1. Citation Zajac, I. T., Duncan, A., Flight, I., Wilson, C., Wittert, G., & Turnbull, D (2015). The Relationship of Self-Rated Health and Health Priorities to Health-Protective Behaviours in Older Australian Men. Paper presented at the Australasian Society for Behavioural Health and Medicine, Perth, Western Australia. ian.zajac@csiro.au 1 |

2. NUTRITION & HEALTH PROGRAM THE RELATIONSHIP OF SELF-RATED HEALTH AND HEALTH PRIORITIES TO HEALTH-PROTECTIVE BEHAVIOURS IN OLDER AUSTRALIAN MEN

3. Overview of Presentation Health disparities for Australian men Self-rated health as theoretical construct Self-rated health as a predictor of past behaviours in Men Self-rated health as a predictor of future behaviours in Men Conclusions 3 | ian.zajac@csiro.au

4. Health disparities in Australia Despite progress towards reducing disparities, men continue to have lower levels of overall health and poorer health outcomes than women. Men’s poorer health outcomes are present across all socioeconomic groups Men of least disadvantage commonly have poorer outcomes than the most disadvantaged women. Men have fewer interactions with the health system than women overall, but a higher proportion of these visits reflect chronic disease than for women ian.zajac@csiro.au 4 |

5. Aboriginal men experience substantially lower life expectancy and poorer health than all other Victorian men and women, including higher rates of most chronic diseases, depression and suicide. Young men (15–34 years) have the highest rates of health-risk behaviours of any men and have avoidable mortality rates two to three times higher than women in this age group. Men of lower socioeconomic status have lower life expectancy than men of higher socioeconomic status, and higher levels of injury and many chronic diseases. Rural men experience higher rates of suicide, mortality due to road-traffic injuries and many chronic diseases, as well as higher levels of social isolation and depression. Male prisoners and ex-prisoners experience high rates of many health conditions and have a death rate four times higher than men without a prison history. Gay, bisexual, transgender and intersex men experience negative health impacts due to discrimination, and have higher rates of depression, anxiety, suicide, and violence. Older men face an increased risk (varying with age) of a range of health conditions, and health risks relating to leaving paid work, social isolation and poor access to health information. Refugee men can experience physical, emotional and sometimes sexual trauma prior to arriving in Australia, and can face barriers accessing health services. Men with disabilities have higher rates of premature mortality and comorbid conditions. The evidence is unclear about the extent to which these are sex and gender specific. Source: http://www.health.vic.gov.au/diversity/men/focus.htm ian.zajac@csiro.au 5 | Health disparities: Fast Facts

6. All Cancers in Australia ian.zajac@csiro.au 6 | Source: http://www.aihw.gov.au/cancer/cancer-in-australia-overview-2012/appendixb/

7. Major Coronary Events ian.zajac@csiro.au 7 | Source: http://www.aihw.gov.au/cardiovascular-health/trends/

8. Melanoma Rates ian.zajac@csiro.au 8 | Source: http://www.environment.gov.au/node/22250http://www.environment.gov.au/node/22250

9. Suicide ian.zajac@csiro.au 9 |

10. Self-rated Health ian.zajac@csiro.au 10 | Popular measure of subjective health Used by a variety of scientific disciplines most commonly in relation to health events (i.e., cardiovascular disease) and mortality outcomes Used as a sociological indicator of health status Poorly understood! –Self-rated health is an individual and subjective conception that is related to the strongest biological indicator, death, and constitutes a cross-road between the social world and psychological experiences on the one hand, and the biological world, on the other. Most empirical studies on self-rated health come from the epidemiological tradition that focuses on the statistical associations of variables rather than on the processes from which the variables emerge. There is an obvious need for more comprehensive approaches to understanding this concept Adapted from M. Jylha, 2009, doi:10.1016/j.socscimed.2009.05.013

11. The Spontaneous Assessment View: SRH is a subjective assessment of a variety of health states (physical, mental, emotional etc...) and as such, is a kind of ‘dependent’ or ‘outcome’ variable. ian.zajac@csiro.au 11 | Self-rated Health Source: Hirve et al., 2014 DOI 10.1007/s11205-013-0334-7

12. Alternate theory is that SRH is a kind of ‘enduring self-concept’ Self-rated health is not only a spontaneous assessment of one's health status. Like a self-concept, self-rated health may be regulated by efforts to achieve one's relatively important health- related goals A relatively stable trait over time, (i.e., highly correlated) Primarily predicted by prior SRH, rather than changes in health ian.zajac@csiro.au 12 | Self-rated Health

13. Study Aims Purpose:  To examine the extent to which previous screening behaviours predict SRH, and to assess whether SRH predicts future behaviour, consistent with the enduring self-concept view.  To explore whether men’s self-health priorities relate to their behaviours in a similar way to SRH Participants:  BASELINE: N=908 community dwelling older men who were participating in a larger, randomised controlled trial of FOBT screening.  INTERVENTION: 3 months after baseline participants offered free screening test for Bowel Cancer  ENDPOINT: N=574 complete endpoint measures, 3 months after intervention  Sample characteristics: ian.zajac@csiro.au 13 |

14. Results: SRH At baseline, most men rated their health as ‘Average’ to ‘Good’ The relationship between SRH at baseline and endpoint was strong (r=.69) ian.zajac@csiro.au 14 |

15. How would you rate the importance of your own health? How do you rank the importance of your health in comparison to finances, relationship, health of significant others, etc? ian.zajac@csiro.au 15 | Results: Health Priorities

16. Results: Past Behaviours Those with higher SRH were more likely to have used PSA testing previously, and not to have smoked in the past Health Priority Rank was not associated with prior health behaviours ian.zajac@csiro.au 16 |

17. Results: Future Behaviours ian.zajac@csiro.au 17 | SRH measured at baseline predicts subsequent participation in screening for bowel cancer. Statistically speaking, the result is not significant in the reduced sample Health Priorities did not predict participation in subsequent screening offer

18. Results: Impact of Behaviour on SRH ian.zajac@csiro.au 18 | Those who participated in screening offer had higher SRH at endpoint (measured after FOBT participation). Those who completed the FOBT were 28% more likely (B=1.28, p=.03) to report higher SRH scores than those who did not screen

19. Results: Change in SRH ian.zajac@csiro.au 19 |

20. Conclusions Self rated health appears to be a reflection of past behaviours, but also predicts participation in future health behaviours Rating one’s health as ‘important’ was not related to either past or future behaviours As per the enduring self-concept model, Self-Rate Health measures may reflect a feedback loop ian.zajac@csiro.au 20 | Self Rated Health Healthy Behaviours

21. Thanks for listening! ian.zajac@csiro.au 21 | Slides available at: www.ianzajac.com