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NEXUS portal, Vol. 2, issue 3 University of British Columbia. NEXUS Research Unit Jul 18, 2008

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Men’s Health continuted 2 Milestones 2 New Publications 2 New Projects 3 Upcoming Events 3 Feature: Steven Robertson 4 NEXUS Portal Volume 2, Issue 3 July 18, 2008 U n i v e r s i t y  o f  B r i t i s h  C o l u m b i a  -  3 0 2 ,  6 1 9 0  A g r o n o m y  R o a d  -  V a n c o u v e r,  B C  V 6 T  1 Z 3 Men’s health: what is it and why does it matter? Men’s health is different from women’s health but binary approaches aren’t enough There are some sex differences between men’s and women’s health and specific diseases (e.g., prostate cancer and breast cancer).  However, it is very important to note that, overall, men’s health should not be seen as the opposite to women’s health. In the past, men’s health was often framed in this way and sometimes led to a struggle  for resources between men’s and women’s health projects, and unhelpful arguments about whether men or women are the greater ‘victim’ of ill health. It is useful to take the example of heart disease in order to explain this further. Heart disease is the leading cause of death for men in Canada and research evidence is pointing toward several gender-specific behaviours, such as delayed help-seeking behaviour, that may have a negative impact on men when suffering a heart attack. However, this evidence does not mean that delaying help seeking when experiencing a heart attack is only a men’s health issue. Indeed, heart disease is also the leading cause of death for women in Canada and there is also evidence that women delay seeking help when experiencing heart attacks. Importantly, however, this evidence suggests that women delay seeking help for differing, gender specific reasons. Dr. John Oliffe, NEXUS Lead Investi- gator, and Dr. Paul Galdas, NEXUS Co- Investigator, are leading researchers in the field of men’s health.  In this issue they explain why the focus on men is a crucial aspect of health behav- iour research. What is men’s health? A men’s health issue can be considered to be one arising from physiological, psychological, social, cultural or environmental factors that have a specific impact on boys or men, and where particular interventions are required for boys or men to achieve improvements in their health or well being. Why is it important to study men’s health behaviour? There is overwhelming evidence that men’s health is much poorer than it need be. In Canada, men die on average five years earlier than women and lead in 14 of the 15 main causes of death. However, this is only part of the story. There is growing evidence that the socialization of men and boys and their resulting enactment of gender (masculinities) can have a deleterious impact on their health and health behaviours. Masculinities research, which is based on this perspective, is increasingly showing that men operate using gender-specific health behaviours and experience illness that requires targeted interventions. It is important to note that some men’s health practices also have great potential to advance the health and well-being of men. For example, prostate cancer support groups clearly demonstrate the value of men’s self-reliance and problem solving in developing grassroots community based health promotion programs for men who have prostate cancer, and their partners. In sum, understanding the problems around men’s health practices, as well as soliciting and mobilizing some solutions are central in our study of men’s health behaviours. “Binary comparisons of men’s and women’s rates of mortality from heart disease are of little use for informing healthcare interventions that will help improve men’s and women’s lives.” In this issue: Studying men’s health: theories and methods We take a gender- sensitive approach that recognizes men’s and women’s health as not in contrast to one another or solely about sex (biological-based) problems, but rather that men and women have particular health concerns that require specific interventions based on their gender – the social and continued on page two... Binaries may also lead us to miss important health practices that are shared by both men and women. As such, there seems to be great potential to learn through collaboration that is focussed on detailing commonalities in men’s and women’s health. In addition, the binaries of masculine and feminine and male and female may not capture other spaces which individuals transition to, or routinely inhabit (e.g., transsexuals). From this perspective we are also interested in gender and gender relations research to explore places and spaces not explicitly considered as men’s or women’s health. Not all men are the same Not all men are the same and this is another reason why crude binary comparisons between men’s and women’s health are unhelpful. Men are not a homogeneous category, and important differences exist between different groups of men. For example, Dr. Galdas’s research on Indo- Canadian men’s health is beginning to show that this population has gender and culturally-specific health needs. Other research has highlighted important differences in men’s rates of death and disease and health-risk behaviour in terms of their age, socio-economic status and sexuality. Men’s positioning within masculine hierarchies impacts their health practices. For example, what can we reasonably expect of men with limited purchasing power and/or access when we advocate diet change, healthy choices or screening for specific diseases? Therefore, inequalities exist across (as well as within) groups of men and this has also helped to guide the design and focus of our research program. Page 2 NEXUS Portal MILESTONES NEXUS Trainees Vicky Bungay defended her PhD dissertation “Women who are street- involved and use crack cocaine: Health inequities, oppression and relations of Power in Vancouver’s Downtown Eastside” on June 6, 2008.  Her supervisor was Joy Johnson. Good for you, Dr. Bungay! Weihong Chen defended her PhD dissertation, “Susceptibility to smoking among Chinese-Canadian Non- Smoking Adolescents” on May 30, 2008. Her co supervisors were Joy Johnson and Joan Bottorff. Well done, Dr. Chen! NEXUS Investigators Dr Lynda Balneaves and Dr John Oliffe recently were granted tenure.  They are both now Associate Professors in the UBC School of Nursing.  Congratulations to you both! NEW PUBLICATIONS Okoli CTC, Richardson CG, Ratner PA, & Johnson JL (2008). An examination of the smoking identities and taxonomies of smoking behaviour of youth. Tobacco Control. 17, 151-158. Oliffe JL, Halpin M, Bottorff JL, Hislop TG, McKenzie M and Mroz L. (2008) How Prostate Cancer Support Groups Do and Do Not Survive: British Columbian Perspectives. American Journal of  Men’s Health. 2; 143. Ratner PA, Johnson JL, Mackay M, Tu AW and Hossain S. (2008). Knowledge of “Heart Attack” Symptoms in a Canadian Urban Community. Clinical Medicine: Cardiology. Johnson J, Malchy L, Mulvogue T, Moffat B,  Boyd S, Buxton J, Bungay V, Loudfoot J (2008) Lessons learned from the SCORE project: a document to support outreach and education related to safer crack use. Self-published. cultural meanings, norms and expectations assigned according to how one is gender identified or ‘read’. The work on the social construction of masculinities represents an important thread in our work. From this perspective, men’s gender is not seen as innate or as a set of traits, but rather, as something that is ‘done’ in everyday life through men’s actions and interactions with others. From this perspective, health behaviours can be seen as being used by some men as representations of masculinity. Health actions are social acts and can be seen as a form of practice which constructs ‘the person’ in the same way that other social and cultural activities do – the ‘doing’ of health is therefore the ‘doing’ of masculinity/gender. We have used photovoice and various qualitative approaches that disrupt masculine ideals that men don’t talk about health and illness. The insights afforded in issues of men’s depression, immigrant men’s health and fathers who smoke reveal the richness of these methods. However, the challenge now is to substantiate the findings from these empirical studies to predict what men’s health practices might prevail as the interim step to designing interventions and services likely to engage discrete groups of men. To achieve this, survey questionnaires, quantitative analyses and longitudinal studies offer important ways forward to develop empirical understandings as targeted men’s health interventions. Knowledge translation with men What seems central to knowledge translation with men is their ‘buy in’. We also know that men can strongly influence the behaviours of other men, and this has implications for the processes used to initiate and sustain conversations about men’s self-health. For example, some of the most successful men’s health promotion programs have drawn on men’s lay perspectives to develop content and delivery strategies. In FACET3 we will use these principles to develop quit programs for fathers who smoke. Specifically, we will work with dad’s who are ‘successful quitters’ to design smoking cessation interventions because we suspect that their insider knowledge will assist us greatly to engage fathers who smoke. Ongoing studies at NEXUS We currently have ongoing programs of research in the areas of prostate cancer, men’s help-seeking behaviour, gender and tobacco use, Indo-Canadian men’s experiences of heart disease and cardiac rehabilitation, and men and depression. Recently we have initiated projects that also seek to understand clinicians’ prespectives.  So rather than drawing entirely on men’s illness narratives we are engaging with specific contexts, including healthcare delivery to develop a more sophisticated understanding of the interaction between men’s health and masculinities. Men’s health continued from page one Page 3 Volume 2, Issue 3 NEW PROJECTS Unpacking the effects of gender and ethnicity on healthcare utilization: The cardiac rehabilitation experiences of Indo-Canadian Men Drs. Paul Galdas (NEXUS Co-Investigator) and John Oliffe (NEXUS Lead Investigator) were recently awarded $167,715 over three years to study the cardiac rehabilitation experiences of Indo-Canadian Men. With NEXUS investigators Sukhdev Grewal, Joy Johnson, Pamela Ratner, and Sabrina Wong they will explore the following questions: 1. What factors shape Indo-Canadian men’s experiences post-myocardial infarction (MI)? 2. How do intersections of gender and ethnicity affect Indo-Canadian men’s decisions to attend, not-attend, or drop-out of a cardiac rehabilitation program? 3. How do intersections of gender and ethnicity shape Indo-Canadian perceived cardiac rehabilitation needs post- MI? 4. What are the key ingredients required for the delivery of an accessible, gender-sensitive and culturally- appropriate cardiac rehabilitation program for Indo-Canadian men post-MI? The knowledge generated by this study will contribute to informing the content and delivery of cardiac rehabilitation (CR) programs to increase its relevance, accessibility and uptake among the male Indo-Canadian population. In addition, the findings will also contribute to helping Indo-Canadian men make better informed decisions about attending a CR program post-MI, which will ultimately help to reduce the overall coronary heart disease burden suffered by the male Indo-Canadian population. To learn more about this and other men’s health projects visit: www.nexus.ubc.ca NEXUS Seminar Series 2008-09 Join us for the 2008-09 NEXUS seminar series. The seminars will be presented at the UBC Point Grey and Okanagan campuses and will also be broadcast online via WebEx. September 24, 2008 – Gender and Diversity Analysis of Chronic Disease Self-Management Programs Sue Mills, NEXUS Postdoctoral Fellow November 26, 2008  – Student Poster Session - Email nexus@nursing.ubc.ca to contribute a poster UBC School of Nursing, Point Grey Campus Vancouver January 21, 2009 – Does an historical overview have anything to offer 21st century policy makers? Aleck Ostry, NEXUS Lead Investigator February 25, 2009 – Diversity in the Nursing Workforce – The Key to Success or a Source of Tension? Angela Wolff, NEXUS PhD Trainee March 25, 2009 – Complementary Medicine Education and Outcomes Lynda Balneaves, NEXUS Lead Investigator and Tracy Truant, NEXUS Co-Investigator For more information visit www.nexus.ubc.ca/opportunities/learning/learning.htm UPCOMING EVENTS NEXUS Portal NEXUS is funded byNEXUS is a community of academic and clinical researchers and graduate students pursuing health behaviour research from a variety of perspectives including Nursing, Public Health, Epidemiology, Health Promotion, Sociology, Pharmaceutical Sciences, and Geography. Its mission is to develop knowledge, interventions, and policy recommendations based on a critical analysis of the social contexts that 1) create barriers to health, 2) affect health seeking, and 3) influence system responses. NEXUS is building expanded research  programs related to these three themes in health behaviour using the analytical lenses of gender, diversity, and place. Dr. Lynda Balneaves Dr. Joan Bottorff Dr. Jane Buxton Dr. Lorraine Greaves Dr. Joy Johnson Dr. John Oliffe Dr. Aleck Ostry Dr. Ric M. Procyshyn Dr. Pamela Ratner Dr. Jean Shoveller Dr. Judith Soon Dr. Annette Browne Dr. Joyce Davison Dr. Paul Galdas Ms. Sukhdev Grewal Dr. Su-Er Guo Dr. T. Gregory Hislop Dr. Mieke Koehoorn Ms. Martha Mackay Ms. Mary McCullum Dr. John Ogrodniczuk Dr. Birgit Reime Dr. Chris Richardson Dr. Carole A. Robinson Dr. Rick Sawatzky Ms. Tracy Truant Dr. Helen Ward Dr. Sabrina Wong Dr. Mary Lynn Young NEXUS Lead Investigators NEXUS Co-Investigators Understanding men’s engagement with health and health care services On Friday, July 11th, Dr. Steven Robertson, a world leader in men’s health and masculinity research from the Metropolitan University in Leeds, England, presented to a packed house of NEXUS affiliates, staff and faculty, and members of the CIHR Institute for Gender & Health. Dr. Roberston’s seminar centered around the presentation of men within health care – both by men themselves and by health care professionals that assist men in meeting their health care needs. The presentation was based on Dr. Robertson’s book Understanding men and health: Masculinities, identity and well-being, which explored men’s engagement with health and the healthcare system. The book was based on interviews with health professionals, gay men, disabled men, and contingently  non- gay/non-disabled men. Analysis of interviews conducted with these groups of men revealed three different levels of men’s involvement in their care including indications that: a) men don’t care about their health; b) okay, maybe they do a little bit; and, c) there is a moral imperative to care. As such, a dichotomy is created in which “real men” embody (or should embody) a “don’t care attitude”, while there is a moral imperative that one should care for one’s own health. Dr. Robertson also included dimensions of control and release, relating to men’s level of vigilance regarding their health promotion practices and activities. Thus, within this 4-dimensional model, 4-zones appear which Left to right Drs. Paul Galdas, Steven Robertson, and John Oliffe specify how men embody different types of masculine practices: Zone 1: (Control/Don’t Care) within which body builders who are hyper-vigilant in their dietary and exercise habits, but utilize steroids without appreciating the long-term consequences on their bodies might fit. Zone 2: (Control/Should Care) within which individuals might fit who display hyper-performances and obsession with a “clean” disciplined lifestyle as the means to embodying masculine ideals. Zone 3: (Release/Don’t Care) within which rebellious teens who binge drink and steal cars, without thought to the repercussions of their actions to themselves or others might fit. Zone 4: (Release/Should Care) within which men who smoke could fit by positioning their tobacco use as release but acknowledging the implications for self and others and need to quit. For practitioners and researchers attempting to target ways to modify men’s common (and detrimental) health behaviours, Robertson suggested four instances that can offer opportunities for engagement with health the and a shift towards a “Do Care” attitude. 1) Life Changes/Stages 2) Family History 3) Concern of Family Members 4) Non-gendered aspects of identity Dr. Robertson also commented on the current status of health promotion for men, including the effectiveness of a provocative British campaign for teste self-exam. The advertisement features celebrity Rachel Stevens in a sexually suggestive manner, with the aim of driving men to perform self- exams. However, Dr. Robertson commented that campaigns such as these are unlikely to be effective in changing men’s health practices, and may actually reinforce men’s objectification of women. To prevent the reinforcement of common gendered stereotypes around health by healthcare professionals, Dr. Robertson recommended teaching gender in nursing and medical school curriculums to aid change in men’s health promotion and access to health care. A lively question and answer period ensued in which connections relating to the Should Care/Don’t Care and Control/Release framework were pursued, and ideas for gendered practices in health and health promotion were explored. We were pleased to host such a provocative and engaging speaker.


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