Estimating the direct and indirect pathways between education and diabetes incidence among Canadian men and women: a mediation analysis

PurposeTo estimate the direct and indirect pathways between education and diabetes.MethodsWe examined the relative contribution of eight different pathways between education and diabetes incidence over a 9-year period in Ontario, Canada. Our data source was respondents (35–60 years of age) to the 2000–2001 Canadian Community Health Survey individually linked with physician and hospital administrative data. Our sample contained 11,899 participants with no previous diagnosis of diabetes. The direct and indirect effects of education level on incident diabetes were estimated using Aalen additive hazard models.ResultsNot having completed secondary education was associated with 120 extra diabetes cases per 10,000 men per year and 43 additional diabetes cases per 10,000 women per year, compared with having Bachelors education or higher. Body mass index accounted for 13 of the 120 extra diabetes cases among men, and 24 of the 43 additional diabetes cases for women.ConclusionsOf the mediating pathways examined in this paper, body mass index was the pathway through which the largest number of diabetes cases was mediated among men and women. A substantial number of excess diabetes cases among respondents with lower education levels, in particular among men, were not mediated through any of the eight pathways examined.     

Work with men to end violence against women: a critical stocktake

This paper provides a critical assessment of efforts to involve men in the prevention of men's violence against women. Although there is a substantial evidence base attesting to the effectiveness of at least some strategies and interventions, this field is also limited in important ways. Violence prevention efforts often have focused on changing men's attitudes, rather than also seeking to transform structural and institutional inequalities. While feminist and queer scholarship has explored diversities and pluralities in the organisation of sexuality, much violence prevention work often assumes a homogenously heterosexual male constituency. Too often this work is conceptually simplistic with regard to gender. Against this background, this paper contests and complicates several assumptions that are part of an emerging consensus in men's violence prevention: first, that it is in men's interests to support progress towards non-violence and gender equality; second, that the best people to engage and work with men are other men; and finally, the strengths and limitations of inviting and drawing on ‘real men’. A critical assessment of the field's working assumptions is vital if it is to contribute to the future prevention of men's violence against women.     

Evoked fear and effects of appeals on attitudes to performing breast self-examination: an information-processing perspective

The effect of fear arousal on attitude toward participating in early detection activities [i.e. breast self-examination (BSE)] was studied from an information-processing perspective. It was hypothesized that fear arousal motivates respondents to more argument-based processing of fear-relevant persuasive information. Respondents first read information about breast cancer in which fear was manipulated. After measuring fear arousal, respondents read a persuasive message about performing BSE. Analyses with reported fear, but not manipulated fear, found support for the hypothesis. Respondents who reported mild fear of breast cancer based their attitude toward BSE more on the arguments provided than respondents who reported low fear of breast cancer. This finding suggests that the use of fear arousal may be an efficient tool in health education practice. However, alternative interpretations are provided, in addition to the suggestion to be careful with using fear arousal in health education messages.     

Physical violence against impoverished women: a longitudinal analysis of risk and protective factors.

Violence represents a significant threat to the health of impoverished women. Few studies have examined what characteristics might be associated with increased risk of violence or protection from physical violence directed at such women, although this information is important in informing violence prevention and intervention efforts. This is the first study to our knowledge that has prospectively examined, in representative probability samples of impoverished women, multiple risk and protective factors to understand their relative importance to physical victimization. Study participants were 810 women in Los Angeles County, 402 in shelters and 408 in Section 8 low-income housing, who completed structured interviews at baseline and 6-month follow-up. Significant (p < .05) multivariate predictors of physical violence experienced during the 6 months prior to follow-up interview were physical or sexual violence experienced as a child, physical violence experienced during the 6 months prior to baseline interview, having multiple sexual partners, psychological distress, and poor social support. Results of this study highlight the persistence of physical violence in the lives of impoverished women and plausible, prospective risk factors for this violence. Findings also highlight opportunities to reduce women's risk of experiencing violence through enhancing women's social support and mental health.     

Mexican American women in a rural area and barriers to their ability to enact protective behaviors against breast cancer

Mexican American women in rural areas have less chance of surviving breast cancer than women in other ethnic populations (Boughton, 2000; Herman, 1996). This research sought to determine why such women do or do not enact behaviors to help them protect themselves from breast cancer. The extended parallel process model (Witte, 1994) provided a guiding theoretical basis for understanding perceptions, and 48 women, in discussion groups and surveys, were asked about self-exams, physician exams, and mammograms. Findings demonstrated that the women had high perceived self-efficacy and susceptibility regarding breast cancer but did not perceive it as severe (i.e., that it could cause death). These perceptions were positively and negatively related to behaviors that protect against breast cancer. Also, several barriers, such as lack of transportation, lack of access to health care, and lack of knowledge regarding breast self-exams, were found.     

Reviewing responsibilities and renewing relationships: an intervention with men on violence against women in India

Violence against women is increasingly seen as a key women's rights issue in India. Some efforts to address it have started to engage men. The current study focuses on the impacts of Men's Action to Stop Violence Against Women (MASVAW), a network of men working on gender-based violence in the state of Uttar Pradesh, in India. The purpose of the study was to determine the extent to which MASVAW activists incorporate gender-equitable attitudes and practices into their own lives and to identify their influence on men around them. The cross-sectional study includes three groups: activists, men living in an area where activists conducted outreach activities and a control group living in an area with no MASVAW activities. Both activists and activist influenced men scored higher on measures of gender-equitable beliefs and practices than controls, suggesting that MASVAW activism is successful. Furthermore, men from the activist influenced group scored higher in gender progressiveness even if they did not have contact with MASVAW themselves, suggesting a diffusion effect of social change. However, there were some areas where the activists had low scores, suggesting need for additional inputs.     

Reviewing responsibilities and renewing relationships: an intervention with men on violence against women in India

Violence against women is increasingly seen as a key women's rights issue in India. Some efforts to address it have started to engage men. The current study focuses on the impacts of Men's Action to Stop Violence Against Women (MASVAW), a network of men working on gender-based violence in the state of Uttar Pradesh, in India. The purpose of the study was to determine the extent to which MASVAW activists incorporate gender-equitable attitudes and practices into their own lives and to identify their influence on men around them. The cross-sectional study includes three groups: activists, men living in an area where activists conducted outreach activities and a control group living in an area with no MASVAW activities. Both activists and activist influenced men scored higher on measures of gender-equitable beliefs and practices than controls, suggesting that MASVAW activism is successful. Furthermore, men from the activist influenced group scored higher in gender progressiveness even if they did not have contact with MASVAW themselves, suggesting a diffusion effect of social change. However, there were some areas where the activists had low scores, suggesting need for additional inputs.     

The cost diary: a method to measure direct and indirect costs in cost-effectiveness research

From a societal perspective long-term clinical trials or follow-up studies should preferably not only include an evaluation of the health effect for the patient, but also an economic evaluation. In order to yield comprehensive medical and nonmedical resource use data, we at least partly depend on respondents' recall for collecting these costing data. A patient cost diary was developed in order to estimate total resource use, expenses, and lost production due to illness and treatment. We applied the cost diary in two randomized clinical trials evaluating the cost-effectiveness of behavioral rehabilitation in 205 fibromyalgia and chronic low back pain patients. The use of the diary was evaluated, studying the feasibility, the influence of the period of data collection on the results, and some aspects of validity. Eighty-five percent of the patients completed at least one diary and in total 68% of the diaries were returned. Although the results for the three alternative periods of data collection (keeping the diary 1 week every month, 2 weeks every 2 months, or a full year) were not significantly different, they were only moderately correlated. Finally, self-reported specialist care contacts were generally in agreement with data from an insurance company. However, for physiotherapy contacts there were differences between the self-reported and insurance data. This study shows how the cost diary might be used successfully in cost-effectiveness studies.     

Simplified figure to present direct and indirect comparisons: Revisiting the graph 10 years later

A “simplified” figure was proposed in 2011 to summarize the results of controlled trials that evaluate different treatments aimed at the same disease condition. The original criteria for classifying individual binary comparisons included superiority, inferiority and no significance difference; hence, they did not differentiate between no proof of difference vs proof of no difference. We updated the criteria employed in the original “simplified” figure in order to include this differentiation. A revised version of the simplified figure is proposed and described herein. An example of application is also presented. The example is focused on first-line treatments for paroxysmal atrial fibrillation. Three treatments (medical therapy, cryoballoon ablation, radiofrequency ablation) are compared with one another through direct and indirect comparisons.     

From sneezes to adieux: stages of health for American men and women

This article traces health from daily symptoms to death for American (U.S.) men and women in three age groups 17-44, 45-64, 65+. How do leading problems change as our perspective shifts from daily symptoms to annual incidence and prevalence rates of diseases and injuries; then to problems that induce long term limitations; to conditions brought to physicians for care; to diagnoses for hospital stays; and finally to causes of death? We study the top 15 conditions in each of these stages of health. Young adults are bothered most by acute and chronic respiratory diseases, but deaths among them are due to diseases and violent injuries that seldom figure in daily life. Fatal chronic diseases becomes more prevalent in middle ages and spur professional care, but they rarely cause daily symptoms. For older people, life threatening chronic conditions stretch through all stages of health. Arthritis also becomes a dominant facet of symptoms, social limitations and ambulatory care. Men's and women's leading daily symptoms are very similar; so are their leading acute and chronic conditions, limiting conditions, diagnoses for health care and causes of death. What distinguishes the sexes is the rate, not the ranks, of health problems they suffer. We elaborate the iceberg of morbidity metaphor, as a device to highlight stage, age and sex differences in health.     

Eating fast leads to insulin resistance: findings in middle-aged Japanese men and women

OBJECTIVE: To examine relationships between speed of eating and insulin resistance. METHODS: Cross-sectional study of 2704 male (mean age and BMI: 48.2 y and 23.3 kg/m(2)) and 761 female (46.3 y and 21.8 kg/m(2)) non-diabetic Japanese civil servants, 75% clerical, and 25% manual laborers, using a two-part questionnaire on life-style factors and diet history with self-assessment of categorical speed of eating and energy intake over a 1-month period. We measured BMI, blood glucose and insulin concentrations and calculated insulin resistance using the homeostasis model assessment of insulin resistance: (HOMA-IR). RESULTS: BMI correlated with eating rate in both sexes, and with daily energy intake in men. Multiple regression analysis of log HOMA-IR by categorical speed of eating, adjusting for age, energy intake and lifestyle factors showed a statistically significant gradual increase in HOMA-IR with increases in relative eating rate in men (p<0.001, for trend) and in women (p<0.01). Adjusting for BMI, this positive relationship appeared only in men (p=0.03). CONCLUSIONS: Our results suggest that eating fast is independently associated with insulin resistance in middle-aged Japanese men and women.     

Mistreatment due to weight: prevalence and sources of perceived mistreatment in women and men

OBJECTIVE: Previous research has documented prejudicial attitudes and discrimination against overweight people. Yet the extent to which overweight people themselves perceive that they have been mistreated because of their weight has not been carefully studied. The purpose of this study was to examine the prevalence of perceived mistreatment due to weight and sources of perceived mistreatment. METHODS AND PROCEDURES: A non-clinical sample of healthy adults (187 men and 800 women) enrolled in a weight gain prevention program comprised the study population. A self-administered questionnaire was used to measure perceived mistreatment due to weight. RESULTS: Overall, 22% of women and 17% of men reported weight-related mistreatment. The most commonly reported sources of mistreatment among women were strangers (12.5%) and a spouse or loved one (11.9%). Men were most likely to report mistreatment by a spouse or loved one (10.2%) and friends (7.5%). Somewhat surprisingly, sex differences in perceived weight-related mistreatment were significant only for stranger as the source. Perceived weight-related mistreatment was positively associated with body mass index (BMI) (r = 0.39, p<0.0001). Reported mistreatment was nearly ten times as pervalent among individuals in the highest quartile of the BMI distribution (42.5%) than among those in the lowest BMI quartile (5.7%), but was significantly greater than zero in all but the very lean. DISCUSSION: Perceived mistreatment due to weight is a common experience and is not restricted to the morbidly obese. Results are discussed in light of the sociocultural value for thinness.     

AIDS in bisexual men in the United States: epidemiology and transmission to women.

BACKGROUND. Homosexual and bisexual men with acquired immunodeficiency syndrome (AIDS) differ, and bisexual men play an important role in the sexual transmission of human immunodeficiency virus (HIV) to women. METHODS. To describe AIDS in these groups, we examined AIDS cases reported nationally through June 1990. RESULTS. Among 65 389 men who reported having had sex with men since 1977, 26% were bisexual. More Black (41%) and Hispanic men (31%) than White men (21%) reported bisexual behavior. Bisexual men were twice as likely to report intravenous drug use (20%) as were homosexual men (9%), regardless of race or ethnicity. Among 3555 women with heterosexually acquired AIDS, 11% reported sexual contact with a bisexual man and no other risk factor, although in some states approximately half reported such contact. In 1989, the AIDS rate due to sex with a bisexual man was three and five times higher among Hispanic and Black women, respectively, than among White women. CONCLUSIONS. Differences between bisexual and homosexual men with AIDS and the relative importance of AIDS in women due to sexual contact with bisexual men should be considered in the development of HIV prevention programs.     

Adding insult to injury: intimate partner violence among women and men reporting activity limitations

PURPOSE: Women with activity limitations (ALs) are at risk for Intimate partner violence (IPV). This study examined IPV in men versus women with ALs. METHODS: Data from the Canadian 1999 General Social Survey compared physical, sexual, emotional, and financial IPV from a current/expartner in 5 years for men and women with ALs compared with those without ALs. Logistic regression examined sex differences in IPV among those with ALs, adjusting for sociodemographic factors. RESULTS: Rates of physical (11.9% versus 7.8%; p < 0.0001), sexual (3.5% versus 1.4%; p < 0.0001), emotional (27.1% versus 17.7%; p < 0.0001), and financial (7.5% versus 3.4%; p < 0.0001) IPV were greater in women with compared with without ALs. A similar pattern was seen for men, with greater rates of physical (9.2% versus 6.6%; p = 0.006), emotional (22.6% versus 18.2%; p = 0.002), and financial (2.6% versus 1.4%; p = 0.005) IPV in men with ALs than men without ALs. Risk factors for IPV included younger age, being divorced/separated or single, and having lower income and poorer health. Women with ALs were more likely than men to experience any IPV (29.1% versus 24.9%) and more severe and more incidents of IPV. In multivariable analysis, women were no longer at greater risk for "any IPV" after adjusting for sociodemographic variables (odds ratio = 1.09; 95% confidence interval, 0.88-1.36). CONCLUSION: This is the first study to document IPV rates in men with ALs. Women with ALs were more likely to be divorced/separated, living in poverty, and in poorer health than men with ALs. These factors accounted for sex differences in IPV rates.     

Looking to the future: South African men and women negotiating HIV risk and relationship intimacy

This paper examines the approaches heterosexual men and women in South Africa use to engage their partners in discussions of HIV and risk factors in their relationships. These strategies entail balancing the risks of infection while managing the challenges of maintaining a relationship. In a context in which there is a great deal of insecurity in relationships it is especially challenging to discuss HIV risks with partners. Our findings reveal that concerns about children or the desire to have children provided a legitimate basis for discussing HIV risk with partners. The focus of these discussions is on the future for their children. Research in South Africa should attend to men's and women's desires to have and to raise children. HIV prevention and treatment programmes can capitalise on concerns regarding children, and the future of the family, to engage men and women in discussing mutually acceptable strategies for preventing infection and ensuring safe conception.     

Eliciting willingness to pay in obstetrics: comparing a direct and an indirect valuation method for complex health outcomes

Objective: To compare direct and indirect willingness to pay (WTP) elicitation methods in terms of feasibility, reliability, and comparability. The application is obstetrics, where always both a mother's and a child's health are at stake. Methods: An open‐ended contingent valuation method (CVM) as a direct WTP elicitation method, and the discrete choice experiment (DCE) as an indirect WTP elicitation method. Vignettes to be valued were based on clinical patient data. Participants were 88 laypersons who received their questionnaires by postal mail. Results: The DCE task was completed faster (p = 0.006) and was regarded easier (p<0.001) than the CVM task. Test–retest for CVM was substantial (ICC = 0.76), and for DCE moderate (k = 0.49). Female sex (p<0.001), age ≥50 years (p = 0.013), higher income (p<0.001), and higher education (p<0.001) were associated with higher WTP. Correlation between CVM and DCE was 0.79 (Kendall's Tau‐b; p<0.001). The implied WTP as derived with DCE was between 2.3 and 10.2 times higher than with CVM. The relationship between the WTPs was linear. Conclusion: It is yet unclear what lies behind the numbers of DCE. DCE has no methodological benefits over the conventional CVM when eliciting WTP for complex health outcomes in obstetrics. Copyright © 2010 John Wiley & Sons, Ltd.     

Looking to the future: South African men and women negotiating HIV risk and relationship intimacy

This paper examines the approaches heterosexual men and women in South Africa use to engage their partners in discussions of HIV and risk factors in their relationships. These strategies entail balancing the risks of infection while managing the challenges of maintaining a relationship. In a context in which there is a great deal of insecurity in relationships it is especially challenging to discuss HIV risks with partners. Our findings reveal that concerns about children or the desire to have children provided a legitimate basis for discussing HIV risk with partners. The focus of these discussions is on the future for their children. Research in South Africa should attend to men's and women's desires to have and to raise children. HIV prevention and treatment programmes can capitalise on concerns regarding children, and the future of the family, to engage men and women in discussing mutually acceptable strategies for preventing infection and ensuring safe conception.