Gender-stratified Logistic Regression Models Research Articles

Addressing urinary incontinence by gender: a nationwide population-based study in Turkiye

BackgroundUrinary incontinence (UI), which usually occurs in women but affects both sexes, is a significant public health challenge. This study aims to comprehensively investigate the prevalence and determinants of UI in men and women, considering gender-specific factors.MethodsThe study performed a secondary analysis on data obtained from 13,383 individuals surveyed in the 2019 Turkish Health Survey, providing a representation of the Turkish population. The dataset included sociodemographic and health-related variables like UI, body mass index (BMI), physical activity, smoking, and chronic diseases—statistical analysis employed chi-square tests and gender-stratified logistic regression models to identify UI-associated factors.ResultsOur results showed that UI affected 8.8% of the population, with a striking gender disparity. Women had a notably higher prevalence at 11.2%, while men had a lower rate of 5.5%. Importantly, this gender gap narrowed with age. For example, in the 34–44 age group, the female/male ratio was 6.9, but it decreased to 1.4 in the 65–74 age group. Marital status and employment status played significant roles. Separated, divorced, or widowed individuals, particularly women, had the highest prevalence at 19.3%. Employment status influenced UI prevalence, with employed men having the lowest rate (2.1%), while retired women faced the highest rate (15.0%). Higher BMI, especially in obese individuals, significantly raised UI prevalence, reaching 7.9% for men and 15.8% for women. Physical inactivity, notably in women (17.0%), and prolonged sedentary hours (13.9%) were associated with higher UI rates. Former smokers, especially women (15.9%), had a notable impact on UI. Poor perceived health and chronic conditions like Chronic Obstructive Pulmonary Disease (COPD), hypertension, and diabetes were significantly associated with higher UI prevalence. Logistic regression analysis revealed that age, education, perceived health status, COPD, and diabetes were significant factors associated with UI in both sexes, while in women, BMI, physical activity, and smoking also played notable roles.ConclusionsThis extensive UI study has unveiled notable gender disparities and determinants. Notably, these disparities decrease with age, underlining UI’s changing nature over time. Modifiable factors impact women more, while non-modifiable factors are linked to men. The study underscores the importance of tailoring healthcare strategies to address UI based on gender.

Gender gap in mobility outside home in urban India

India has one of the highest levels of gender inequality in the world. Work participation rate of women is among the lowest, with a wide gender gap. There are seclusion norms that restrict the mobility of women outside the home. However, transport literature in India has not explored the impact of this lack of autonomy on gender differences in travel demand. I use 2019 population-representative nationwide time-use survey of India. The dataset reported both travel and non-travel activities for 30-minute episodes over a 24-hour period. For urban residents, I analysed gender differences in trip rates and mobility rates, where the latter is defined as the percentage going out of home at least once on the reporting day. I developed gender-stratified logistic regression models at the individual level with mobility as a binary outcome. It was found that 53% of the females did not report going out of the home compared to only 14% of males. The mobility of females reduces steeply from adolescence to young adulthood and then remains largely stable at a low level before reducing further for older adults. No such variation is observed among males, except their mobility is also reduced among older adults. There is a clear dichotomy with women mostly participating in in-house activities while men mostly involved in out-of-home activities. Adolescence or adulthood, marriage, living with one or more household members, having an infant in the house, lower income, and less education are associated with a lower likelihood of female mobility. The results highlight the need for gender-stratified analysis for transportation research, and a need for greater engagement across the disciplines of development economics, social sciences, and transport planning.

RACE, GENDER, AND LATE-LIFE PRODUCTIVE ACTIVITIES AND DEMENTIA IN THE HEALTH ABC STUDY

Abstract We hypothesized productive activities, e.g., working and volunteering, would reduce dementia risk and mitigate racial disparities using longitudinal Health, Aging, and Body Composition data (n=3,069). We ran gender-stratified logistic regression models for dementia with socio-demographic and APOE adjustments. Among older men, no significant relationships existed between dementia with work, volunteering, or race in any models. Among older women, in unadjusted models, working vs. not (Yr1) was significantly related to 30% lower odds of dementia (OR=0.70, p≤0.05), and volunteering vs. not (Yr1) was significantly related to 24% lower odds of dementia (OR=0.76, p≤0.05). But, these activities were not significant in other models. Black vs. White women had 35% (OR=1.35, p≤0.05) and 32% (OR=1.32, p=0.052) higher odds of dementia in working and volunteering models with socio-demographic adjustments, respectively, but race was not significant after APOE adjustment. Productive activities are possible contextual interventions to reduce racial disparities in incident dementia among older women.

Using apps to self-monitor diet and physical activity is linked to greater use of disordered eating behaviors among emerging adults

Use of weight-related self-monitoring (WRSM) apps is common among emerging adults, as are weight and shape concerns. The present study aimed to examine (1) whether emerging adult use of dietary-focused (e.g., MyFitnessPal) and physical activity-focused (e.g., Fitbit) WRSM apps was associated with weight-control and muscle-building behaviors, including commonly recommended/conventional behaviors and disordered behaviors and (2) whether prior use of weight-control and muscle-building behaviors in adolescence might explain such relationships. Data were collected as part of the EAT (Eating and Activity over Time) 2010–2018 study (n = 1446) and analyzed using gender-stratified logistic regression models adjusted for demographic characteristics and body mass index. Among women and men, physical activity- and dietary-focused app use were associated with greater adjusted prevalence of disordered weight-control behaviors (e.g., fasting, purging), and disordered muscle-building behaviors (e.g., using steroids). Physical activity- and dietary-focused app use were also associated with a higher adjusted prevalence of commonly recommended weight-control and conventional muscle-building behaviors (e.g., exercising, changing eating habits), but only among those who were also engaging in disordered behaviors. The observed associations remained statistically significant in models that further adjusted for adolescent use of the respective behaviors. Findings suggest that emerging adults who use physical activity- and dietary-focused WRSM apps are more likely to engage in disordered weight-control and muscle-building behaviors and that associations are not explained by engagement in these behaviors during adolescence. Future research is needed to examine if there are aspects of WRSM apps that could be modified to reduce potential harm.

Movement behaviors associated with mental health among US military service members

ABSTRACT Compared to the general adult population, military service members experience an excess burden of mental health problems (e.g., posttraumatic stress disorder, PTSD). Physical activity, screen time, and sleep (i.e., movement behaviors) are independently associated with mental health, but their combined effects are poorly understood, particularly in military populations. We analyzed data from active component service members in the national 2018 Health Related Behaviors Survey (N = 17,166). Weighted gender-stratified logistic regression models examined the associations of meeting recommended/healthy levels of moderate-to vigorous physical activity (MVPA), screen time, and sleep duration – separately and in combination (none, some, all) – with PTSD, suicide ideation, and serious psychological distress. In both men and women, meeting sleep recommendations was associated with reduced odds of each outcome. Meeting MVPA recommendations was associated with lower odds of serious psychological distress only in men (OR = 0.76, 95% CI: 0.58–1.00). No/low screen time was associated with lower odds of suicide ideation only in women (OR = 0.66, 95% CI: 0.45–0.95). The odds of all three outcomes were lower in those who reported some or all (vs. none) recommended/healthy movement behaviors, with the lowest odds found in the “all” group, suggesting a possible dose-response relationship. Findings can help inform multiple behavior change interventions to improve service members’ psychological fitness and military readiness.

Interrelationships of Economic Stressors, Mental Health Problems, Substance Use, and Intimate Partner Violence among Hispanic Emergency Department Patients: The Role of Language-Based Acculturation.

We analyzed the interrelationships of economic stressors, mental health problems, substance use, and intimate partner violence (IPV) among a sample of Hispanic emergency department patients and probed if Spanish language preference, which may represent low acculturation and/or immigrant status, had a protective effect, in accordance with the Hispanic health paradox. Study participants (n = 520; 50% female; 71% Spanish speakers) provided cross-sectional survey data. Gender-stratified logistic regression models were estimated for mental health problems (PTSD, anxiety, depression), substance use (risky drinking, cannabis, illicit drug use), and IPV. Results showed that economic stressors were linked with mental health problems among men and women. Among men, PTSD was associated with greater odds of cannabis and illicit drug use. Men who used cannabis and illicit drugs were more likely to report IPV. Male Spanish speakers had lower odds of anxiety and cannabis use than English speakers. Female Spanish speakers had lower odds of substance use and IPV than English speakers. The protective effect of Spanish language preference on some mental health, substance use, and IPV outcomes was more pronounced among women. Future research should identify the mechanisms that underlie the protective effect of Spanish language preference and explore factors that contribute to the observed gender differences.

Adverse childhood experiences are associated with at-risk drinking, cannabis and illicit drug use in females but not males: an Emergency Department study

ABSTRACT Background Adverse childhood experiences (ACEs) are associated with adult substance use in the general population. Given pervasive health disparities among underserved populations, understanding how ACEs are associated with substance use among urban Emergency Department (ED) patients could help inform design of effective screening, brief interventions, and referral to treatment. Objectives To estimate gender differences in prevalence of separate and cumulative ACEs among a sample of urban ED patients, and assess its association with at-risk drinking (4+/5+ drinks for females/males), cannabis, and illicit drug use. We hypothesized that the association between ACEs and each outcome would be stronger among females than males. Methods Cross-sectional survey data were obtained from 1,037 married/partnered ED patients (53% female) at a public safety-net hospital. Gender-stratified logistic regression models were estimated for each substance use outcome. Results One+ ACEs were reported by 53% of males and 60% of females. Females whose mother was a victim of domestic violence had greater odds of at-risk drinking compared to females who did not report this ACE (AOR = 1.72; 95% CI 1.03, 2.88). Females’ cumulative ACEs were associated with cannabis use (OR = 2.26, 95% CI 1.06, 4.83) and illicit drug use (OR = 3.35; 95% CI 1.21, 9.30). Males’ separate and cumulative ACEs were not associated with increased likelihood for any of the outcomes. Conclusion ACEs are associated with greater odds of substance use among female than male ED patients. The prevalence of ACE exposure in this urban ED sample underscores the importance of ED staff providing trauma-informed care.

Medical, Nonmedical, and Illegal Stimulant Use by Sexual Identity and Gender

Major knowledge gaps regarding medical and nonmedical prescription stimulant use and illegal stimulant use (i.e., cocaine/crack/methamphetamine) by sexual identity and gender have implications for individuals' health and well-being. This study improves stimulant use measurement by differentiating the type of stimulant use and focusing on lesbian, gay, and bisexual subpopulations. Data were pooled for adults in the 2015-2017 National Survey on Drug Use and Health (n=126,463; analyzed in 2019). Gender-stratified logistic regression models examined associations between sexual identity and past-year illegal stimulant use. Gender-stratified multinomial logistic regression models estimated odds of (1) medical use only versus no past-year prescription stimulant use, (2) any nonmedical stimulant use versus no past-year use, and (3) any nonmedical stimulant use versus medical use only. Illegal stimulant use varied by sexual identity (men: gay, 9.2%; bisexual, 7.5%; heterosexual, 3.2%; women: gay/lesbian, 3.2%; bisexual, 7.8%; heterosexual, 1.5%), as did nonmedical prescription stimulant use. Relative to same-gender heterosexuals, gay (AOR=2.61, 95% CI=2.00, 3.40) and bisexual (AOR=1.70, 95% CI=1.24, 2.33) men had higher odds of past-year illegal stimulant use, as did gay/lesbian (AOR=1.63, 95% CI=1.16, 2.28) and bisexual (AOR=2.70, 95% CI=2.23, 3.26) women. Sexual minorities reported higher odds of nonmedical prescription stimulant use than heterosexuals. Any nonmedical prescription opioid use was reported by 26.4% of people who reported nonmedical stimulant use and 27.0% of people who reported illegal stimulant use. Lesbian, gay, and bisexual individuals had a higher prevalence of stimulant use than their heterosexual counterparts. This has important implications for health disparities, especially given the high levels of polysubstance use. Taking a multilevel approach is crucial to reduce stimulant-related harms for lesbian, gay, and bisexual individuals.

Gendered relationship between HIV stigma and HIV testing among men and women in Mozambique: a cross-sectional study to inform a stigma reduction and male-targeted HIV testing intervention

ObjectivesIncreasing and sustaining engagement in HIV care for people living with HIV are critical to both individual therapeutic benefit and epidemic control. Men are less likely to test for HIV...

The Association Between Exposure to Violent Pornography and Teen Dating Violence in Grade 10 High School Students

Exposure to pornography in general has been linked with adolescent dating violence and sexual aggression, but less is known about exposure to violent pornography specifically. The current study examined the association of violent pornography exposure with different forms of teen dating violence (TDV) using baseline survey data from a sample of Grade 10 high school students who reported being in a dating relationship in the past year (n = 1694). Gender-stratified logistic regression models generated odds ratios adjusted for demographics, substance use, history of suspension/expulsion, gender equitable attitudes, and tolerance of rape myths to identify significant associations between violent pornography exposure and self-reported physical, sexual, and threatening TDV perpetration and victimization. Violent pornography exposure was associated with all types of TDV, though patterns differed by gender. Boys exposed to violent pornography were 2-3 times more likely to report sexual TDV perpetration and victimization and physical TDV victimization, while girls exposed to violent pornography were over 1.5 times more likely to be perpetrate threatening TDV compared to their non-exposed counterparts. Comprehensive prevention strategies for TDV may consider the potential risks associated with exposure to violent pornography, particularly for boys, and provide an alternative source of education about healthy sexual behavior and relationships.

Abstract P245: Economic Residential Segregation is Associated With Obesity and Visceral Adiposity in Brazilian Women: the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)

Introduction: Obesity and obesity-related diseases are increasing globally with the sharpest increases occurring in low and middle-income countries. Economic residential segregation results in increased exposure to adverse neighborhood environments; however, the impact of segregation on markers of obesity have been mostly investigated in US-based samples. Using a novel spatial measure of neighborhood-level economic residential segregation (hereafter, segregation) we examined the association between segregation, obesity and visceral adiposity in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Methods: The sample included 6,104 women and 4,789 men ages 35-74 with complete geocoded information from the baseline examination of ELSA-Brasil (2008-2010). Segregation was based on data from the 2010 IBGE demographic census and calculated for study-defined neighborhoods using the local Gi* statistic— a spatially weighted z-score that represents how much a neighborhood’s income composition deviates from the larger metropolitan area. Body mass index (BMI) was calculated by dividing the participants’ measured weight in kilograms by their measured height in meters squared. Participants were considered “obese” if they had a BMI greater than 30 kg/m 2 . Visceral adiposity was assessed using measured waist circumference (in cm) as a proxy. Based on statistically significant interactions between gender and segregation, gender-stratified multivariable logistic and linear regression models were used to test associations between segregation and obesity status and visceral adiposity, respectively. Results: Approximately 14% of the sample resided in segregated neighborhoods. Blacks and Browns were more likely to reside in segregated neighborhoods than Whites (Blacks: 25.9%; Browns: 20.2%; Whites: 8.2%). The prevalence of obesity in the sample was 24% among women and 20% among men and was highest among Black women living in the most economically segregated neighborhood environments (35%). After adjusting for age, sex, race, education, income, and study site, segregation was positively associated with obesity among women (OR: 1.29, 95% CI: 1.07-1.56). Associations for men were not statistically significant (OR: 1.07; 95% CI: 0.85-1.34). Similar patterns were found for visceral adiposity among women (High Segregation, β=1.94 ± 0.51, p=0.0002; Medium Segregation, β=0.90 ± 0.39, p=0.0192) with no statistically significant findings among men. Conclusion: Women residing in economically segregated neighborhoods in Brazil appear to be at an increased risk of obesity and have higher levels of visceral adiposity. Black women may be at highest risk in these settings. Policies and/or structural interventions designed to improve neighborhood conditions may be viable strategies to mitigate the burden of obesity in this setting.

Disability trends in Canada: 2001-2014 population estimates and correlates.

Disability is a major concern for the health of midlife and older Canadians. Understanding disability trends is critical for detecting socio-economic and health precursors that could be amenable to policy interventions. The purpose of this study is to assess trends in rates of disability among Canadian adults age 40-64 and 65+. We also examine the impact of changing socio-demographic and health factors over time on the trends. Data from the 2001-2014 Canadian Community Health Survey (CCHS), a repeated cross-sectional nationally representative study, are used to estimate age- and gender-stratified logistic regression models of disability as a function of the year of interview to assess trends. Disability is defined as experiencing difficulties with a variety of individual functions, such as seeing, walking, climbing stairs, and bending. Among men and women 65 and older, disability has declined since 2001 in most subgroups and regardless of changing socio-economic and health characteristics. Adults 40-64years of age, in contrast, have experienced stagnating disability over the observation period. If it were not for changes in the distribution of education and household income, the disability rate would be increasing significantly. Older Canadian adults are experiencing mild but systemic improvements in disability. More worrisome is the stagnating trend among midlife cohorts, which could portend greater disability burden in the future as Canada's population ages. Preventive efforts need to be targeted at vulnerable groups at earlier ages in order to prevent future increases in disability-related financial, caregiving, and medical burden.

Genetic variants in the CNTNAP2 gene are associated with gender differences among dyslexic children in China

BackgroundIt is well known that males have a higher prevalence of developmental dyslexia (DD) than females. Although the mechanism underlying this gender difference remains unknown, the contactin-associated protein-like 2 (CNTNAP2) gene, which shows sex-specific patterns in some neurodevelopmental disorders, has attracted extensive attention. This study aimed to explore whether CNTNAP2 shows a sex-specific association with DD in a Chinese population. MethodsUsing genomic DNA samples of 726 students [372 cases (282 male, 90 female), 354 controls (267 male, 87 female)], we genotyped five SNPs of CNTNAP2. Gender-stratified logistic regression models were used to determine the relationships between the CNTNAP2 variants and DD. FindingsAfter adjustment for the false discovery rate (FDR), two SNPs (rs3779031, rs987456) of CNTNAP2 were associated with DD risk in females but not in males. Female participants carrying the rs3779031 G allele had a lower risk of DD than those with the A genotype [GG vs AA: OR (95%CI) = 0.281 (0.097–0.814)]. The rs987456 CC genotype was associated with a decreased risk of DD in females [CC vs AA+CA: OR (95%CI) = 0.222 (0.078–0.628)]. Furthermore, the interaction between CNTNAP2 (rs987456) and environmental factors (scheduled reading time) played a protective role in females [OR (95%CI) = 0.431 (0.188–0.987)]. InterpretationWe performed a genetic association study on CNTNAP2 variants and DD. The sex specificity of CNTNAP2 in DD, along with the gene-environment interaction may help us to understand gender differences in DD.

Gender, Sexual Self-Efficacy and Consistent Condom Use Among Adolescents Living in the HIV Hyper-Endemic Setting of Soweto, South Africa.

Within HIV-endemic settings, few studies have examined gendered associations between sexual self-efficacy (SSE), one's confidence or perceived control over sexual behavior, and uptake of HIV prevention behaviors. Using cross-sectional survey data from 417 sexually-experienced adolescents (aged 14-19, median age=18, 60% female) in Soweto, South Africa, we measured SSE using a 6-item scale (range:0-6) with 'high-SSE'=score>3 (study alpha=0.75). Gender-stratified logistic regression models assessed associations between high-SSE and lifetime consistent condom use. A higher proportion of women reported high-SSE (68.7%) than men (49.5%, p<0.001). We observed no difference in reported consistent condom use by gender (45.5% among women, 45.8% among men; p=0.943). In confounder models, high-SSE was associated with consistent condom use among men (aOR=3.51, 95%CI=1.86-6.64), but not women (aOR=1.43, 95%CI=0.74-2.77). Findings highlight that individual-level psychosocial factors are insufficient for understanding condom use and must be considered alongside the relational, social, and structural environments within which young women navigate their sexual lives.

Gender difference in early initiation of methamphetamine use among current methamphetamine users in Muse, Northern Shan State, Myanmar

BackgroundGlobally, methamphetamine (MA) use is a significant public health concern due to unprecedented health effects of its use. However, gender similarities and differences in early age of MA initiation and its risk factors among current MA users have been understudied in a developing country setting.MethodsA community-based, cross-sectional study was conducted using a computer assisted self-interviewing program from January to March 2013 in Muse, Northern Shan State, Myanmar. A total of 1362 (775 male and 587 female) self-reported current MA users aged between 18 and 35 years were recruited using respondent-driven sampling. Two gender-stratified multiple logistic regression models (models I and II) were done for analysis.ResultsFor similarities, 73.0% of males and 60.5% of females initiated MA before their 18th birthday. The early age of MA initiation was positively associated with the reasons and places of the first time MA use among both genders. For differences, males [hazard ratio 1.35; 95% confidence interval, 1.18–1.54] had a significantly higher risk than females to initiate MA at earlier age. Among male users, participants who had bisexual/homosexual preferences were more likely to initiate MA use earlier. In contrast, female users who exchanged sex for money and/or drugs were more likely to initiate MA in earlier age.ConclusionsMore than 60.0% of male and female participants initiated MA use early; however, males initiated use earlier than females. Although similarities were found among both genders, differences found in key risk factors for early age MA initiation suggest that gender-specific, MA prevention programs are urgently needed in Myanmar.

Military Sexual Trauma Among Recent Veterans: Correlates of Sexual Assault and Sexual Harassment.

Military sexual trauma (MST) includes sexual harassment or sexual assault that occurs during military service and is of increasing public health concern. The population prevalence of MST among female and male veterans who served during Operations Enduring Freedom and Iraqi Freedom (OEF/OIF) has not been estimated to our knowledge. The purpose of this study is to assess the population prevalence and identify military correlates of MST, sexual harassment, and sexual assault among OEF/OIF veterans. MST was assessed in the 2009-2011 National Health Study for a New Generation of U.S. Veterans, a survey of 60,000 veterans who served during the OEF/OIF eras (response rate, 34%, n=20,563). Weighted prevalence estimates and AORs of MST, sexual harassment, and sexual assault among women and men were calculated. Gender-stratified logistic regression models controlled for military and demographic characteristics. Data analyses were conducted in 2013-2014. Approximately 41% of women and 4% of men reported experiencing MST. Deployed men had lower risk for MST compared with non-deployed men, though no difference was found among women. However, veterans reporting combat exposure during deployment had increased risk for MST compared with those without, while controlling for OEF/OIF deployment. Among women, Marines and Navy veterans had increased risk for MST compared with Air Force veterans. MST was significantly higher among veterans who reported using Veterans Affairs healthcare services. These prevalence estimates underscore the importance of public awareness and continued investigation of the public health impact of MST.

The impact of parental educational trajectories on their adult offspring's overweight/obesity status: A study of three generations of Swedish men and women

The objective of this study was to investigate the impact of grandparental and parental education and parental educational trajectory on their adult offspring's overweight/obesity. We used register data from the Uppsala Birth Cohort Multigenerational Study, based on a representative cohort born in Sweden 1915–1929 (G1). Our sample included 5122 women and 11,204 men who were grandchildren of G1 (G3), their parents (G2), and grandparents. G3's overweight/obesity (BMI ≥25 kg/m2) was based on pre-pregnancy weight/height for women before their first birth (average age = 26 years), and measured weight/height at conscription for men (average age = 18 years). G1's, G2's, and G3's highest educational attainment was obtained from routine registers and classified as low, intermediate, or high based on respective sample distributions. Parental (G2) educational trajectory was defined as change in education between their own and their highest educated parent (G1), classified into 5 categories: always advantaged (AA), upward trajectory (UT), stable–intermediate (SI), downward trajectory (DT), and always disadvantaged (AD). We used hierarchical gender-stratified logistic regression models adjusted for G3's age, education, year of BMI collection, lineage and G2's year of birth and income. Grandparental and parental education were negatively associated with men's odds of overweight/obesity and parental education affected women's overweight/obesity risk. Furthermore, men and women whose parents belonged to the UT, SI, DT, and AD groups had greater odds of overweight/obesity compared to men and women whose parents belonged to the AA group (adjusted for G3's age, year of BMI collection, lineage, and G2's year of birth). These associations were attenuated when further adjusting for parental income and G3's own education. Socioeconomic inequalities can have long-term consequences and impact the health of future generations. For overweight/obesity in concurrent young cohorts, this inequality is not fully offset by upward educational trajectory in their parent's generation.

Abstract 61: Associations of Cardiorespiratory and Musculoskeletal Fitness with Body Mass Index and Waist Circumference: Fitness versus Fatness in a Population-based Sample of Chilean 8th Graders

Background: In addition to excess adiposity, low cardiorespiratory fitness (CRF) and low musculoskeletal fitness (MSF) are important, independent risk factors for future cardio-metabolic disease in adolescents. To the best of our knowledge the fitness versus fatness relationship has not been studied in a population-based sample in Latin America. Hypothesis: We hypothesized that the physical fitness variables of CRF and MSF will be negatively associated with BMI and WC in an adolescent population in Chile, independent of potential confounders, but that a significant proportion of adolescents with poor body composition will exhibit healthy fitness levels. Methods: This cross-sectional study was based on a representative, single-stage, stratified cluster sample of 19,929 8th graders (median age = 14 years) in the 2011 National Education Survey from all regions of Chile. CRF was assessed with the 20 m shuttle run test, MSF with standing broad jump, and body composition with BMI and WC. CRF, MSF, BMI, and WC were classified according to health-related standards, validated against cardio-metabolic risk factors. Gender-stratified logistic regression models for both CRF and MSF included socioeconomic status, age, region, the other fitness variable, BMI, and WC. Analyses were weighted and considered complex sample design. Results: In both genders, the adjusted prevalence of high-risk CRF was higher among students with high-risk BMI (boys: prevalence ratio (PR) = 1.88; girls: PR = 1.71; both p&lt;0.05) and with high-risk WC (boys: PR = 1.77; girls: PR = 1.21; both p&lt;0.05), compared with their healthy counterparts. BMI but not WC was an independent correlate of high-risk MSF in girls (PR = 1.32; p&lt;0.05). Both BMI (PR=1.64; p&lt;0.05) and WC (PR=1.11; p&lt;0.05) were independent correlates of high-risk MSF in boys. A substantial proportion of students with poor body composition had healthy fitness, and vice versa: 46% of boys and 25% of girls with high-risk BMI had healthy CRF. Conversely, 35% of boys and 55% of girls with high-risk CRF had a healthy BMI. Similarly, 47% of boys and 51% of girls with high-risk BMI had healthy MSF whereas 43% of boys and girls with high-risk MSF had a healthy BMI. Conclusions: In this large representative sample of Chilean adolescents, BMI and WC were inversely correlated with CRF and MSF. Nonetheless, the sizeable proportion of adolescents with poor body composition but healthy fitness, and vice versa, underscores the importance of assessing both CRF and MSF for a more complete representation of adolescent cardio-metabolic risk.

The impact of parents’ fear of strangers and perceptions of informal social control on children's independent mobility

Declines in children's independent mobility are commonly attributed to parents’ fear of strangers, yet few empirical studies have investigated this relationship. We examined: (1) the impact of parents’ fear of strangers on children's independent mobility; and (2) whether informal social control (i.e., parents’ confidence that other residents would look out for local children) mitigated any association. Gender stratified logistic regression models tested these associations for 10–12 year-olds and their parents (n=1231) in Perth, Australia. For girls, parental fear of strangers was associated with lower odds of independent mobility (OR=0.71, p=0.002), and informal social control and other social and built environment variables had little attenuating influence. This pattern was consistent for boys; however odds ratios were lower and statistical significance weaker. Initiatives that target parental fears combined with interventions that normalise children's walking may help increase independent mobility.

The Influence of Worksite and Employee Variables on Employee Engagement in Telephonic Health Coaching Programs: A Retrospective Multivariate Analysis

This study assessed 11 determinants of health coaching program participation. A cross-sectional study design used secondary data to assess the role of six employee-level and five worksite-level variables on telephone-based coaching enrollment, active participation, and completion. Data was provided by a national provider of worksite health promotion program services for employers. A random sample of 34,291 employees from 52 companies was selected for inclusion in the study. Survey-based measures included age, gender, job type, health risk status, tobacco risk, social support, financial incentives, comprehensive communications, senior leadership support, cultural support, and comprehensive program design. Gender-stratified multivariate logistic regression models were applied using backwards elimination procedures to yield parsimonious prediction models for each of the dependent variables. Employees were more likely to enroll in coaching programs if they were older, female, and in poorer health, and if they were at worksites with fewer environmental supports for health, clear financial incentives for participation in coaching, more comprehensive communications, and more comprehensive programs. Once employees were enrolled, program completion was greater among those who were older, did not use tobacco, worked at a company with strong communications, and had fewer environmental supports for health. Both worksite-level and employee-level factors have significant influences on health coaching engagement, and there are gender differences in the strength of these predictors.