Mapping Canadian Men's Recent and Intended Health Behavior Changes Through the Don't Change Much Electronic Health Program.

BACKGROUND: Although evaluation studies confirm the strong potential of men's electronic health (eHealth) programs, there have been calls to more fully understand acceptability, engagement, and behavior change to guide future work. Relatedly, mapping of behavior changes using health promotion theories including the transtheoretical model (or stages of change) has been recommended to build a translatable empirical base to advance design and evaluation considerations for men's eHealth programs. OBJECTIVE: This study aimed to use a benchmark sample as a reference group to map the recent and intended health behavior changes in Canadian men who use the Don't Change Much (DCM) eHealth program. The hypothesis being tested was that increased exposure to DCM would be positively associated with men's recent and intended health behavior changes. METHODS: DCM users (n=863) were sampled for demographic data and self-reported recent and intended health behavior changes. Respondents also reported their usage (frequency and duration) for each of the 3 DCM components (web, newsletter, and social media) and were allocated to limited exposure (257/863, 29.8%), low exposure (431/863, 49.9%), and high exposure (175/863, 20.3%) subgroups. A benchmark sample (n=2000), comprising respondents who had not accessed DCM provided a reference group. Bivariate analysis of recent and intended health behavior changes and DCM exposure levels were used to compute the strength of association between the independent variables (exposure levels) and the 10 categorical dependent variables (recent and intended health behavior changes). Binary logistic regression models were computed for each of the 10 recent and intended health behavior changes. Linear regression was used to model the association between the number of recent and intended changes and the level of exposure to DCM. RESULTS: Compared with the benchmark reference group, DCM high-exposure respondents had significantly increased odds for 9 of the 10 health behavior changes, with the largest effect size observed for Changed diet or Improved eating habits (odds ratio [OR] 5.628, 95% CI 3.932-8.055). High-exposure respondents also had significantly increased odds for 9 intended health changes, with the largest effect sizes observed for Reduce stress level (OR 4.282, 95% CI 3.086-5.941). Moderate effect size (goodness of fit) was observed for increased total number of recent (F12,2850=25.52; P.001; adjusted R2=.093) and intended health behavior changes (F12,2850=36.30; P.001; adjusted R2=.129) among high-exposure respondents. CONCLUSIONS: DCM respondents contrasted the predominately precontemplative benchmark sample mapping across the contemplative, preparation, and action stages of the transtheoretical health behavior change model. Almost 10% of variation in the recent and 13% of variation in the intended health behavior changes can be explained by DCM exposure and demographic factors, indicating the acceptability of this men's eHealth resource.

Canadian men's health stigma, masculine role norms and lifestyle behaviors.

Men are at high risk for both morbidity and premature mortality from several of the most common serious diseases. Although numerous factors have been identified to explain men's risk, this study focused on the relationship between lifestyle behaviors, health-related self-stigma and masculine role norms. An age and location stratified sample of 2000 Canadian men completed measures assessing five lifestyle behaviors (smoking, alcohol use, sleep, diet and exercise), a screen for depression, and measures of self-stigma and masculine role norms. The results showed that elements of both health-related self-stigma and masculine role norms were associated with increased risk for being above the clinical threshold for four of the lifestyle behaviors and depression. The most frequent and largest relationships were associated with exercise and depression. The total number of lifestyle behaviors for which participants were above the clinical cut-points was also associated with self-stigma and masculine role norms. These findings demonstrate the importance of health-related self-stigma and masculine role norms as potential barriers to men's health and well-being.

Canadian Men's Health Literacy: A Nationally Representative Study.

Though men's health promotion has attracted increased research attention, conspicuously absent have been empirical insights to health literacy levels within and across male subgroups. Recent advancements in the measurement of health literacy have made available avenues for evaluating individual and social determinants of health literacy. Important insights can be drawn to detail patterns and diversity among men as a means to informing the design, implementation, and evaluation of tailored health promotion programs. Drawing on 2000 Canada-based men's responses to the Health Literacy Questionnaire, correlations between demographic variables and six health literacy scales are described. Low income, low education, and living alone were associated with men's low health literacy, with the strongest effect sizes for the "Social support for health" and "Actively engaged with health care professionals" scales. Multiple linear regressions confirmed low income as the strongest predictor of men's low health literacy in all the scales except "Appraisal of health information." Low income, self-identifying as gay, bisexual, or other, and living alone were strongly predictive of low scores on the "Social support for health" scale. The findings affirm the importance of considering men's health literacy and inequities to advance effective men's health promotion programs.

Prospective multifactorial analysis of Canadian Forces basic training attrition.

The aim of this prospective study was to identify key predictors of attrition from Canadian Forces basic training. Baseline health data from 5,169 Canadian Forces recruits (85.4% men) collected using the Recruit Health Questionnaire were linked with administrative data on basic training releases. A total of 8.0% of recruits from this sample was released from basic training. A wide range of factors falling within each of the following categories were examined as potential predictors of attrition: demographic characteristics, social environment, health status, lifestyle, and personality. Logistic regression analyses pointed to increased odds of attrition among noncommissioned member candidates, recruits with one or more dependents, as well as those with an annual household income of less than $20,000, poor/ fair self-rated health, medium/high severity of somatic symptoms, higher neuroticism, lower mastery, and higher agreeableness. Overall, results underscored the importance of good general health and resilient personality to basic training success.

Confirmatory factor analysis of the childhood anxiety sensitivity index: a gender comparison.

The Childhood Anxiety Sensitivity Index (CASI) is an 18-item self-report tool designed to measure the construct of anxiety sensitivity (i.e. the belief that anxiety may have harmful consequences such as sickness, embarrassment, or loss of control) in children and adolescents. Previous factor analytic examinations of the CASI have produced varied results. Gender may play a role in this observed variability. In an effort to confirm the factor structure of the measure across gender, CASI items for 671 children and adolescents were subjected to confirmatory factor analysis. Results indicated that for boys two-, three-, and four-factor structures provided a relatively good fit to the data, with the three-factor structure emerging as having the best fit overall. In contrast, for girls only the three-factor structure fitted the data well. Direct comparison of fit of the three-factor model across gender provided evidence to support the notion that childhood anxiety sensitivity is similar in structure across gender.

Assessing the Relative Impact of Diverse Stressors among Public Safety Personnel.

Public Safety Personnel (PSP; e.g., correctional workers and officers, firefighters, paramedics, police officers, and public safety communications officials (e.g., call center operators/dispatchers)) are regularly exposed to potentially psychologically traumatic events (PPTEs). PSP also experience other occupational stressors, including organizational (e.g., staff shortages, inconsistent leadership styles) and operational elements (e.g., shift work, public scrutiny). The current research quantified occupational stressors across PSP categories and assessed for relationships with PPTEs and mental health disorders (e.g., anxiety, depression). The participants were 4820 PSP (31.7% women) responding to established self-report measures for PPTEs, occupational stressors, and mental disorder symptoms. PPTEs and occupational stressors were associated with mental health disorder symptoms (ps < 0.001). PSP reported substantial difficulties with occupational stressors associated with mental health disorder symptoms, even after accounting for diverse PPTE exposures. PPTEs may be inevitable for PSP and are related to mental health; however, leadership style, organizational engagement, stigma, sleep, and social environment are modifiable variables that appear significantly related to mental health.

Composite health behaviour classifier as the basis for targeted interventions and global comparisons in men's health.

INTRODUCTION: Lifestyle-related diseases are the leading cause of death among North American men. We evaluated health behaviours and their predictors that contribute to morbidity and mortality among Canadian men as a means to making recommendations for targeted interventions. METHODS: A cross-sectional analysis of Canadian men drawn from 5362 visitors to our online survey page was conducted. The current study sample of 2000 men (inclusion: male and >18 years; exclusion: incomplete surveys) were stratified to the 2016 Canadian census. The primary outcome was the number of unhealthy men classified using our Canadian Composite Classification of Health Behaviour (CCCHB) score. Secondary outcomes included the number of men with unhealthy exercise, diet, smoking, sleep, and alcohol intake, as well as socioeconomic and demographic factors associated with unhealthy behaviours to be used for targeting future interventions. RESULTS: Only 118/2000 (5.9%) men demonstrated 5/5 healthy behaviours, and 829 (41.5%) had 3/5 unhealthy behaviours; 391 (19.6%) men currently smoked, 773 (38.7%) demonstrated alcohol overuse, 1077 (53.9%) did not get optimal sleep (<7 or >9 hours per night), 977 (48.9%) failed to exercise >150 minutes/week, and 1235 (61.8%) had an unhealthy diet. Multivariate analysis indicated that men with high school education were at increased risk of unhealthy behaviours (odds ratio [OR] 1.58; 95% confidence interval [CI] 1.15-2.18; p=0.005), as were men living with relatives (OR 2.10; 95% CI1.04-4.26; p=0.039), or with their partner and children (OR 1.34; 95% CI 1.02-1.76; p=0.034). CONCLUSIONS: An overwhelming 41.5% of Canadian men had 3/5 unhealthy behaviours, affirming the need for targeted lifestyle interventions. Significant health inequities within vulnerable subgroups of Canadian men were identified and may guide the content and delivery of future interventions.

The structure of post-traumatic stress disorder symptoms in three female trauma samples: a comparison of interview and self-report measures.

Empirical research increasingly suggests that post-traumatic stress disorder (PTSD) is comprised of four factors: re-experiencing, avoidance, numbing, and hyperarousal. Nonetheless, there remains some inconsistency in the findings of factor analyses that form the bulk of this empirical literature. One source of such inconsistency may be assessment measure idiosyncrasies. To examine this issue, we conducted confirmatory factor analyses of interview and self-report data across three trauma samples. Analyses of the interview data indicated a good fit for a four-factor model across all samples; analyses of the self-report data indicated an adequate fit in two of three samples. Overall, findings suggest that measure idiosyncrasies may account for some of the inconsistency in previous factor analyses of PTSD symptoms.

Unhealthy Behaviors Among Canadian Men Are Predictors of Comorbidities: Implications for Clinical Practice.

Men's poor health behaviors are an increasingly prevalent issue with long-term consequences. This study broadly samples Canadian men to obtain information regarding health behaviors as a predictor of downstream medical comorbidities. A survey of Canadian men included questions regarding demographics, comorbidities, and health behaviors (smoking and alcohol consumption, sleep and exercise behaviors, and dietary habits). Health behaviors were classified as either healthy or unhealthy based upon previous studies and questionnaire thresholds. Multivariate regression was performed to determine predictors for medical comorbidities. The 2,000 participants were aged 19-94 (median 48, interquartile range 34-60). Approximately half (47.4%) were regular smokers, 38.7% overused alcohol, 53.9% reported unhealthy sleep, 48.9% had low levels of exercise, and 61.8% had unhealthy diets. On multivariate analysis, regular smoking predicted heart disease (OR 2.08, p < .01), elevated cholesterol (OR 1.35, p = .02), type 2 diabetes (OR 1.57, p = .02), osteoarthritis (OR 1.43, p = .04), and depression (OR 1.62, p < .01). Alcohol overuse predicted hypertension (OR 1.40, p < .01) and protected against type 2 diabetes (OR 0.61, p < .01). Unhealthy sleep predicted hypertension (OR 1.46, p < .01), erectile dysfunction (OR 1.50, p = .04), and depression (OR 1.87, p < .01). Low levels of exercise predicted hypertension (OR 1.30, p = .03) and elevated cholesterol (OR 1.27, p = .05). Finally, unhealthy diet predicted depression (OR 1.65, p < .01). This study confirms the association of poor health behaviors and comorbidities common to middle-aged and older men. The results emphasize the potential scope of targeted gender-sensitized public awareness campaigns and interventions to reduce common male disease, morbidity, and mortality.

A longitudinal investigation of fear of falling, fear of pain, and activity avoidance in community-dwelling older adults.

OBJECTIVE: The primary purpose of this study was to examine the role of fear of falling, fear of pain, and associated activity avoidance in the prediction of pain and falls. METHOD: A 6-month longitudinal study of older community-dwelling adults. RESULTS: The authors found that fear of falling is a better predictor of falls than is activity avoidance. Moreover, fear of pain did not predict future pain-related avoidance or future pain in the sample of seniors. DISCUSSION: The findings confirm the ability of fear of falling to predict falls but challenge preexisting models developed to account for the relationship between falls and fear. The findings also suggest limits on the generalizability of fear-avoidance models of pain. The authors conclude by suggesting mechanisms that could account for the relationship of fears with falls and pain. Unlike previous conceptualizations, these mechanisms do not rely on activity avoidance as an explanation.

Landing for success: a biomechanical and perceptual analysis of on-ice jumps in figure skating.

Technical evaluation in the sport of figure skating is characterized by a subjective marking system. Figure skating judges are responsible for quickly and accurately discerning the quality of technical elements as well as assigning a score to the overall aesthetic appearance of a performance. Traditionally, overall placement marks are assigned for the entire performance; however, the landing of a jump is widely acknowledged as one of the most critical elements of a skater's program. Therefore, our aims were to identify the biomechanical variables that contribute to technical success in executing landings and to establish whether landings rated as biomechanically optimal are also awarded high technical merit scores by judges. Ten nationally ranked competitive figure skaters were asked to execute on-ice, double and triple revolution jumps and to try to land the jumps void of technical faults within a calibrated space. Data were collected at 60 Hz using standard three-dimensional videography. Data reduction was done using the APAS system (Ariel Dynamics Inc). Concurrently, videotapes were viewed and evaluated by 42 accredited judges to determine the perceived technical quality of the landing performances. Judges were asked to evaluate the landing phase of each jump against a landing criteria document. A comparative criteria model was developed to facilitate an assessment of excellence in landing performances through both empirical and subjective analyses. Results of these analyses were twofold: a biomechanical profile of on-ice landings was obtained, and on-ice jump landing strategies rated by empirical evaluations were in agreement with judge's perceptions of the same performances.

Fear of pain and fear of falling among younger and older adults with musculoskeletal pain conditions.

BACKGROUND: The fear-avoidance model of pain accounts for the debilitating consequences of strong fear as a component of reactions to painful conditions (eg, movements become anxiety-provoking because they cause pain). The model, which is supported in the literature, posits that fear of pain interferes with recovery because it leads to avoidance of beneficial activity. Despite the high prevalence of pain among the elderly, investigations of fear of pain in this population are scarce. A related construct, fear of falling, has been studied among elderly (but not younger) adults as an age-specific concern. OBJECTIVES: To examine the relationship between fear of pain and fear of falling. Specifically, it is hypothesized that fear of pain and fear of falling are distinct constructs. Moreover, the authors investigated whether fear of falling becomes more relevant with increasing age in a sample of seniors and younger adults with musculoskeletal conditions. METHODS: A convenience sample of younger and older adult physiotherapy outpatients (n=226) receiving treatment for musculoskeletal conditions were recruited for the study. Fear of pain and fear of falling were assessed using self-report measures. RESULTS: There were no age differences with respect to fear of pain and fear of falling. Regression analyses showed that fear of pain measures contribute substantial unique variance to the prediction of each other; however, they only make minor unique contributions to the prediction of fear of falling. Similar results were obtained through confirmatory analyses using structural modelling techniques. CONCLUSIONS: The analyses supported the distinctiveness of fear of pain and fear of falling. Moreover, among physiotherapy outpatients with musculoskeletal pain conditions, fear of falling and fear of pain are distinct constructs that appear to represent the concerns of both seniors and younger pain patients.

Light treatment improves sleep quality and negative affectiveness in high arctic residents during winter.

The seasonal extremes of photoperiod in the high Arctic place particular strain on the human circadian system, which leads to trouble sleeping and increased feelings of negative affect in the winter months. To qualify for our study, potential participants had to have been at Canadian Forces Station (CFS) Alert (82° 30' 00″ N) for at least 2 weeks. Subjects filled out questionnaires regarding sleep difficulty, psychological well-being and mood and wore Actigraphs to obtain objective sleep data. Saliva was collected at regular intervals on two occasions, 2 weeks apart, to measure melatonin and assess melatonin onset. Individuals with a melatonin rhythm that was in disaccord with their sleep schedule were given individualized daily light treatment interventions based on their pretreatment salivary melatonin profile. The light treatment prescribed to seven of the twelve subjects was effective in improving sleep quality both subjectively, based on questionnaire results, and objectively, based on the actigraphic data. The treatment also caused a significant reduction in negative affect among the participants. Since the treatment is noninvasive and has minimal associated side effects, our results support the use of the light visors at CFS Alert and other northern outposts during the winter for individuals who are experiencing sleep difficulty or low mood.

Sleep deficits in the High Arctic summer in relation to light exposure and behaviour: use of melatonin as a countermeasure.

BACKGROUND: There are conflicting reports regarding seasonal sleep difficulties in polar regions. Herein we report differences in actigraphic sleep measures between two summer trials (collected at Canadian Forces Station Alert, 82.5°N, in 2012 and 2014) and evaluate exogenous melatonin for preventing/treating circadian phase delay due to nocturnal light exposure. METHODS: Subjects wore actigraphs continuously to obtain sleep data. Following seven days of actigraphic recording the subjects filled out questionnaires regarding sleep difficulty and psychosocial parameters and subsequently remained in dim light conditions for 24 hours, during which saliva was collected bihourly to measure melatonin. During Trial 2, individuals who reported difficulty sleeping were prescribed melatonin, and a second saliva collection was conducted to evaluate the effect of melatonin on the circadian system. RESULTS: Trial 1 subjects collectively had late dim light melatonin onsets and difficulty sleeping; however, the Trial 2 subjects had normally timed melatonin rhythms, and obtained a good quantity of high-quality sleep. Nocturnal light exposure was significantly different between the trials, with Trial 1 subjects exposed to significantly more light between 2200 and 0200h. Melatonin treatment during Trial 2 led to an improvement in the subjective sleep difficulty between the pre- and post-treatment surveys; however there were no significant differences in the objective measures of sleep. CONCLUSIONS: The difference in sleep and melatonin rhythms between research participants in June 2012 and June 2014 is attributed to the higher levels of nocturnal light exposure in 2012. The avoidance of nocturnal light is likely to improve sleep during the Arctic summer.

A look at nutritional supplement use in adolescents.

PURPOSE: To examine the use of nutritional supplements by adolescents. Supplements examined were those purported to influence performance and body mass. METHODS: 333 adolescents (190 male, 139 female, 4 nonrespondents) between the ages of 13 and 19 years, from a midwestern province in Canada, completed a pencil-and-paper survey. Participants, who were enrolled in health and wellness/physical education classes, were requested to provide information about current and potential use of 10 readily available nutritional supplements, as well as their knowledge of these products as potentially performance enhancing. Differences in use, potential use, and knowledge, as a function of gender, age, and level of physical activity were examined using Chi-square analyses and ANOVA techniques. RESULTS: The most popular dietary aids were multivitamin/mineral preparations (42.5%). More adolescent males than females reported that they currently used both creatine and diuretics. Female respondents indicated that they would consume herbal weight control products significantly more than males. Older students and students reporting high levels of physical activity were significantly more likely to be supplementing with creatine and protein. Males were more likely than females to believe that creatine and androsterone were performance-enhancing agents. Individuals highly involved in physical activity tended to believe that multivitamins, creatine, L-carnitine, energizers, and protein supplements could enhance their performance. CONCLUSIONS: This study highlights the fact that many nutritional supplements fall within the spectrum of adolescent use, and that this use may be driven by misguided beliefs in their performance-enhancing abilities. Groups at particular risk, such as individuals involved in physical activity to a high degree, are highlighted and the need for gender-specific information is suggested.

Gender and ethnic differences in health beliefs and behaviors.

This study explored the extent to which college men and women of various racial and ethnic groups differ in their health beliefs and behaviors. Exploratory factor analyses of survey responses from a diverse sample of 1816 undergraduate students identified 21 items in six cohesive domains: Diet; Anger and Stress; Preventive Care; Medical Compliance; Substance Use; and Beliefs about Masculinity. Analyses of variance explored group differences across these domains. Findings revealed consistent gender differences, with men engaging in riskier behaviors and holding riskier beliefs than women. Main effects for ethnicity were also observed, but only for the diet domain was a gender by ethnicity interaction found. Implications for establishing gender- and ethnicity-based health promotion and disease prevention interventions are discussed.

Body image, eating disorders, and the drive for muscularity in gay and heterosexual men: the influence of media images.

This Internet research project examined the relationship between consumption of muscle and fitness magazines and/or various indices of pornography and body satisfaction in gay and heterosexual men. Participants (N = 101) were asked to complete body satisfaction questionnaires that addressed maladaptive eating attitudes, the drive for muscularity, and social physique anxiety. Participants also completed scales measuring self-esteem, depression, and socially desirable responding. Finally, respondents were asked about their consumption of muscle and fitness magazines and pornography. Results indicated that viewing and purchasing of muscle and fitness magazines correlated positively with levels of body dissatisfaction for both gay and heterosexual men. Pornography exposure was positively correlated with social physique anxiety for gay men. The limitations of this study and directions for future research are outlined.

Sexuality and the drive for muscularity: evidence of associations among British men.

Previous studies have documented associations between sexuality and body image, but the directionality of this association is unclear among men. This study examined whether men's drive for muscularity can be considered a correlate of their sexuality. A community-based sample of 292 heterosexual men from London, UK, completed a survey consisting of measures of drive for muscularity, sociosexuality, sexual assertiveness, sexual esteem, and sexual sensation seeking. A multiple regression analysis showed that greater drive for muscularity was predicted by more unrestricted sociosexuality (i.e., a greater proclivity for short-term, transient relationships), greater sexual sensation seeking, and greater sexual assertiveness, once the effects of participant age and body mass index had been accounted for. Possible avenues for intervention based on a sex-positive approach are discussed in conclusion.

Social dominance orientation predicts drive for muscularity among British men.

The present study tested the hypothesis that men's drive for muscularity would be associated with their valuation of domination, power, status, and aggression over others. A community sample of 359 men from London, UK, completed measures of drive for muscularity, social dominance orientation, right-wing authoritarianism, trait aggression, and need for power, as well as their demographic details. Bivariate correlations showed that greater drive for muscularity was significantly correlated with most of the measures and their subscales. However, in a multiple regression analysis, the only significant predictor of drive for muscularity was support for group-based dominance hierarchies (Adj. R(2)=.17). These results suggest that men's drive for muscularity is associated with a socio-political ideology that favours social dominance.

Selection of key stressors to develop virtual environments for practicing stress management skills with military personnel prior to deployment.

Virtual environments (VEs) are presently being used to treat military personnel suffering from posttraumatic stress disorder (PTSD). In an attempt to reduce the risk of PTSD, VEs may also be useful for stress management training (SMT) to practice skills under stress, but such use necessitates the development of relevant stress-inducing scenarios and storyboards. This article describes the procedures followed to select which VEs could be built for the Canadian Forces. A review and analysis of the available literature and of data collected postdeployment from 1,319 respondents on the frequency of stressors and their association with psychological injuries were pulled together to propose eight potential virtual stressors that can be used to practice SMT: seeing dead bodies or uncovering human remains; knowing someone being seriously injured or killed; receiving artillery fire; being unable to help ill or wounded civilians because of the rules of engagement; seeing destroyed homes and villages; clearing and searching homes, caves, or bunkers; receiving small-arms fire; and participating in demining operations. Information reported in this article could also be useful to document traumatic stressors experienced in theater of operations and their potential impact on psychological injuries.