"In My Mind, It Was Just Temporary": A Qualitative Study of the Impacts of Cancer on Men and Their Strategies to Cope.

Individuals who are diagnosed and treated for cancer use a variety of strategies to manage its impacts. However, there is currently a lack of research on men's experience with managing cancer impacts, which is necessary to better support them throughout the cancer care continuum. This study explored the experience of men diagnosed with cancer, focusing on the impacts of the illness and its treatment and men's strategies to cope. A qualitative descriptive design was used. Thirty-one men (Mage = 52.7 [26-82] years) diagnosed with various cancer types were recruited to take part in individual telephone interviews (n = 14) or online focus groups (n = 17) addressing the impacts of cancer and strategies they used to cope with these impacts. Directed content analysis was performed, using Fitch's (2008) supportive care framework to guide the analysis. Cancer impacts and strategies used to cope were classified into six categories: physical, psychological, interpersonal, informational, practical, and spiritual. Results indicate that the cancer experience is diverse and multifaceted rather than homogeneous. Medical and supportive care services could be more effectively personalized to meet the diversity of men's needs by adopting a comprehensive and holistic approach to supportive care. Working in partnership with patients, it appears promising to recognize and identify men's needs and match them to appropriate resources to provide truly supportive care.

Perceived autonomy support from healthcare professionals and physical activity among breast cancer survivors: A propensity score analysis.

The majority of women treated for breast cancer are physically inactive although physical activity (PA) could attenuate many adverse effects of cancer and treatment. Autonomy support from healthcare professionals may improve PA initiation, adherence and maintenance. This study aimed to determine, using a causal inference approach, whether or not perceived autonomy support (PAS) from healthcare professionals is associated with light, moderate, and vigorous intensity PA among women treated for breast cancer. Data were drawn from the longitudinal study "Life After Breast Cancer: Moving On" (n = 199). PAS was measured with the Health Care Climate Questionnaire and PA was assessed using GT3X triaxial accelerometers. Associations between PAS and PA were estimated with linear regressions and adjusted estimations were obtained using propensity score-based inverse probability of treatment weights (IPTW). Results reveal no association between PAS and PA of light ([Formula: see text](95%CI) = -0.09 (-0.68, 0.49)), moderate ([Formula: see text] (95%CI) = -0.03 (-0.17, 0.11)), or vigorous ([Formula: see text](95%CI) = 0.00 (-0.03, 0.02)) intensity. Different forms of engagement and support by healthcare professionals should be explored to identify the best intervention targets to encourage women to adopt and maintain regular PA in the cancer continuum.

Milestones and turning points in the experience of physical activity throughout cancer care: a qualitative study to inform physical activity promotion.

PURPOSE: Physical activity (PA) is an important supportive care strategy to manage cancer and treatment-related side effects, yet PA participation is low among people diagnosed with cancer. This study examined patients', health professionals', and managers' perspectives on PA throughout cancer care to glean implications for PA promotion. METHODS: Random selection and purposeful sampling methods allowed for the recruitment of 21 patients (76.2% women) and 20 health professionals and managers (80% women) who participated in individual semi-structured interviews. Interview questions explored facilitators and barriers to PA participation and promotion across the cancer care continuum. Interviews were audio-recorded and transcribed. Then, qualitative thematic analysis was performed. RESULTS: The analysis produced five main themes describing milestones in PA participation throughout cancer care: (1) Getting Started, (2) Discovering PA Resources, (3) Taking Action, (4) Striving for Change, and (5) Returning to a "New Normal." The sub-themes underscored turning points, i.e., tasks and challenges to PA participation that had to be overcome at each milestone. Achieving milestones and successfully navigating turning points were dependent on clinical, social, and community factors. CONCLUSION: Cancer patients appear to progress through a series of milestones in adopting and maintaining PA throughout cancer care. Intervention strategies aimed at promoting PA could test whether support in navigating turning points could lead to greater PA participation. These findings require replication and extension, specifically among patients who are men, younger adults, and culturally diverse.

Barriers and facilitators of supportive care access and use among men with cancer: a qualitative study.

PURPOSE: Men diagnosed with cancer are underrepresented in existing supportive care programming and related research, with preliminary indications that men face unique challenges in accessing and engaging with such services. This study aims to identify barriers and facilitators related to the supportive care service access and use among men diagnosed with cancer. METHODS: From March to May 2021, thirty-one Quebec men (Mage = 52.7, range:(26-82 years) diagnosed with various cancer types were recruited to take part in individual telephone interviews (n = 14) or online focus groups (n = 17) addressing experiences of cancer supportive care services. Content analysis of qualitative data was performed. RESULTS: Barriers and facilitators to men's supportive care access and use were grouped into four categories: (1) alignment between services and men's needs and preferences; (2) delivery of services in an accessible, inclusive, and responsive way; (3) communication and promotion of services in ways that are acceptable, appealing, and attractive to men; and (4) social norms and perceptions of gender and masculinity affecting men's perceptions of and engagement with services. CONCLUSIONS: Barriers and facilitators influencing access and use of supportive care services in men are numerous and diverse. These findings may inform the development of new and the adaptation of current supportive care strategies to better address men's needs and preferences after a cancer diagnosis. IMPLICATIONS FOR CANCER SURVIVORS: Increased adequacy of services tailored to men's needs and preferences, with an emphasis on supporting men to take an active role in their recovery, could improve access and adherence to care. Services adopting a more integrated, patient-centered, and holistic approach to service delivery could positively impact the cancer care trajectory and health outcomes of men. Larger systemic changes may be needed to support men in engaging in currently existing activities and services.

Examining public health practitioners' perceptions and use of behavioural sciences to design health promotion interventions.

BACKGROUND: Behavioural sciences have been shown to support the development of more effective interventions aimed at promoting healthy lifestyles. However, the operationalization of this knowledge seems to be sub-optimal in public health. Effective knowledge transfer strategies are thus needed to optimize the use of knowledge from behavioural sciences in this field. To this end, the present study examined public health practitioners' perceptions and use of theories and frameworks from behavioural sciences to design health promotion interventions. METHODS: This study adopted an exploratory qualitative design. Semi-structured interviews were conducted among 27 public health practitioners from across Canada to explore current intervention development processes, the extent to which they integrate theory and framework from behavioural sciences, and their perceptions regarding the use of this knowledge to inform intervention design. Practitioners from the public sector or non-profit/private organizations who were involved in the development of interventions aimed at promoting physical activity, healthy eating, or other healthy lifestyle habits (e.g., not smoking) were eligible to participate. RESULTS: Public health practitioners generally agreed that behaviour change is an important goal of public health interventions. On the other hand, behavioural science theories and frameworks did not appear to be fully integrated in the design of public health interventions. The main reasons were (1) a perceived lack of fit with current professional roles and tasks; (2) a greater reliance on experiential-produced knowledge rather than academic knowledge (mainly for tailoring interventions to local setting characteristics); (3) the presence of a fragmented knowledge base; (4) the belief that theories and frameworks require too much time and resources to be operationalized; and 4) the belief that using behavioural sciences might undermine partnership building. CONCLUSIONS: This study provided valuable insights that may inform knowledge transfer strategies that could be optimally designed to support the integration of behavioural sciences theories and frameworks into public health practices.

Developing practice guidelines to integrate physical activity promotion as part of routine cancer care: A knowledge-to-action protocol.

BACKGROUND: Cancer is a leading cause of disease burden worldwide and the first cause of mortality in Canada with 30.2% of deaths attributable to cancer. Given aging of the population and the improvement of prevention and treatment protocols, the number of cancer survivors is steadily increasing. These individuals have unique physical and mental health needs some of which can be addressed by integrating physical activity promotion into ongoing and long-term care. Despite the benefits of being active, delivery of PA programs for cancer patients in both clinical and community settings remains challenging. This knowledge-to-action protocol-called Kiné-Onco-aims to develop a practice guideline for the delivery, implementation, and scaling-up of cancer-specific physical activity promotion programs and services in clinical and community settings located in Québec, Canada. METHOD: The Kiné-Onco project involves knowledge synthesis of scientific and grey literature to establish the benefits and added value of physical activity for cancer patients and survivors, describes current practices in delivering physical activity programs, analyses quantitative data from electronic health records (EHR) of patients participating in a novel hospital-based physical activity program, collects and analyses qualitative data from patients and healthcare providers interviews about lived experience, facilitators, and barriers to physical activity promotion, outlines deliberative workshops among multidisciplinary team members to develop implementation guidelines for physical activity promotion, and summarizes a variety of knowledge transfer and exchange activities to disseminate the practice guidelines. DISCUSSION: This paper describes the protocol for a knowledge-to-action project aimed at producing and sharing actionable evidence. Our aim is that physical activity promotion programs and services be scaled up in such a way as to successfully integrate physical activity promotion throughout cancer treatment and survivorship in order to improve the physical and mental health of the growing population of individuals having received a cancer diagnosis.

NutriQuébec: a unique web-based prospective cohort study to monitor the population's eating and other lifestyle behaviours in the province of Québec.

INTRODUCTION: The epidemic of non-communicable diseases including cardiovascular diseases and type 2 diabetes is attributable in large part to unhealthy eating and physical inactivity. In the fall of 2016, the Québec government launched its first-ever Government Health Prevention Policy (Politique gouvernementale de prévention en santé (PGPS)) to influence factors that lead to improved health status and quality of life as well as reduced social inequalities in health in the population of Québec. NutriQuébec is a web-based prospective open cohort study whose primary aim is to provide essential data for the evaluation of the PGPS on the Québec population's eating and other lifestyle behaviours over time. METHODS AND ANALYSIS: Over a first phase of 3 years, NutriQuébec will enrol 20 000 adults living in the province of Québec in Canada through a multimedia campaign designed to reach different segments of the population, including subgroups with lower socioeconomic status. Participants will be invited to complete on a web platform nine core questionnaires on a yearly basis. Questionnaires will assess several dimensions related to lifestyle, including eating and physical activity behaviours, as well as a large number of personal characteristics and global health status. Temporal trends in eating and lifestyle behaviours will be analysed in relation to the implementation of the PGPS to provide essential data for its evaluation at a population level. Data analyses will use sociodemographic weights to adjust responses of participants to achieve, so far as is possible, representativeness of the adult Québec population. ETHICS AND DISSEMINATION: Université Laval Research Ethics Board approved the NutriQuébec project. Data analysis, presentations in conferences and publication of manuscripts are scheduled to start in 2020. TRIAL REGISTRATION NUMBER: NCT04140071.

Smoking in Young Adults: A Study of 4-Year Smoking Behavior Patterns and Residential Presence of Features Facilitating Smoking Using Data From the Interdisciplinary Study of Inequalities in Smoking Cohort.

INTRODUCTION: Young adults have the highest prevalence of smoking among all age groups in most industrialized countries and exhibit great variability in smoking behavior. Differences in associations between features in residential environments and smoking initiation, prevalence, and cessation have been extensively examined in the literature. Nonetheless, in many cases, findings remain inconsistent. This paper proposes that a potential driver of these inconsistencies is an almost exclusive focus on point-specific smoking outcomes, without consideration for the different behavior patterns that this age group may experience over time. AIMS AND METHODS: Based on data from the Interdisciplinary Study of Inequalities in Smoking cohort of 18- to 25-year-old Montreal residents (n = 1025), we examined associations between 4-year smoking patterns measured at three timepoints and proximal presence/density of tobacco retail outlets and presence of smoker accommodation facilities in Montreal, Canada. Associations were tested using two-level multinomial and logistic models. RESULTS: In fully adjusted models, compared to never-smokers, residents of areas with a higher density of tobacco retail were more likely to (1) be characterized as established smokers, (2) have experienced repeated changes in smoking status (being "switchers") during the 4-year study period, and (3) be former smokers. CONCLUSIONS: From a conceptual standpoint, these findings highlight the importance of acknowledging and examining smoking behavior patterns among young adults. Furthermore, specific pattern-feature associations may point to unique mechanisms by which features could influence smoking behavior patterns. These findings require replication and extension, including testing hypotheses regarding tobacco retail density's role in sustaining smoking and in influencing changes in smoking status. IMPLICATIONS: Results from this study highlight the importance of describing and examining different young adult smoking behavior patterns and how they may be influenced by residential environment features such as the density of tobacco retail. Findings suggest that young adults residing in areas with a higher density of tobacco retailers are more likely to have experienced repeated changes in smoking status and to be established smokers. Further research in this area is needed to advance knowledge of the putative mechanisms by which residential features may influence smoking behavior patterns and to ultimately orient policy and interventions seeking to curb smoking at the local level.

Adolescents' Weight Management Goals: Healthy and Unhealthy Associations with Eating Habits and Physical Activity.

BACKGROUND: This study aims to quantify associations between one's weight management goal and eating behaviors and physical activity among teenagers. METHODS: Weighted logistic regressions were performed predicting healthy behaviors from weight goal separately for boys and girls while controlling for age, body mass index, socioeconomic indicators, school type, and region using data from the 2010 to 2011 Enquête québécoise sur la santé des jeunes du secondaire, a survey of a representative sample of Quebec adolescents (N = 32,040). RESULTS: About 18%, 31%, 19%, and 34% of boys and 32%, 34%, 5%, and 25% of girls were respectively trying to lose weight, maintain their weight, gain weight, and not trying to do anything about their weight. Trying to lose weight was associated with lower likelihood of eating breakfast daily (boys: odds ratio [OR] = 0.72; 95% confidence interval [CI] = 0.61, 0.84 girls: OR = 0.61; 95% CI = 0.54, 0.70). Among girls, trying to lose weight was also associated with higher likelihood of consuming at least 5 portions of fruits and vegetables (OR = 1.20; 95% CI = 1.04, 1.37), lower likelihood of drinking sugar-sweetened beverages daily (OR = 0.77; 95% CI = 0.66, 0.90). Each weight-related goal was associated with unhealthy behaviors but most of them were also associated with adoption of healthier ones. CONCLUSION: Having a weight related goal cannot inherently be thought of as health promoting goal.

Residential environments and smoking behaviour patterns among young adults: A prospective study using data from the Interdisciplinary Study of Inequalities in Smoking cohort.

Young adults have the highest prevalence of smoking among all age groups. Studies have shown associations between presence/density of tobacco retail and presence of smoker accommodation and smoking prevalence. However, little is known about their potential to influence different smoking patterns including initiation, maintenance, or cessation. This is important because smoking behaviour patterns in young adults may be subject to ongoing changes. Moreover, smoking pattern determinants may be different to those of smoking prevalence, and feature-pattern associations may be scale-dependent, requiring the consideration of different analytical spatial units. We examined associations between prospectively-measured smoking behaviour patterns and presence/density of tobacco retail, and presence of smoker accommodation facilities across 2 nested spatial units in Montreal, Canada. Data were from 18 to 25 year-old Montreal residents who had participated in the Interdisciplinary Study of Inequalities in Smoking cohort both at baseline in 2011-2012 and follow-up in 2014 and resided in the same area at follow-up. 2-year smoking behaviour patterns were assessed for 2 cohorts based on participants' smoking status at baseline. Associations were examined using multilevel logistic models. Young adults who were smokers at baseline residing in areas with higher local-level presence of tobacco retail were less likely to quit smoking (i.e.: to be non-smokers for fewer than 2 years). Higher presence of smoker accommodation was not associated with smoking patterns at any scale. Findings provide evidence of scale-specific associations between residential environment features and smoking behaviour patterns in young adults, which may point to specific exposure-outcome processes underlying these associations.

The Role of Access to a Regular Primary Care Physician in Mediating Immigration-Based Disparities in Colorectal Screening: Application of Multiple Mediation Methods.

BACKGROUND: Colorectal cancer screening participation is lower among recent immigrants than among Canadian-born individuals. We assessed whether this screening disparity is mediated by access to regular primary care physicians (PCP). METHODS: Pooling years 2003 to 2014 of the Canadian Community Health Survey, lifetime screening in respondents aged 50 to 75 years of age who immigrated in the previous 10 years (n = 1,067) was compared with Canadian-born respondents (N = 102,366). Regression- and inverse probability weighting-based methods were used to estimate the total effect (TE) and controlled direct effect (CDE) of recent immigration on never having received either a stool- or endoscopic-based screening test. The proportion of the TE that would be eliminated if all had a PCP was computed using these estimates [proportion eliminated (PE) = (TE - CDE)/(TE - 1)]. Analyses were stratified by visible minority status and adjusted for income, rurality, age, sex, marital status, education, and exposure to a provincially organized colorectal screening program. RESULTS: The prevalence of never having been screened was 71% and 57% in visible minority and white recent immigrants, respectively, and 46% in white Canadian-born respondents. If all had regular PCPs, there would be no reduction in the screening inequality between white recent immigrants and Canadian-born (null PE), and the inequality between visible minority immigrants and white Canadian-born may increase by 6% to 13%. CONCLUSIONS: Ensuring all have regular PCPs may lead to greater screening gains among Canadian-born than recent immigrants. IMPACT: Improving access to PCPs may increase colorectal screening overall, but not reduce immigration-based disparities screening. Alternative interventions to reduce this disparity should be explored.

The association between income and leisure-time physical activity is moderated by utilitarian lifestyles: A nationally representative US population (NHANES 1999-2014).

The objective of this study was to determine whether the relationship between income and leisure-time physical activity (LTPA) persists after accounting for a person's utilitarian PA (all non-LTPA), sociodemographic characteristics and transportation PA. Data were from eight cycles (1999-2014) of the nationally representative samples of the US adult population from the National Health and Nutrition Examination Survey (n = 35,239). Whether the poverty income ratio (0-1.3, 1.3-1.86, 1.86+ [reference]) was associated with minutes of LTPA (moderate, vigorous) after stratifying for utilitarian PA (sedentary, light, moderate, and vigorous) was assessed in multiple linear regressions adjusted for age, sex, race, education, marital status, weight status, hours worked, and minutes of transportation-related PA in the past week. Likelihood of meeting national physical activity recommendations was also assessed in multiple logistic regressions adjusting for the covariates described. For both sedentary and light utilitarian PA levels, compared to the reference, persons living in households of the lowest poverty income ratio were consistently associated with approximately 17-30 less minutes of moderate LTPA minutes per week, and 20-25 less minutes of vigorous LTPA across all survey cycles. Compared to the reference, the likelihood of meeting national PA recommendations was approximately 31-55% less for these households. The known association between lower income and lower LTPA persist, but is the most persistent and consistent for those with less active utilitarian (such as sedentary) lifestyles. Interventions aimed at increasing LTPA among people with low income and sedentary utilitarian lifestyles whether or not they are in the workforce are particularly needed.

Cervical cancer screening in Montreal: Building evidence to support primary care and policy interventions.

In Canada, over 40% of invasive cervical cancers occur among women who have never been screened. Although 12% of Canadian women have never been screened, this number can be as high as 43% among certain social groups. Little is published on factors associated with screening uptake and inequalities among women residing in Quebec. Four waves of the Canadian Community Health Survey (2003, 2005, 2008, 2012, N = 6393) were utilized to assess lifetime screening and screening in the previous 3 years among women residing in Montreal. Chi-squared statistics were calculated, Poisson regression was utilized to model prevalence ratios, and prevalence differences were calculated. In total, 13.6% of women had never been screened and 12.1% had not been screened in the previous 3 years. Immigrant status was the strongest predictor of never being screened [recent vs non-immigrant: Prevalence Ratio (PR), 3.9 (95% Confidence Interval (CI): 2.9-5.4)] and not having a primary care physician (PCP) was the strongest predictors of not being screened recently [PR = 3.0 (95% CI: 2.3-3.9)]. The two most common reasons for not being screened were not "know[ing] it was necessary" and not "get[ting] around to it." These results provide a description of sub-populations which might benefit from cervical screening interventions: immigrants and women without a PCP. Interventions targeting access to PCPs, expanding training of non-physicians to conduct screening, organized screening, or autoadministered screening test may mitigate inequalities. Future work should assess their acceptability and feasibility, and evaluate the impact of these types of primary care and policy interventions.

Quality of life trajectories during the first year following hematopoietic cell transplantation: an inception cohort study.

BACKGROUND: Allogeneic hematopoietic cell transplantation (HCT) affects quality of life (QOL). Patient-reported outcomes examine symptoms, side effects, distress, and physical and social problems, but positive outcomes have been ignored. This inception cohort study followed people over the first year following HCT to document positive and negative outcomes. METHODS: People with hematologic cancers treated by HCT completed complementary self-report instruments at four milestones: (a) pre-transplant (N = 88); (b) engraftment (N = 80); (c) short-term post-discharge (N = 60); and (d) long-term post-discharge (N = 45). We examined symptoms, side effects, illness intrusiveness, depressive symptoms, positive and negative affect, and self-esteem. We compared QOL in HCT with diverse published values. RESULTS: QOL deteriorated following HCT. Most variables returned to baseline by short-term post-discharge, but self-esteem and illness intrusiveness required more time. Illness intrusiveness at 1 year post-discharge was higher in HCT than other cancer groups; negative affect, too, was higher, but HCT survivors also reported higher positive affect. HCT and other cancer survivors reported similar depressive symptom levels. Compared to healthy people, HCT survivors reported more severe depressive symptoms, but similar positive and negative affect. CONCLUSIONS: QOL changes dramatically following HCT. People report more interference with valued activities and interests after 1 year than survivors of other cancers, but depressive symptoms are not higher. Positive and negative affect are equivalent to healthy community residents. Continued involvement in psychologically meaningful activities may preserve QOL.

Physical activity and lung cancer risk in men and women.

PURPOSE: Although evidence has accumulated that recreational physical activities (PA) may reduce lung cancer risk, there is little evidence concerning the possible role of a potentially more important source of PA, namely occupational PA. We investigated both recreational and lifetime occupational PA in relation to lung cancer risk in a population-based case-control study in Montreal, Canada (NCASES = 727; NCONTROLS = 1,351). METHODS: Unconditional logistic regression was used to estimate odds ratios (OR), separately for men and women, adjusting for smoking, exposure to occupational carcinogens, and sociodemographic and lifestyle factors. RESULTS: In both sexes, increasing recreational PA was associated with a lower lung cancer risk (ORMEN = 0.66, 95% confidence interval (CI) 0.47-0.92; ORWOMEN = 0.55, 95% CI 0.34-0.88, comparing the highest versus lowest tertiles). For occupational PA, no association was observed among women, while increasing occupational PA was associated with increased risk among men (ORMEN = 1.96, 95% CI 1.27-3.01). ORs were not modified by occupational lung carcinogen exposure, body mass index, and smoking level; results were similar across lung cancer histological types. CONCLUSIONS: Our results support the previous findings for recreational PA and lung cancer risk. Unexpectedly, our findings suggest a positive association for occupational PA; this requires replication and more detailed investigation.

Beyond Smoking Prevalence: Exploring the Variability of Associations between Neighborhood Exposures across Two Nested Spatial Units and Two-Year Smoking Trajectory among Young Adults.

Young adults have the highest prevalence of smoking amongst all age groups. Significant uptake occurs after high school age. Although neighborhood exposures have been found to be associated with smoking behavior, research on neighborhood exposures and the smoking trajectories among young adults, and on the role of geographic scale in shaping findings, is scarce. We examined associations between neighborhood exposures across two nested, increasingly large spatial units and smoking trajectory over two years among young adults living in Montreal, Canada. A sample of 2093 participants aged 18-25 years from the Interdisciplinary Study of Inequalities in Smoking (ISIS) was surveyed. The dependent variable was self-reported smoking trajectory over the course of two years. Residential addresses, data on presence of tobacco retail outlets, and the presence of smoking accommodation facilities were coded and linked to spatial units. Three-level multinomial models were used to examine associations. The likelihood of being a smoker for 2+ years was significantly greater among those living in larger spatial unit neighborhoods that had a greater presence of smoking accommodation. This association was not statistically significant at the smaller spatial units. Our findings highlight the importance of studying young adults' smoking trajectories in addition to static smoking outcomes, and point to the relevance of considering spatial scale in studies of neighborhoods and smoking.

Identifying risk profiles for childhood obesity using recursive partitioning based on individual, familial, and neighborhood environment factors.

BACKGROUND: Few studies consider how risk factors within multiple levels of influence operate synergistically to determine childhood obesity. We used recursive partitioning analysis to identify unique combinations of individual, familial, and neighborhood factors that best predict obesity in children, and tested whether these predict 2-year changes in body mass index (BMI). METHODS: Data were collected in 2005-2008 and in 2008-2011 for 512 Quebec youth (8-10 years at baseline) with a history of parental obesity (QUALITY study). CDC age- and sex-specific BMI percentiles were computed and children were considered obese if their BMI was ≥95th percentile. Individual (physical activity and sugar-sweetened beverage intake), familial (household socioeconomic status and measures of parental obesity including both BMI and waist circumference), and neighborhood (disadvantage, prestige, and presence of parks, convenience stores, and fast food restaurants) factors were examined. Recursive partitioning, a method that generates a classification tree predicting obesity based on combined exposure to a series of variables, was used. Associations between resulting varying risk group membership and BMI percentile at baseline and 2-year follow up were examined using linear regression. RESULTS: Recursive partitioning yielded 7 subgroups with a prevalence of obesity equal to 8%, 11%, 26%, 28%, 41%, 60%, and 63%, respectively. The 2 highest risk subgroups comprised i) children not meeting physical activity guidelines, with at least one BMI-defined obese parent and 2 abdominally obese parents, living in disadvantaged neighborhoods without parks and, ii) children with these characteristics, except with access to ≥1 park and with access to ≥1 convenience store. Group membership was strongly associated with BMI at baseline, but did not systematically predict change in BMI. CONCLUSION: Findings support the notion that obesity is predicted by multiple factors in different settings and provide some indications of potentially obesogenic environments. Alternate group definitions as well as longer duration of follow up should be investigated to predict change in obesity.

Worksite health and wellness programs: Canadian achievements & prospects.

Canada has experienced a substantial reduction in mortality related to cardiovascular disease (CVD). There is a general consensus that more effective and widespread health promotion interventions may lead to further reductions in CVD risk factors and actual disease states. In this paper, we briefly outline the prevalence of selected risk factors for CVD in Canada, describe characteristics of the Canadian labor market and workforce, and depict what is known about health and wellness program delivery systems in Canadian workplaces. Our review indicates that there have been numerous and diverse relevant legislative and policy initiatives to create a context conducive to improve the healthfulness of Canadian workplaces. However, there is still a dearth of evidence on the effectiveness of the delivery system and the actual impact of workplace health and wellness programs in reducing CVD risk in Canada. Thus, while a promising model, more research is needed in this area.

Associations between different forms of body dissatisfaction and the use of weight-related behaviors among a representative population-based sample of adolescents.

Weight management strategies have two components: weight goals and behaviors to reach weight goals. In the literature, weight goals and weight-related behaviors have both been linked with body dissatisfaction separately, but have rarely been examined simultaneously. This paper examines the associations between different forms of body dissatisfaction and various weight-related behaviors and investigates the moderating role of weight goals in these associations. Measures included weight goals (matching or mismatching current weight status), self-reported frequencies of use of weight-related behaviors, and a body dissatisfaction measure (strength of aspiring for weight gain or weight loss) from a representative population-based sample of adolescents (n = 2,346, 51 % female). Sex-specific multilevel logistic and ordinal regression analyses indicated that aspiring for a thinner body among girls was associated with more frequent use of healthy and unhealthy behaviors, whereas body dissatisfaction of any type among boys was linked to more frequent use of unhealthy behaviors. Girls aspiring for substantial weight loss and boys aspiring for substantial weight gain were more likely to use disordered health behaviors. Aiming for a goal that is mismatched with current weight status increases the use of unhealthy behaviors among body dissatisfied adolescents. We conclude that in order to elaborate interventions aimed at promoting health, research should focus on processes leading to specific forms of body dissatisfaction which in turn produce varying frequencies of use of weight-related behaviors.

The potential modal shift and health benefits of implementing a public bicycle share program in Montreal, Canada.

BACKGROUND: This study estimated the modal shift associated with the implementation of a public bicycle share program in Montreal, Canada. METHODS: A population-based sample of adults participated in two cross sectional telephone surveys. Self-reported travel behaviors were collected at the end of the first (fall 2009) and second (fall 2010) season of implementation. The sample included 2502 (Mean age=47.8 years, 61.8% female), and 2509 (Mean age=48.9 years, 59.0% female) adult respondents in each survey. RESULTS: The estimated modal shift associated with the implementation of the PBSP from motor vehicle use to walking, cycling, and public transportation was 6483 and 8023 trips in 2009 and 2010. This change represents 0.34% and 0.43% of all motor vehicle trips in Montreal. CONCLUSIONS: The implementation of a PBSP was associated with a shift toward active transportation. The modal shift was complex and not simply the result of a discrete shift from one mode to another. Promotion of active transportation should encourage integration of multiple active transportation modes to better reflect people's actual transportation behaviors.