported that it was convenient to cycle on the route between home and work were more likely to do so (1-149 min/wk: OR = 4.60, 95% CI 2.88 to 7.34; ≥ 150 min/wk: OR = 3.14, 95% CI 2.11 to 4.66). Positive attitudes in favour of car use were positively associated with time spent walking to or from work but negatively associated with cycling to or from work. Strong perceived behavioural control for car use was negatively associated with walking. In this relatively affluent sample of commuters, a range of individual and household characteristics, perceptions of the route environment and psychological measures relating to car use were associated with walking or cycling to and from work. Taken together, these findings suggest that social and physical contexts of travel decision-making should be considered and that a range of influences may require to be addressed to bring about behaviour change.

• Food and drink consumption at school lunchtime: the impact of lunch type and contribution to overall intake in British 9-10-year-old children.

  Authors: Flo Harrison, Amy Jennings, Andy Jones, Ailsa Welch, Esther van Sluijs, Simon Griffin, Aedín Cassidy

  Public health nutrition. 09/2011;

  OBJECTIVE: To examine the differences in dietary intakes of children consuming school meals and packed lunches, the contribution of lunchtime intake to overall dietary intake, and how lunchtimeOBJECTIVE: To examine the differences in dietary intakes of children consuming school meals and packed lunches, the contribution of lunchtime intake to overall dietary intake, and how lunchtime intake relates to current food-based recommendations for school meals. DESIGN: Cross-sectional analysis of overall intake of macronutrients and food choice from 4 d food diaries and school lunchtime intake from the two diary days completed while at school. SETTING: Norfolk, UK. SUBJECTS: One thousand six hundred and twenty-six children (aged 9-10 years) attending ninety Norfolk primary schools. RESULTS: At school, lunchtime school meal eaters consumed more vegetables, sweet snacks, chips, starchy foods and milk, and less squash/cordial, fruit, bread, confectionery and savoury snacks than packed lunch eaters. These differences were also reflected in the overall diet. On average school meal eaters met the School Food Trust (SFT) food-based standards, while food choices among packed lunch eaters were less healthy. The contribution of food consumed at school lunchtime to overall diet varied by food and lunch type, ranging from 0·8 % (milk intake in packed lunches) to 74·4 % (savoury snack intake in packed lunches). CONCLUSIONS: There were significant differences in the foods consumed by school meal and packed lunch eaters, with food choices among school meal eaters generally in line with SFT standards. The food choices made at school lunchtime make a significant contribution to overall diet.

• Breakfast consumption and daily physical activity in 9-10-year-old British children.

  Authors: Pauline Aj Vissers, Andy P Jones, Kirsten Corder, Amy Jennings, Esther Mf van Sluijs, Ailsa Welch, Aedin Cassidy, Simon Griffin

  Public health nutrition. 09/2011;

  OBJECTIVE: To examine the association between breakfast consumption and physical activity in a well-characterised sample of English children. DESIGN: Cross-sectional study using food diaries toOBJECTIVE: To examine the association between breakfast consumption and physical activity in a well-characterised sample of English children. DESIGN: Cross-sectional study using food diaries to record breakfast consumption and accelerometry to assess physical activity. SETTING: Norfolk county, England. SUBJECTS: Children (n 1697) aged 9-10 years from the SPEEDY (Sport, Physical Activity and Eating behaviour: Environmental Determinants in Young people) study. RESULTS: Boys who consumed a poor-quality breakfast based on dairy product, cereal and fruit intakes spent approximately 7 min more time in moderate-to-vigorous physical activity (MVPA) during weekday afternoons and evenings compared with those who did not consume breakfast (P < 0·05). On weekend days, boys who consumed a poor- or good-quality breakfast spent approximately 6 and 5 min less time respectively being sedentary during the mornings compared with breakfast non-consumers (P < 0·05). Boys who consumed a good-quality breakfast spent almost 3 min more in MVPA during the morning on weekend days compared with non-consumers, and boys who consumed a poor- or good-quality breakfast were 22 % and 16 % more active overall respectively than breakfast non-consumers (P < 0·05). During the rest of the day, boys who consumed a good-quality breakfast spent about 11 min less time being sedentary (P < 0·05) and 7 min more time in MVPA (P < 0·01). CONCLUSIONS: Although some associations between breakfast consumption and physical activity were detected for boys, the present study does not provide strong evidence that failing to consume breakfast, or having a low energy intake at breakfast time, is detrimental to children's physical activity levels.

• The influence of distance to school on the associations between active commuting and physical activity.

  Authors: Jenna Panter, Andrew Jones, Esther Van Sluijs, Simon Griffin

  Pediatric exercise science. 02/2011; 23(1):72-86.

  The purpose of this cross-sectional study was to examine the associations between active commuting behavior, levels of physical activity and distance to school in 9-10 year old children. ParticipantsThe purpose of this cross-sectional study was to examine the associations between active commuting behavior, levels of physical activity and distance to school in 9-10 year old children. Participants were children (n = 1824) who took part in the SPEEDY study (Sport, Physical activity and Eating behavior: Environmental Determinants in Young people). For both boys and girls, significant positive associations were observed between walking to school and physical activity and moderate-to-vigorous physical activity during weekday journey times (8-9 am and 3-4 pm), and the size of association also became stronger with increasing distance from school. Promotion of active commuting to school might be an important way to increase levels of physical activity in school children.

• Environmental and psychological correlates of older adult's active commuting.

  Authors: Jenna R Panter, Andrew P Jones, Esther M F van Sluijs, Simon J Griffin, Nicholas J Wareham

  Medicine and science in sports and exercise. 12/2010; 43(7):1235-43.

  This study explored the environmental and psychological correlates of active commuting in a sample of adults from the European Prospective Investigation into Cancer Norfolk cohort. Members of theThis study explored the environmental and psychological correlates of active commuting in a sample of adults from the European Prospective Investigation into Cancer Norfolk cohort. Members of the cohort who were in employment, lived within 10 km of work, and did not report a limitation that precluded walking were included in this analysis. Psychological factors, perceptions of the neighborhood environment and travel mode to work were reported using questionnaires. Neighborhood and route environmental characteristics were estimated objectively using a geographical information system. The mediating effects of psychological factors were assessed using a series of regression models. A total of 1279 adults (mean age=60.4 yr, SD=5.4 yr) were included in this analysis, of whom 25% actively commuted to work. In multivariable regression analyses, those who reported strong habits for walking or cycling were more likely to actively commute, whereas those living 4-10 km from work were less likely to actively commute. In addition, living in a rural area was associated with a decreased likelihood of men's active commuting, and in women, living in a neighborhood with high road density and having a route to work that was not on a main or secondary road was associated with an increased likelihood of active commuting. There was weak evidence that habit acted to partly mediate the associations between environmental correlates and active commuting in both sexes. The findings suggest that interventions designed to encourage the development of habitual behaviors for active commuting may be effective, especially among those living close to work.

• Commuting and health in Cambridge: a study of a 'natural experiment' in the provision of new transport infrastructure.

  Authors: David Ogilvie, Simon Griffin, Andy Jones, Roger Mackett, Cornelia Guell, Jenna Panter, Natalia Jones, Simon Cohn, Lin Yang, Cheryl Chapman

  BMC public health. 11/2010; 10:703.

  Modifying transport infrastructure to support active travel (walking and cycling) could help to increase population levels of physical activity. However, there is limited evidence for the effects ofModifying transport infrastructure to support active travel (walking and cycling) could help to increase population levels of physical activity. However, there is limited evidence for the effects of interventions in this field, and to the best of our knowledge no study has convincingly demonstrated an increase in physical activity directly attributable to this type of intervention. We have therefore taken the opportunity presented by a 'natural experiment' in Cambridgeshire, UK to establish a quasi-experimental study of the effects of a major transport infrastructural intervention on travel behaviour, physical activity and related wider health impacts. The Commuting and Health in Cambridge study comprises three main elements: a cohort study of adults who travel to work in Cambridge, using repeated postal questionnaires and basic objective measurement of physical activity using accelerometers; in-depth quantitative studies of physical activity energy expenditure, travel and movement patterns and estimated carbon emissions using household travel diaries, combined heart rate and movement sensors and global positioning system (GPS) receivers; and a longitudinal qualitative interview study to elucidate participants' attitudes, experiences and practices and to understand how environmental and social factors interact to influence travel behaviour, for whom and in what circumstances. The impacts of a specific intervention - the opening of the Cambridgeshire Guided Busway - and of other changes in the physical environment will be examined using a controlled quasi-experimental design within the overall cohort dataset. Addressing the unresolved research and policy questions in this area is not straightforward. The challenges include those of effectively combining different disciplinary perspectives on the research problems, developing common methodological ground in measurement and evaluation, implementing robust quantitative measurement of travel and physical activity behaviour in an unpredictable 'natural experiment' setting, defining exposure to the intervention, defining controls, and conceptualising an appropriate longitudinal analytical strategy.

• More than measurement: practice team experiences of screening for type 2 diabetes.

  Authors: Jonathan Graffy, Julie Grant, Kate Williams, Simon Cohn, Sara Macbay, Simon Griffin, Ann Louise Kinmonth

  Family practice. 08/2010; 27(4):386-94.

  The feasibility, cost-effectiveness and best means to implement population screening for type 2 diabetes remain to be established. To learn from the experiences of practice staff undertaking aThe feasibility, cost-effectiveness and best means to implement population screening for type 2 diabetes remain to be established. To learn from the experiences of practice staff undertaking a diabetes screening programme in order to inform future screening initiatives. Qualitative analysis of interviews with staff in six general practices in the 'ADDITION-Cambridge' trial; three randomly allocated to intensively manage screen-detected patients and three providing usual care. We conducted semi-structured interviews with seven nurses, four doctors, three health care assistants and four managers. Four researchers analysed the transcripts practice by practice, preparing vignettes and comparing interpretations. Participants commented on a summary report. Each practice team implemented the screening and intervention programme differently, depending on numbers at risk and decisions about staff contributions. Several emphasized the importance of administrative support. As they screened, they extended the reach of the programme, testing patients outside the target group if requested, checking other risk factors, providing health information and following up people with impaired glucose tolerance. Staff felt that patients accepted the screening and subsequent management as any other clinical activity. Although those developing screening programmes attempt to standardize them, primary care teams need to adapt the work to fit local circumstances. Staff need a sense of ownership, training, well-designed information technology systems and protected time. Furthermore, screening is more than measurement; at the individual level, it is a complete health care interaction, requiring individual explanations, advice on health-related behaviour and appropriate follow-up. The UK 'NHS Health Checks' programme should embrace these findings.

• Impact of neighbourhood food environment on food consumption in children aged 9-10 years in the UK SPEEDY (Sport, Physical Activity and Eating behaviour: Environmental Determinants in Young people) study.

  Authors: Paula Skidmore, Ailsa Welch, Esther van Sluijs, Andrew Jones, Ian Harvey, Flo Harrison, Simon Griffin, Aedín Cassidy

  Public health nutrition. 07/2010; 13(7):1022-30.

  Poor diet in childhood increases risk of obesity but the relationship between access to food and children's food choice is underexplored. We determined relationships between distance to and densityPoor diet in childhood increases risk of obesity but the relationship between access to food and children's food choice is underexplored. We determined relationships between distance to and density of food outlets on children's food choice. Children (n 1721) aged 9-10 years who participated in a cross-sectional study from a sample of state and private schools across urban and rural areas. Food consumption was reported using a short validated FFQ. A Geographic Information System was used to determine proximity to local food outlets. Multivariable regression analyses were performed to determine associations between food consumption and distance to and density of local food outlets. Norfolk, England. Boys (n 754) and girls (n 967) aged 9-10 years. The impact of distance to or density of food outlets on food choice was small after adjustment. Living further away from a supermarket increased portions of fruit (0.11 portions/week per 1 km increase in distance to nearest supermarket, P < 0.05) and vegetables (0.11 portions/week, P < 0.05) consumed. Living closer to convenience stores was also associated with an increased consumption of crisps, chocolate and white bread. Density of supermarkets was associated with both an increase in vegetable intake (0.31 portions/week, P < 0.05) and unhealthy foods. Distance to and density of food outlets are both associated with children's food choice, although the impact appears to be small and the relationship is complex. However, the effects of individual foods combined could be important, particularly as even small differences in intake can impact on body weight over time.

• Randomised controlled trial of the effects of physical activity feedback on awareness and behaviour in UK adults: the FAB study protocol [ISRCTN92551397]

  Authors: Clare Watkinson, van Sluijs Esther, Stephen Sutton, Theresa Marteau, Simon Griffin

  BMC Public Health. 01/2010;

  Abstract Background While there are increasing data implicating poor recognition of physical inactivity as a potential barrier to healthy behaviour change, the efficacy of feedback to promoteAbstract Background While there are increasing data implicating poor recognition of physical inactivity as a potential barrier to healthy behaviour change, the efficacy of feedback to promote physical activity is uncertain. Using a randomised controlled trial nested within a population-based cohort study, we plan to test three variations of physical activity feedback against a control group. Our primary objective is to assess the efficacy of physical activity feedback in promoting physical activity behaviour change. Secondary objectives are to determine the influence of feedback on physical activity awareness and cognitions, and to compare behavioural effects by type of feedback. Methods/Design We aim to recruit 500 healthy participants aged 30 to 55 years from the ongoing Fenland Study (Cambridge, UK). Following careful phenotyping during baseline measurement (anthropometric, clinical, body composition and fitness measurements, as well as questionnaires assessing self-reported and self-rated physical activity, psychosocial correlates of physical activity behaviour, diet, lifestyle and general health), participants wear a combined heart rate and movement sensor (Actiheart^®) for six continuous days and nights. After receipt of the physical activity data (around 2 weeks later), participants are randomly allocated to either a control group (no feedback) or one of three types of personalised physical activity feedback ('simple', 'visualised' or 'contextualised'), and complete repeat measures of self-rated physical activity and psychosocial correlates. Approximately five weeks after receiving feedback, all participants wear the Actiheart^®for another six-day follow-up period and complete repeat questionnaires. Values at outcome, adjusted for baseline, will be compared between randomised groups. Discussion Given the randomised trial design and use of objective measure of physical activity, this study is likely to provide valuable insights into the efficacy of a feedback intervention in changing physical activity behaviour, as well as the psychological mechanisms involved. Trial Registration Current Controlled Trials: ISRCTN92551397

• Who will increase their physical activity? Predictors of change in objectively measured physical activity over 12 months in the ProActive cohort

  Authors: Rebecca Simmons, van Sluijs Esther, Wendy Hardeman, Stephen Sutton, Simon Griffin

  BMC Public Health. 01/2010;

  Abstract Background The aim was to identify predictors of change in objectively measured physical activity over 12 months in the ProActive cohort to improve understanding of factors influencingAbstract Background The aim was to identify predictors of change in objectively measured physical activity over 12 months in the ProActive cohort to improve understanding of factors influencing change in physical activity. Methods ProActive is a physical activity promotion trial that took place in Eastern England (1999-2004). 365 offspring of people with type 2 diabetes underwent measurement of physical activity energy expenditure (PAEE) using heart rate monitoring, fitness, and anthropometric and biochemical status at baseline and 1 year ( n = 321). Linear regression was used to quantify the associations between baseline demographic, clinical, psychosocial and behavioural variables and change in PAEE over 12 months. This study is registered as ISRCTN 61323766. Results ProActive participants significantly increased their PAEE by 0.6 kj/min (SD 4.2, p = 0.006) over one year, the equivalent of around 20 minutes brisk walking/day. Male sex and higher fitness at baseline predicted increase in PAEE. No significant associations were found for any other variables. Very few baseline demographic, clinical, psychosocial and behavioural predictors were associated with change in objectively measured physical activity. Conclusions Traditional baseline determinants of self-reported physical activity targeted by behavioural interventions may be relatively weak predictors of change in objectively measured physical activity. Further research is needed to improve our understanding of factors influencing change in physical activity to inform the development and targeting of interventions.

• An investigation of patterns of children's sedentary and vigorous physical activity throughout the week

  Authors: Rebekah Steele, van Sluijs Esther, Stephen Sharp, Jill Landsbaugh, Ulf Ekelund, Simon Griffin

  International Journal of Behavioral Nutrition and Physical Activity. 01/2010;

  Abstract Background Participation in higher intensity activity (i.e. vigorous physical activity [VPA]) appears more consistently associated with lower adiposity, unfortunately little is known aboutAbstract Background Participation in higher intensity activity (i.e. vigorous physical activity [VPA]) appears more consistently associated with lower adiposity, unfortunately little is known about the nature and patterns of VPA participation in children. Objective To examine the volume and patterns of vigorous and sedentary activity during different segments of the week (weekend, school-based and out-of-school). We also investigated differences by sex, socioeconomic status (SES) and weight status. Design A cross-sectional study including 1568 UK children aged 9-10 years. Outcome measures Sedentary activity (mins), total activity (counts/min) and VPA (mins) were measured by accelerometry. Using a series of 2 level mixed effects linear regression models we tested differences across the segmented week (school time [0900-1500] vs. out-of-school time [0700-0900 & 1500-2100]; and weekday vs. weekend); all models were adjusted for sex, weight status (gender- and age-specific body mass index [BMI] cut points), SES, age and accelerometer registered wear time. Results Boys and girls accumulated higher VPA out-of-school compared to during school (boys mean ± SD 16.9 ± 9.6 vs 12.6 ± 5.8; girls, 13.1 ± 7.7 vs 8.2 ± 4.0, both p < 0.001); but there were no differences for weekday v weekend VPA (p > 0.05). Less time was spent sedentary on weekdays compared to weekends (p < 0.001). Although boys were more physically active and girls accumulated more sedentary time, the overall pattern in which their physical activity intensity varied across the various day segments was similar when stratified by weight status and SES; and large volumes of sedentary time were observed each hour across the day. Conclusions The promotion of VPA during the weekend may hold the greatest promise for increasing VPA. Interventions aimed at increasing physical activity in 9-10 year old children should aim to target all children independent of sex, SES or weight status.

• Impact of informed-choice invitations on diabetes screening knowledge, attitude and intentions: an analogue study

  Authors: Eleanor Mann, Ian Kellar, Stephen Sutton, Ann Kinmonth, Matthew Hankins, Simon Griffin, Theresa Marteau

  BMC Public Health. 01/2010;

  Abstract Background Despite concerns that facilitating informed choice would decrease diabetes screening uptake, &apos;informed choice&apos; invitations that increased knowledge did not affectAbstract Background Despite concerns that facilitating informed choice would decrease diabetes screening uptake, &apos;informed choice&apos; invitations that increased knowledge did not affect attendance (the DICISION trial). We explored possible reasons using data from an experimental analogue study undertaken to develop the invitations. We tested a model of the impact on knowledge, attitude and intentions of a diabetes screening invitation designed to facilitate informed choices. Methods 417 men and women aged 40-69 recruited from town centres in the UK were randomised to receive either an invitation for diabetes screening designed to facilitate informed choice or a standard type of invitation. Knowledge of the invitation, attitude towards diabetes screening, and intention to attend for diabetes screening were assessed two weeks later. Results Attitude was a strong predictor of screening intentions (β = .64, p = .001). Knowledge added to the model but was a weak predictor of intentions (β = .13, p = .005). However, invitation type did not predict attitudes towards screening but did predict knowledge (β = -.45, p = .001), which mediated a small effect of invitation type on intention (indirect β = -.06, p = .017). Conclusions These findings may explain why information about the benefits and harms of screening did not reduce diabetes screening attendance in the DICISION trial.

  Download

• Impact of informed-choice invitations on diabetes screening knowledge, attitude and intentions: an analogue study.

  Authors: Eleanor Mann, Ian Kellar, Stephen Sutton, Ann Louise Kinmonth, Matthew Hankins, Simon Griffin, Theresa M Marteau

  BMC public health. 01/2010; 10:768.

  Despite concerns that facilitating informed choice would decrease diabetes screening uptake, 'informed choice' invitations that increased knowledge did not affect attendance (the DICISION trial). WeDespite concerns that facilitating informed choice would decrease diabetes screening uptake, 'informed choice' invitations that increased knowledge did not affect attendance (the DICISION trial). We explored possible reasons using data from an experimental analogue study undertaken to develop the invitations. We tested a model of the impact on knowledge, attitude and intentions of a diabetes screening invitation designed to facilitate informed choices. 417 men and women aged 40-69 recruited from town centres in the UK were randomised to receive either an invitation for diabetes screening designed to facilitate informed choice or a standard type of invitation. Knowledge of the invitation, attitude towards diabetes screening, and intention to attend for diabetes screening were assessed two weeks later. Attitude was a strong predictor of screening intentions (β = .64, p = .001). Knowledge added to the model but was a weak predictor of intentions (β = .13, p = .005). However, invitation type did not predict attitudes towards screening but did predict knowledge (β = -.45, p = .001), which mediated a small effect of invitation type on intention (indirect β = -.06, p = .017). These findings may explain why information about the benefits and harms of screening did not reduce diabetes screening attendance in the DICISION trial.

• Impact of an informed choice invitation on uptake of screening for diabetes in primary care (DICISION): randomised trial.

  Authors: Theresa M Marteau, Eleanor Mann, A Toby Prevost, Joana C Vasconcelos, Ian Kellar, Simon Sanderson, Michael Parker, Simon Griffin, Stephen Sutton, Ann Louise Kinmonth

  BMJ (Clinical research ed.). 01/2010; 340:c2138.

  To compare the effect of an invitation promoting informed choice for screening with a standard invitation on attendance and motivation to engage in preventive action. Randomised controlledTo compare the effect of an invitation promoting informed choice for screening with a standard invitation on attendance and motivation to engage in preventive action. Randomised controlled trial. Four English general practices. 1272 people aged 40-69 years, at risk for diabetes, identified from practice registers using a validated risk score and invited to attend for screening. Intervention was a previously validated invitation to inform the decision to attend screening, presenting diabetes as a serious potential problem, and providing details of possible costs and benefits of screening and treatment in text and pie charts. This was compared with a brief, standard invitation simply describing diabetes as a serious potential problem. The primary end point was attendance for screening. The secondary outcome measures were intention to make changes to lifestyle and satisfaction with decisions made among attenders. The primary end point was analysed for all 1272 participants. 55.8% (353/633) of those in the informed choice group attended for screening, compared with 57.6% (368/639) in the standard invitation group (mean difference -1.8%, 95% confidence interval -7.3% to 3.6%; P=0.51). Attendance was lower among the more deprived group (most deprived third 47.5% v least deprived third 64.3%; P<0.001). Interaction between deprivation and effect of invitation type on attendance was not significant. Among attenders, intention to change behaviour was strong and unaffected by invitation type. Providing information to support choice did not adversely affect attendance for screening for diabetes. Those from more socially deprived groups were, however, less likely to attend, regardless of the type of invitation received. Further attention to invitation content alone is unlikely to achieve equity in uptake of preventive services. Current Controlled Trials ISRCTN 73125647.

• Validation of a maternal questionnaire on correlates of physical activity in preschool children.

  Authors: Alison McMinn, Esther van Sluijs, Nicholas Harvey, Cyrus Cooper, Hazel Inskip, Keith Godfrey, Simon Griffin

  The international journal of behavioral nutrition and physical activity. 12/2009; 6(1):81.

  ABSTRACT: BACKGROUND: Valid measures of physical activity correlates in preschool children are lacking. This study aimed to assess the validity, factor structure and internal consistency of aABSTRACT: BACKGROUND: Valid measures of physical activity correlates in preschool children are lacking. This study aimed to assess the validity, factor structure and internal consistency of a maternal questionnaire on potential correlates of four-year-old children's physical activity. METHODS: The questionnaire was designed to measure the following constructs: child personal factors; parental support and self-efficacy for providing support; parental rules and restrictions; maternal attitudes and perceptions; maternal behaviour; barriers to physical activity; and the home and local environments. Two separate studies were conducted. Study I included 24 mothers of four-year-old children who completed the questionnaire then participated in a telephone interview covering similar items to the questionnaire. To assess validity, the agreement between interview and questionnaire responses was assessed using Cohen's kappa and percentage agreement. Study II involved 398 mothers of four-year-old children participating in the Southampton Women's Survey. In this study, principal components analysis was used to explore the factor structure of the questionnaire to aid future analyses with these data. The internal consistency of the factors identified was assessed using Cronbach's alpha. RESULTS: Kappa scores showed 30% of items to have moderate agreement or above, 23% to have fair agreement and 47% to have slight or poor agreement. However, 89% of items had fair agreement as assessed by percentage agreement ([greater than or equal to]66%). Limited variation in responses to variables is likely to have contributed to some of the low kappa values. Six questions had a low kappa and low percentage agreement (defined as poor validity); these included questions from the child personal factors, maternal self-efficacy, rules and restrictions, and local environment domains. The principal components analysis identified eleven factors and found several variables to stand alone. Eight of the composite factors identified had acceptable internal consistency (alpha[greater than or equal to]0.60) and three fell just short of achieving this (0.60>alpha>0.50). CONCLUSIONS: Overall, this maternal questionnaire had reasonable validity and internal consistency for assessing potential correlates of physical activity in young children. With minor revision, this could be a useful tool for future research in this area. This, in turn, will aid the development of interventions to promote physical activity in this age group.

• Applied public health research - falling through the cracks?

  Authors: Rebecca Simmons, David Ogilvie, Simon Griffin, Lincoln Sargeant

  BMC public health. 09/2009; 9(1):362.

  ABSTRACT: Background There is a degree of dissonance between the types of evaluative research required by organisations providing or commissioning health care, those recommended by organisationsABSTRACT: Background There is a degree of dissonance between the types of evaluative research required by organisations providing or commissioning health care, those recommended by organisations developing evidence-based guidance, and those which research funding bodies are prepared to support. Methods We present a case study of efforts to establish a pragmatic but robust evaluation of local exercise referral schemes. We considered the epidemiological, ethical and practical advantages and disadvantages of a number of study designs and applied for research funding based on an uncontrolled design, outlining the difficulties of carrying out a randomised controlled trial to evaluate an existing service. Results Our proposal was praised for its relevance and clear patient outcomes, but the application was twice rejected because both funders and reviewers insisted on a randomised controlled trial design, which we had found to be impractical, unacceptable to service users and potentially unethical. Conclusions The case study highlights continuing challenges for applied public health research in the current funding climate.

• Environmental supportiveness for physical activity in English schoolchildren: a study using Global Positioning Systems.

  Authors: Andrew Jones, Emma Coombes, Simon Griffin, Esther van Sluijs

  The international journal of behavioral nutrition and physical activity. 08/2009; 6(1):42.

  ABSTRACT: BACKGROUND: There is increasing evidence that the environment plays a role in influencing physical activity in children and adults. As children have less autonomy in their behaviouralABSTRACT: BACKGROUND: There is increasing evidence that the environment plays a role in influencing physical activity in children and adults. As children have less autonomy in their behavioural choices, neighbourhood environment supportiveness may be an important determinant of their ability to be active. Yet we know rather little about the types of environment that children use for bouts of physical activity. This study uses accelerometery and global positioning system technologies to identify the characteristics of environments being used for bouts of continuous moderate to vigorous physical activity (MVPA) in a sample of English schoolchildren. METHODS: The sample was 100 children from SPEEDY (Sport, Physical activity and Eating behaviour: Environmental Determinants in Young people), a cohort of 2064 9-10 year-olds from Norfolk, England, recruited in 2007. Children wore an ActiGraph GT1M accelerometer and a Garmin Forerunner 205 GPS unit over four consecutive days. Accelerometery data points were matched to GPS locations and bouts (5 minutes or more) of MVPA were identified. Bout locations were overlaid with a detailed landcover dataset developed in a GIS to identify the types of environment associated with MVPA. Findings are presented using descriptive statistics. RESULTS: Boys were more active than girls, spending an average of 20 (SD 23) versus 11 (SD 15) minutes per day in MVPA bouts. Children who spent more time outside the home were more active (p=0.002), especially girls and children living in rural locations (both p<0.05). Children tended to be active close to home, with 62.5% of all recorded bouts occurring inside neighbourhoods, although boys (p=0.05) and rural children (p=0.01) were more likely to roam outside their neighbourhood. Amongst urban children, gardens (28% of bout time) and the street environment (20%) were the most commonly used environments for MVPA bouts. Amongst rural children farmland (22%) and grassland (17%) were most frequently used. CONCLUSIONS: The study has developed a new method for the identification of environments in which bouts of continuous physical activity are undertaken. The results highlight the importance of the provision of urban gardens and green spaces, and the maintenance of safe street environments as places for children to be active.

• Randomised controlled trial of the efficacy of aerobic exercise in reducing metabolic risk in healthy older people: The Hertfordshire Physical Activity Trial.

  Authors: Francis Finucane, Jessica Horton, Lisa Purslow, David Savage, Soren Brage, Herve Besson, Kenneth Horton, Ema De Lucia Rolfe, Alison Sleigh, Stephen Sharp, Helen Martin, Avan Ahie Sayer, Cyrus Cooper, Ulf Ekelund, Simon Griffin, Nicholas Wareham

  BMC endocrine disorders. 07/2009; 9(1):15.

  ABSTRACT: BACKGROUND: While there are compelling observational data confirming that individuals who exercise are healthier, the efficacy of aerobic exercise interventions to reduce metabolic risk andABSTRACT: BACKGROUND: While there are compelling observational data confirming that individuals who exercise are healthier, the efficacy of aerobic exercise interventions to reduce metabolic risk and improve insulin sensitivity in older people has not been fully elucidated. Furthermore, while low birth weight has been shown to predict adverse health outcomes later in life, its influence on the response to aerobic exercise is unknown. Our primary objective is to assess the efficacy of a fully supervised twelve week aerobic exercise intervention in reducing clustered metabolic risk in healthy older adults. A secondary objective is to determine the influence of low birth weight on the response to exercise in this group. Methods/ Design We aim to recruit 100 participants born between 1931-1939, from the Hertfordshire Cohort Study and randomly assign them to no intervention or to 36 fully supervised one hour sessions on a cycle ergometer, over twelve weeks. Each participant will undergo detailed anthropometric and metabolic assessment pre- and post-intervention, including muscle biopsy, magnetic resonance imaging and spectroscopy, objective measurement of physical activity and sub-maximal fitness testing. DISCUSSION: Given the extensive phenotypic characterization, this study will provide valuable insights into the mechanisms underlying the beneficial effects of aerobic exercise as well as the efficacy, feasibility and safety of such interventions in this age group.