Dietary patterns with combined and site-specific cancer incidence in Alberta's Tomorrow Project cohort.

BACKGROUND/OBJECTIVES: Poor diet quality has been associated with an increased risk of cancer. Here, we examine the association between dietary patterns derived with two methods, and combined and site-specific cancer incidence in Canada. SUBJECTS/METHODS: Dietary data were obtained from participants enrolled in Alberta's Tomorrow Project, a prospective cohort study, between 2000 and 2008. Principle component analysis (PCA) and reduced rank regression (RRR) were used to derive dietary patterns, and data linkage with the Alberta Cancer Registry was used for incident cancer cases. Cox proportional hazard regressions were used to estimate multivariable-adjusted models for the association between each dietary pattern score with combined and site-specific cancer incidence. RESULTS: PCA revealed three dietary patterns ("western", "prudent", and "sugar, fruits, and dairy") and RRR resulted in four patterns ("dietary fiber", "vitamin D", "fructose", and "discretionary fat"). Five cancer sites were included in our site-specific analysis: lung, colon, breast, prostate, and endometrial cancers. The most protective dietary patterns for combined cancer sites were the "Prudent" pattern (HR = 0.82, CI = 0.73-0.92) and the "Dietary fiber" pattern (HR = 0.82, CI = 0.69-0.97). The "Fructose" pattern was associated with increased risk of combined cancers (HR = 1.14, CI = 1.02-1.27). Three dietary patterns were protective against colon cancer ("Prudent", "Dietary fiber", and "Discretionary fats"), and other risk reductions were seen for the "sugar, fruit, and dairy" pattern (lung cancer), and the "Dietary fiber" pattern (prostate cancer). CONCLUSIONS: These results support cancer prevention strategies for a diet high in vegetables, fruits, fish, and whole grains. Further studies should explore the possible association between discretionary fats and colon cancer.

Sleep Health in Male-dominated Workplaces: A Qualitative Study Examining the Perspectives of Male Employees.

OBJECTIVE: The purpose of this qualitative study was to explore working men's perspectives about sleep health and the intersecting influences of gender and work, describing participant's views on current and potential programming and organizational support to promote sleep health. METHODS: Twenty men employed in male-dominated industries in the north-central region of Alberta, Canada, participated in 4 consultation group discussions addressing motivators, facilitators and barriers to sleep health. RESULTS: Participants reported sleeping an average of 6.36 (SD ±1.1) hours per night, and the majority worked more than 40 hours per week. Data were analyzed using an inductive approach. The findings provided important insights. In normalizing sleep deprivation and prioritizing the need to "just keep going" on six or less hours of sleep, the men subscribed to masculine ideals related to workplace perseverance, stamina and resilience. Workplace cultures and practices were implicated including normative dimensions of overtime and high productivity and output, amid masculine cultures constraining emotions and conversations about sleep, the sum of which muted avenues for discussing, let alone promoting sleep. Challenges to good sleep were primarily constructed around time constraints, and worry about meeting work and home responsibilities. Men's preferences for workplace support included providing and incentivizing the use of sleep health resources, designing work for sleep health (e.g., shift schedules, overtime policies) and getting advice from experienced coworkers and experts external to the workplace organization. CONCLUSION: These findings hold potential for informing future gender-sensitive programming and organizational practices to support sleep health among working men.

Experiences with and Perception of a Web-Based Mindfulness, Nutrition, and Fitness Platform Reported by First-Year University Students: A Qualitative Study.

BACKGROUND: My Viva Plan (MVP) (https://www.myvivainc.com/) is a web-based application developed by a dietitian that aims to support healthy living by providing resources and self-monitoring tools to help promote a healthy diet, healthy mind, and physical fitness. First-year university students have the potential to benefit because poor dietary choices, limited physical activity, and high stress are prevalent in this population. In addition, they are also active technology users. OBJECTIVE: This study aims to understand experiences and perception of MVP by first-year university students using this tool as part of a 12-week randomized controlled trial. DESIGN: One-on-one semistructured interviews were conducted following a 12-week intervention involving use of MVP. PARTICIPANTS/SETTING: First-year university students from the University of Alberta, Edmonton, Canada (n = 32). INTERVENTION: Participants were instructed to use MVP as much as possible for 12 weeks in either the fall/2018 or winter/2019 semesters. QUALITATIVE DATA ANALYSIS: Interviews were audio-recorded, transcribed verbatim, and analyzed abductively using content analysis. RESULTS: Participants reported varied use of MVP across the 12-week period. Data were categorized using the HealthChange Methodology (Behaviors, Emotions, 37 Situations, Thinking) framework. Participants provided various examples of emotions (eg, motivation, stress), situations (eg, time, living arrangements, finances), and thinking (eg, self-awareness, level of satisfaction with MVP, and how MVP was or could be better tailored for students) that acted as either facilitators or barriers to MVP use and explained their behaviors associated with this tool. CONCLUSIONS: Overall, participant behaviors regarding MVP varied and were influenced by several factors, including their emotions, situations, and thinking. The Behaviors, Emotions, Situations, Thinking framework may be helpful for dietitians to identify barriers and facilitators affecting their client's use of ehealth tools for lifestyle behavior change. This information can be used to optimize client support when using these tools.

The Impact of a Web-Based Mindfulness, Nutrition, and Physical Activity Platform on the Health Status of First-Year University Students: Protocol for a Randomized Controlled Trial.

BACKGROUND: First-year university students are at an increased risk for developing mental health issues and a poor nutritional status. Self-care plays an essential role in optimizing mental health and can prevent or manage stress, anxiety, and depression. Web-based self-monitoring of diet and physical activity can lead to similar or improved health outcomes compared with conventional methods. Such tools are also popular among university students. OBJECTIVE: The primary aim of this 12-week randomized controlled trial is to assess the impact of a web-based wellness platform on perceived stress among first-year university students. The secondary aim is to assess the effects of the platform on diet quality. The exploratory objectives are to explore the effects of the platform on body composition, health-related quality of life, mindfulness, mental well-being, and physical activity. METHODS: A total of 97 first-year undergraduate students were randomized to either the intervention (n=48) or control (n=49) group. The intervention consisted of access to a web-based platform called My Viva Plan (MVP), which aims to support healthy living by focusing on the topics of mindfulness, nutrition, and physical activity. The platform is fully automated and guided by the principles of cognitive behavioral theory. Participants in the intervention group were instructed to use the MVP as frequently as possible over 12 weeks. The control group did not receive access to MVP. Perceived stress was assessed using the Stress Indicators Questionnaire at baseline, week 6, and week 12. Three-day food records were used to analyze the dietary intake at baseline and week 12. Health-related quality of life, mindfulness, mental well-being, and physical activity questionnaires were completed at baseline, week 6, and week 12. Body composition was assessed at baseline and week 12. Study assessments were completed in person at baseline and week 12 and electronically at week 6. RESULTS: Study recruitment started in August 2018, with batch enrollment for students registered in the fall (September 2018 to December 2018) and winter (January 2019 to April 2019) academic terms at the University of Alberta, Edmonton, Alberta. CONCLUSIONS: This study is the first to explore the impact of a web-based platform designed to promote health and wellness on perceived stress and diet quality among first-year university students. TRIAL REGISTRATION: ClinicalTrials.gov NCT03579264; https://clinicaltrials.gov/ct2/show/NCT03579264. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/24534.

Men's Physical Activity and Sleep Following a Workplace Health Intervention: Findings from the POWERPLAY STEP Up challenge.

The workplace provides an important delivery point for health promotion, yet many programs fail to engage men. A gender-sensitive 8-week team challenge-based intervention targeting increased physical activity was delivered at a petrochemical worksite. The purpose of this study was to examine men's pre-post physical activity and sleep following the intervention, as well as to explore program acceptability and gather men's recommendations for health promotion. Pre-post surveys assessed physical activity, sleep, program exposure, acceptability, and suggestions for continued support. Overall, 328 men completed baseline surveys and 186 (57%) completed follow-up surveys. Walking increased by 156.5 min/week, 95% confidence interval (61.2, 251.8), p = .001. Men with higher program exposure increased moderate and vigorous activity 49.4 min more than those with low exposure (p = .026). Sleep duration and quality were higher postintervention, though changes were modest. Program acceptability was high as was intention to maintain physical activity. Men's suggestions to enable physical activity involved workplace practices/resources, reducing workload, and leadership support. These findings suggest that a gender-sensitive physical activity workplace intervention showed promise for improving physical activity and sleep among men. The men's suggestions reflected workplace health promotion strategies, reinforcing the need for employers to support ongoing health promotion efforts.

Positive Lifestyle Behavior Changes Among Canadian Men: Findings From the HAT TRICK Program.

PURPOSE: To estimate program effectiveness regarding physical activity (PA), diet, and social connectedness as part of a feasibility study. DESIGN: Pre-post quasi-experimental. SETTING: HAT TRICK was delivered in collaboration with a Canadian semi-professional ice hockey team and offered at the arena where they trained and played games. PARTICIPANTS: Participants (N = 62) at baseline were overweight (BMI >25kg/m2) and inactive (<150 minutes of MVPA/week) men age 35+ years. INTERVENTION: Gender-sensitized 12-week intervention for men targeting PA, healthy eating and social connectedness. METHOD: Baseline, post-intervention (12 weeks) and 9-month follow-up self-report and accelerometer data were collected. Multi-level modeling assessed growth trajectories of outcome measures across time. RESULTS: Accelerometer measured weekly/min. of moderate PA showed significant linear trends (95%CI: 42.9 - 175.3) from baseline (147.0 ± 104.6), 12-week (237.7 ± 135.5) and 9-month follow-up (204.89 ± 137.7) qualified with a quadratic trend. Self-reported weekly/min of moderate and vigorous PA showed significant linear trends (95%CI: 94.1, 264.1; 95%CI: 35.1, 109.6) from baseline (52.6 ± 83.8, 22.42 ± 44.9), 12 week (160.1 ± 157.4, 66.6 ± 74.4) and 9-month follow-up (118.6 ± 104.6, 52.2 ± 59.2) qualified with quadratic trends. DINE measured fat score rating showed linear trends over time (95%CI -14.24, -6.8), qualified with a quadratic trend. DINE fibre score and social connectedness showed no trends. CONCLUSION: Findings yield valuable information about the implementation of gender-sensitized lifestyle interventions for men and demonstrate the importance of male-specific strategies for reaching and engaging overweight, physically inactive men.

A systematic review of workplace behavioral interventions to promote sleep health in men.

Sleep health is an important aspect of wellbeing and merits incorporation into workplace health promotion programs for employees. Men are a unique population with whom many traditional workplace health promotion programs have had limited success. This systematic review posed the question do workplace health promotion programs improve sleep among men, and what program design features contribute to improving sleep among working men? Databases searched were MEDLINE, EMBASE, the Cochrane Library, CINHAL, Academic Search Complete and Health Source: Nursing/Academic Edition and Google Scholar. Empirical research reporting non-pharmacological behavioral sleep programs and/or interventions for working men were eligible for review. 1049 articles were identified; 15 intervention studies were included: 13 interventions were delivered through workplaces, and two recruited workers to programs delivered outside of work. Interventions incorporated health education, stress reduction/relaxation, and/or physical activity components. Eleven studies reported positive findings for sleep health outcome(s) in men. A moderate level of evidence exists for sleep health programs with physical activity and stress management components. Evidence for the effectiveness of sleep health education programs was mixed. That only one study included a gender-sensitized intervention, where men's preferences shaped the content of a stress-reduction program which resulted in improved sleep quality, attests to the insufficient evidence and lack of gender-specific content and analyses. Next research steps should include considering cultural constructions of masculinity in program design in order to strengthen the appeal and engagement of men, and optimize health benefits for working men.

Health Literacy Among Canadian Men Experiencing Prostate Cancer.

The objective was to describe the health literacy of a sample of Canadian men with prostate cancer and explore whether sociodemographic and health factors were related to men's health literacy scores. A sample of 213 Canadian men (M age = 68.71 years, SD = 7.44) diagnosed with prostate cancer were recruited from an online prostate cancer support website. The men completed the Health Literacy Questionnaire along with demographic, comorbidity, and prostate cancer treatment-related questions online. Of the 5-point scales, men's health literacy scores were highest for "Understanding health information enough to know what to do" (M = 4.04, SD = 0.48) and lowest for "Navigating the health care system" (M = 3.80, SD = 0.58). Of the 4-point scales, men's scores were highest for "Feeling understood and supported by health care professionals" (M = 3.20, SD = 0.52) and lowest for "Having sufficient information to manage my health" (M = 2.97, SD = 0.46). Regression analyses indicated that level of education was positively associated with health literacy scores, and men without comorbidities had higher health literacy scores. Age and years since diagnosis were unrelated to health literacy. Support in health system navigation and self-management of health may be important targets for intervention.

The Association Between Men's Heath Behaviors and Interest in Workplace Health Promotion.

Background: Predictors of men's health behaviors and interest in workplace health promotion are not well known. The aim of this study was to describe men's interest in workplace health promotion and associated health behaviors. Method: Male employees (N = 781) at six workplaces in British Columbia, Canada, were invited to complete a survey of their health behaviors, demographics, and interest in health promotion prior to implementation of a workplace health program. Findings: A total of 227 male employees (Mage = 43.6 years; SD = 12.1) completed the survey (response rate = 29%). Regarding health behaviors, 62.1% reported 150 weekly minutes of moderate-to-vigorous physical activity (MVPA), 29.3% consumed 5+ servings of fruit/vegetables per day, 56.8% reported 7+ hours sleep/night, 14.4% smoked, and 81.3% consumed alcohol. Men spent 50% of their workday sitting, and higher body mass index (BMI), higher income, and greater hours worked were related to greater hours sitting. Age was inversely related to MVPA. Alcohol consumption was lower among men who were older, had higher income, and worked fewer hours. Most men were interested in being physically active (85%), managing stress (85%), eating healthy (89%), and cancer screening (91%). Higher stage of change for physical activity (ß = .20, p = .003) and fruit/vegetable consumption (ß = .18, p = .027) were related to interest in these activities. Conclusions/Application to Practice: Occupational health providers should consider worker demographics and could support interventions that target individuals with varying levels of health behaviors given the importance of meeting the needs of often sedentary workers.

Prevalence and Correlates of Accelerometer-Based Physical Activity and Sedentary Time Among Kidney Transplant Recipients.

BACKGROUND: Physical activity is recommended for kidney transplant recipents as it may improve outcomes including mortality, exercise capacity, muscle strength, and health-related quality of life. OBJECTIVE: The objective of this study was to examine accelerometer-based physical activity and sedentary time profiles among kidney transplant recipients and examine possible demographic and clinical correlates of physical activity and sedentary time. DESIGN: Cross-sectional. SETTING: Edmonton, Alberta, Canada. PATIENTS: Kidney transplant recipients were recruited (N = 1,284) from the Northern Alberta Renal Program's Nephrology Information System database (1993-2016). MEASUREMENTS: Participants wore an ActiGraph GT3X+ accelerometer on their hip during waking hours for seven consecutive days. METHODS: Kidney transplant recipients (1993-2016) recruited from the Northern Alberta Renal Program's Nephrology Information System database wore an accelerometer and completed a self-reported questionnaire. Multiple linear regression was used to determine associations between activity level, demographic, and clinical characteristics. RESULTS: Participants' (n = 133; 11% response rate) mean age (SD) was 58 (14) years and 56% were female. Mean total sedentary time was 9.4 (1.4) hours per day; total moderate-to-vigorous physical activity (MVPA) time was 20.7 (19.6) minutes per day. MVPA was significantly associated with age where each additional year was associated with 0.48 fewer min/day (ie, ~30 seconds) (unstandardized beta: B = -0.48 min/day, 95% confidence interval [95% CI]: -0.75, -0.22). Sedentary time was significantly associated with age (B = 1.0 min/day, 95% CI: 0.03, 1.9), body mass index (B = 2.7 min/day, 95% CI: 0.2, 5.13), education (B = 39.1 min/day, 95% CI: 12.3, -65.8), and inversely associated with income (B = -44.9 min/day, 95% CI: -73.1, -16.8). LIMITATIONS: Limitations include the cross-sectional design, poor response rate, and limited generalizability of the results. CONCLUSIONS: Kidney transplant recipients showed high volumes of sedentary time and low volumes of health-enhancing physical activity. Understanding correlates of these behaviors may aid in the development of interventions to favorably change these behaviors.

CONTEXTE: L'activité physique est recommandée aux receveurs d'une greffe rénale puisqu'elle peut améliorer leur santé ­ augmentation de la tolérance à l'effort, de la force musculaire et de la qualité de vie liée à l'état de santé ­ et limiter les issues indésirables, notamment la mortalité. OBJECTIF: L'objectif était double: caractériser l'activité physique et le profil de sédentarité des receveurs d'une greffe rénale avec un accéléromètre, et analyser les possibles corrélations démographiques et cliniques de l'activité physique et du comportement sédentaire. TYPE D'ÉTUDE: Étude transversale. CADRE: Edmonton, en Alberta (Canada). SUJETS: Des patients ayant reçu une greffe rénale entre 1993 et 2016 (n = 1284) et recrutés dans la base de données du système d'information en néphrologie du Northern Alberta Renal Program (NARP). MESURES: Les participants portaient un accéléromètre Actigraph GT3X+ à la hanche durant les heures d'éveil pour sept jours consécutifs. MÉTHODOLOGIE: Les receveurs d'une greffe rénale (1993 à 2016) recrutés dans la base de données du système d'information en néphrologie du NARP ont porté un accéléromètre et rempli un questionnaire d'auto-déclaration. Une régression linéaire multiple a été employée pour établir les associations entre le niveau d'activité physique et les données démographiques et cliniques des patients. RÉSULTATS: Les participants (n = 133; taux de réponse de 11 %), dont 56 % étaient des femmes, étaient âgés de 58 ans en moyenne (écart-type [É-T]: 14 ans). La période de sédentarité s'élevait en moyenne à 9,4 heures par jour (É-T: 1,4 heure), alors que la période moyenne d'activité physique modérée à vigoureuse (APMV) s'établissait à 20,7 minutes par jour (É-T: 19,6 minutes). L'APMV a été associée de façon significative à l'âge du patient, où chaque année additionnelle en âge a correspondu à une réduction de 0,48 minute par jour (environ 30 sec.) de l'APMV (bêta non normalisé [ß] = -0,48 min/jour; 95% IC: -0,75 à -0,22). Les comportements sédentaires ont été associés de façon significative à l'âge (ß = 1,0 min/jour, 95% IC: 0,03 à 1,9), à l'IMC (ß = 2,7 min/jour, 95% IC: 0,2 à 5,13), au niveau de scolarité (ß = 39,1 min/jour, 95% IC: 12,3 à -65,8), et inversement associés au revenu du patient (ß = -44,9 min/jour, 95% IC: -73,1 à -16,8). LIMITES: La généralisation des résultats est limitée par la nature transversale de l'étude et par le faible taux de réponse. CONCLUSION: Les receveurs d'une greffe rénale sont largement sédentaires et pratiquent peu d'activité physique ayant un effet bénéfique sur leur santé. La compréhension des corrélations de ces comportements pourrait faciliter le développement d'interventions visant à les modifier favorablement.

Healthy Eating and Active Living for Diabetes-Glycemic Index (HEALD-GI): Protocol for a Pragmatic Randomized Controlled Trial.

BACKGROUND: Rigorous evidence is needed regarding the best approach for increasing the uptake of Diabetes Canada's evidence-based recommendations to include low-glycemic index (GI) foods in daily meal planning as an effective dietary self-care strategy for glycemic control among people with type 2 diabetes (T2D). OBJECTIVE: This study aims to present the study design and baseline data from the Healthy Eating and Active Living for Diabetes-Glycemic Index (HEALD-GI) trial, which was designed to evaluate the effectiveness of an enhanced GI-targeted nutrition education on GI-related knowledge and mean daily GI among adults with T2D in Edmonton, Alberta. METHODS: We used a pragmatic randomized controlled trial design and allocated 67 adults (aged ≥18 years) with T2D living in Edmonton, Alberta, Canada, to a control group that received standard printed copies of Canada's Food Guide and Diabetes Canada's GI resources or to an intervention group that received the same materials, plus a customized Web-based platform with 6 self-directed learning modules and print material. Each module included videos, links to reliable websites, chat rooms, and quizzes. Evidence-based GI concept information included GI values of foods and low-GI shopping, recipes, and cooking tips by a registered dietitian. In addition, support through email, text messaging (short message service), phone calls, or postal mail was provided to reinforce participants' learning. The primary outcome, average dietary GI, was assessed using 3-day food records. Additional measures including GI knowledge and self-efficacy, glycated hemoglobin (HbA1c), lipids, systolic blood pressure, body mass index (BMI; weight, height), waist circumference, and computer proficiency were assessed at baseline and at 3-month postintervention. RESULTS: Between November 2017 and February 2018, we contacted adults (aged ≥18 years) with T2D living in Edmonton, Alberta, screened and recruited eligible participants into the study. All data collection ended in June 2018. Overall, 64% (43/67) participants were males; mean age was 69.5 (SD 9.3) years, with a mean diabetes duration of 19.0 (SD 13.7) years. Mean BMI was 30.1 (SD 5.7) kg/m2, and mean HbA1c value was 7.1% (SD 1.2%). Data analysis was completed in December 2018. CONCLUSIONS: The GI concept is often difficult to teach. The HEALD-GI study aims to provide evidence in support of an alternative approach to translating the GI concept to adults with T2D. Findings from this study may help registered dietitians to better disseminate low-GI dietary recommendations using efficient and cost-effective, patient-centered approaches. Furthermore, evidence generated will contribute to addressing some of the controversies regarding the clinical usefulness of the GI concept. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/11707.

Women's experience with peer counselling and social support during a lifestyle intervention among women with a previous gestational diabetes pregnancy.

PURPOSE: Women who are diagnosed with gestational diabetes mellitus have an increased risk of developing type 2 diabetes, but most receive little guidance regarding disease prevention. This study examined the role and usefulness of social support, including peer counselling in facilitating behaviour change as a part of a healthy eating and physical activity intervention among women with a previous gestational diabetes mellitus pregnancy. METHODS: We used a qualitative descriptive approach to investigate participants' experiences with the social support they received during the intervention. We used purposeful sampling and invited women and peer counsellors to participate in semi-structured interviews. Data were analyzed using content analysis. RESULTS: We interviewed nine women and two peer counsellors. Participants received emotional, appraisal, and informational types of social support from the peer counsellor and exercise specialist that they reported as useful. Additionally, participants' received informal emotional and instrumental support from family, friends, and colleagues that they found useful in supporting behaviour change. CONCLUSIONS: Different types of social support are important to encourage behaviour change. These findings provide insight into the types of social support women with previous gestational diabetes mellitus find useful, in addition to practical ways that social support can be incorporated into future interventions.

Men's Perspectives of a Gender-Sensitized Health Promotion Program Targeting Healthy Eating, Active Living, and Social Connectedness.

Men in high income countries have poorer dietary habits and higher rates of overweight and obesity than women. A major challenge with engaging men in health promotion is the perception that attention to one's health runs counter to masculine identities. Contemporary health promotion programs are believed to hold little "manly" appeal and often fail to engage and retain men. The HAT TRICK program was designed to engage men with their health by delivering an intervention in collaboration with a semi-professional ice hockey team. The program included 12 weekly sessions promoting healthy eating, active living, and social connectedness among men. Gender-sensitized elements were reflected in the program design, setting, content, and delivery. Semistructured telephone interviews were conducted with 23 men to explore perspectives of their participation in the gender-sensitized intervention. Participants were white (100%) with a mean age of 53 years ( SD ± 9.9), Body Mass Index (BMI) of 37 kg/m2 ( SD ± 6.8), and waist circumference of 127 centimeters ( SD ± 14.5). Inductive thematic analysis revealed three overarching themes, including: (a) Harnessing nostalgia for past masculinities: "Closet athletes from 30 years ago," (2) Offsetting resistance to change with sensible health advice: "Don't give up drinking beer, just have less," and (3) Gendered social spaces for doing health: "A night out with the guys," The findings support the value of gender-sensitized approaches to men's health promotion. Further research is needed to identify which gender-sensitized elements are critical to engaging men in healthy lifestyle changes.

Evaluating the Evidence on Sitting, Smoking, and Health: Is Sitting Really the New Smoking?

Sitting has frequently been equated with smoking, with some sources even suggesting that smoking is safer than sitting. This commentary highlights how sitting and smoking are not comparable. The most recent meta-analysis of sedentary behavior and health outcomes reported a hazard ratio of 1.22 (95% confidence interval [CI] = 1.09, 1.41) for all-cause mortality. The relative risk (RR) of death from all causes among current smokers, compared with those who have never smoked, is 2.80 (95% CI = 2.72, 2.88) for men and 2.76 for women (95% CI = 2.69, 2.84). The risk is substantially higher for heavy smokers (> 40 cigarettes per day: RR = 4.08 [95% CI = 3.68, 4.52] for men, and 4.41 [95% CI = 3.70, 5.25] for women). These estimates correspond to absolute risk differences of more than 2000 excess deaths from any cause per 100 000 persons per year among the heaviest smokers compared with never smokers, versus 190 excess deaths per 100 000 persons per year when comparing people with the highest volume of sitting with the lowest. Conflicting or distorted information about health risks related to behavioral choices and environmental exposures can lead to confusion and public doubt with respect to health recommendations.

Dietary Patterns Prior to Pregnancy and Associations with Pregnancy Complications.

Few studies have explored pre-pregnancy diet and its relationship with pregnancy outcomes. The objectives of this study were to: (1) derive pre-pregnancy dietary patterns for women enrolled in a prospective cohort in the province of Alberta, Canada; (2) describe associations between dietary patterns and socio-demographic characteristics; and (3) describe associations between dietary patterns and pregnancy complications. Upon enrolment into the Alberta Pregnancy Outcomes and Nutrition (APrON) study (median age of gestation, 17 weeks), women (n = 1545) completed a validated 142-item food frequency questionnaire recording food and beverages consumed "in the 12 months prior to pregnancy". Other assessments included pre-pregnancy body mass index (BMI), gestational weight gain, gestational hypertension, gestational diabetes, and socio-demographic characteristics. Dietary patterns were derived using principal components analysis. Scores were calculated to represent adherence with each dietary pattern retained. Four dietary patterns were retained, accounting for 22.9% of the variation in the overall diet. Dietary patterns were named the "healthy", "meat and refined carbohydrate", "beans, cheese and salad" or "tea and coffee" patterns. Higher "healthy" pattern scores prior to pregnancy were associated with lower odds of developing gestational hypertension during pregnancy (adjusted Odds Ratio (OR): 0.6, 95% Confidence Intervals (CI): 0.4, 0.9). Diet prior to pregnancy is an important target for interventions and may reduce the likelihood of developing complications such as gestational hypertension during pregnancy.

Associations of objectively assessed physical activity and sedentary time with health-related quality of life among lung cancer survivors: A quantile regression approach.

OBJECTIVES: No studies have examined objectively assessed physical activity, sedentary time, and patient-reported outcomes among lung cancer survivors. The objective of this study was to determine associations of objectively assessed moderate-to-vigorous intensity physical activity (MVPA) and sedentary time with health-related quality of life (HRQoL) and fatigue among lung cancer survivors. MATERIALS AND METHOD: Lung cancer survivors in Southern Alberta (N = 540) were invited to complete a mailed survey that assessed HRQoL [Functional Assessment of Cancer Therapy-Lung (FACT-L)], physical and functional well-being [Trial Outcome Index (TOI)], and fatigue [Fatigue Scale (FS)]. Physical activity and sedentary time data was collected using an Actigraph® GT3X+ accelerometer that was worn on the hip for seven consecutive days. Quantile regression was used to examine associations of HRQoL and fatigue with physical activity and sedentary time at the 25th, 50th, and 75th HRQoL and fatigue percentiles. RESULTS: A total of 127 lung cancer survivors participated for a 24% response rate (Mean age = 71 years; Mean time since diagnosis = 75 months). Total MVPA minutes was positively associated with fewer fatigue symptoms at the 25th percentile (ß = 0.16, p = 0.046). Total sedentary time was inversely associated with HRQoL at the 75th percentile (ß = -0.07, p = 0.014) and inversely associated with fatigue symptoms at the 50th percentile (ß = -0.04, p = 0.009). Total sedentary time was also inversely associated with physical and functional well-being scores at the 25th (ß = -0.07, p = 0.045), 50th (ß = -0.07, p = 0.004) and 75th (ß = -0.04, p = 0.035) percentiles. CONCLUSION: Across the HRQoL, fatigue, and physical and functional well-being distributions, sedentary time was inversely associated with HRQoL, fatigue, and physical and functional well-being in lung cancer survivors. Small associations were observed between MVPA and fatigue, but no associations emerged with HRQoL or physical and functional well-being.

Factors That Impact the Success of Interorganizational Health Promotion Collaborations: A Scoping Review.

OBJECTIVE: To explore published empirical literature in order to identify factors that facilitate or inhibit collaborative approaches for health promotion using a scoping review methodology. DATA SOURCE: A comprehensive search of MEDLINE, CINAHL, ScienceDirect, PsycINFO, and Academic Search Complete for articles published between January 2001 and October 2015 was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. STUDY INCLUSION AND EXCLUSION CRITERIA: To be included studies had to: be an original research article, published in English, involve at least 2 organizations in a health promotion partnership, and identify factors contributing to or constraining the success of an established (or prior) partnership. Studies were excluded if they focused on primary care collaboration or organizations jointly lobbying for a cause. DATA EXTRACTION: Data extraction was completed by 2 members of the author team using a summary chart to extract information relevant to the factors that facilitated or constrained collaboration success. DATA SYNTHESIS: NVivo 10 was used to code article content into the thematic categories identified in the data extraction. RESULTS: Twenty-five studies across 8 countries were identified. Several key factors contributed to collaborative effectiveness, including a shared vision, leadership, member characteristics, organizational commitment, available resources, clear roles/responsibilities, trust/clear communication, and engagement of the target population. CONCLUSION: In general, the findings were consistent with previous reviews; however, additional novel themes did emerge.

Demographic and clinical correlates of accelerometer assessed physical activity and sedentary time in lung cancer survivors.

OBJECTIVE: To determine demographic and clinical correlates of accelerometer assessed physical activity and sedentary time among a population-based sample of lung cancer survivors. METHODS: Lung cancer survivors in Southern Alberta, Canada (N = 527) were invited to complete a mailed survey assessing socio-demographics and wear an Actigraph® GT3X+ accelerometer for 7 days. Average daily minutes of physical activity and sedentary time were derived from the accelerometer data. Accelerometer data were processed using standard Freedson cutpoints, and correlates of physical activity and sedentary time were determined with linear regression. RESULTS: A total of 127 lung cancer survivors participated (mean age = 71 years), for a 24% response rate. Moderate-to-vigorous physical activity was negatively associated with being >60 years of age (ß = -7.4, CI: -14.7, -0.10). Moderate-to-vigorous physical activity accumulated in 10-minute bouts was associated with receiving surgery and adjuvant chemotherapy (ß = 9.1, CI: 2.1, 16.1). Sedentary time was associated with being >60 years of age (ß = 32.4, CI: 3.1, 61.7), smoking (ß = 63.9, CI: 22.5, 105.4), and being overweight/obese (ß = 28.6, CI: 6.4, 50.1). CONCLUSION: Age, smoking history, and body mass index emerged as correlates of accelerometer assessed light, moderate, and vigorous physical activity, and sedentary time among lung cancer survivors. IMPLICATIONS FOR CANCER SURVIVORS: Identifying correlates of physical activity and sedentary time may aid in the development of targeted behavioral interventions for this population.

Correlates of accelerometer-assessed physical activity and sedentary time among adults with type 2 diabetes.

OBJECTIVES: The aims of this study were to describe the volume and patterns of objectively assessed sedentary behaviour, light intensity physical activity (LPA) and moderate-vigorous physical activity (MVPA), and to examine socio-demographic correlates, among adults living with type 2 diabetes. METHODS: Participants (n = 166) wore an accelerometer (Actigraph® GT3X+) for seven consecutive days during waking hours and completed a questionnaire. Physical activity (PA) and sedentary time were described, and multivariable linear regression was used to estimate associations between socio-demographic characteristics and sedentary time and PA. RESULTS: Participants, 46% of whom were female, had a mean age of 65.4 years (standard deviation (SD) = 9.5), body mass index (BMI) of 31.5 (6.6) kg/m2 and had been living with diabetes for an average of 13.1 (7.6) years. Participants were sedentary for 543.6 minutes/day, spent 273.4 minutes/day and 22.4 minutes/day in LPA and MVPA respectively. BMI was associated with increased sedentary time and reduced LPA (-2.5 minutes/day, 95% CI: -4.33 to -0.70) and MVPA (-0.62 minutes/day, 95% CI: -1.05 to -0.18) time. Compared with males, females had more LPA (34.4 minutes/day, 95% CI: 10.21-58.49) and less MVPA (-6.2 minutes/day, 95% CI: -12.04 to -0.41) time. Unemployed participants had 30.05 minutes more MVPA (95% CI: 3.35-56.75) than those who were employed or homemakers, and those not reporting income had 13 minutes/day more MVPA time than participants in the lowest income category (95% CI: 3.46-22.40). CONCLUSION: Adults living with type 2 diabetes were not sufficiently active and were highly sedentary. Our results emphasize the need for more research exploring the diabetes-related health outcomes of sedentary behaviour and physical inactivity among people living with type 2 diabetes.

Acceptability of the POWERPLAY Program: A Workplace Health Promotion Intervention for Men.

The workplace health promotion program, POWERPLAY, was developed, implemented, and comprehensively evaluated among men working in four male-dominated worksites in northern British Columbia, Canada. The purpose of this study was to explore the POWERPLAY program's acceptability and gather recommendations for program refinement. The mixed-method study included end-of-program survey data collected from 103 male POWERPLAY program participants, interviews with workplace leads, and field notes recorded during program implementation. Data analyses involved descriptive statistics for quantitative data and inductive analysis of open-ended questions and qualitative data. Among participants, 70 (69%) reported being satisfied with the program, 51 (51%) perceived the program to be tailored for northern men, 56 (62%) believed the handouts provided useful information, and 75 (74%) would recommend this program to other men. The findings also highlight program implementation experiences with respect to employee engagement, feedback, and recommendations for future delivery. The POWERPLAY program provides an acceptable approach for health promotion that can serve as a model for advancing men's health in other contexts.