Michael J. Rovito

Developing a Computer Touch-Screen Interactive Colorectal Screening Decision Aid for a Low-Literacy African American Population Lessons Learned

African Americans have higher colorectal cancer (CRC) mortality than White Americans and yet have lower rates of CRC screening. Increased screening aids in early detection and higher survival rates. Coupled with low literacy rates, the burden of CRC morbidity and mortality is exacerbated in this population, making it important to develop culturally and literacy appropriate aids to help low-literacy African Americans make informed decisions about CRC screening. This article outlines the development of a low-literacy computer touch-screen colonoscopy decision aid using an innovative marketing method called perceptual mapping and message vector modeling. This method was used to mathematically model key messages for the decision aid, which were then used to modify an existing CRC screening tutorial with different messages. The final tutorial was delivered through computer touch-screen technology to increase access and ease of use for participants. Testing showed users were not only more comfortable with the touch-screen technology but were also significantly more willing to have a colonoscopy compared with a “usual care group.” Results confirm the importance of including participants in planning and that the use of these innovative mapping and message design methods can lead to significant CRC screening attitude change.

Perceptions of testicular cancer and testicular self-examination among college men: a report on intention, vulnerability, and promotional material preferences.

Testicular self-exam (TSE) is an important tool to prevent late-stage diagnosis of testicular cancer (TC). However, most young men remain unaware of their risk for TC despite a growing number of interventions promoting knowledge and awareness of the disease. Of those interventions, very few discuss perceived vulnerability, perceived value of health promotion, and/or preference for informational materials as viable predictors of behavioral change. In this study, 300 university males were surveyed on their perceptions of vulnerability, perceived value of health promotion methods, TC/TSE knowledge, and preference for health promotional information. The results indicated that men were generally unaware of TC and were unsure of their risk of developing the disease. Participants reported very positive responses to questions about the value of health promotion methods, particularly TSE, and indicated a high intention to perform health promotion behaviors. Most important, participants noted that they preferred personalized, tailored information to learn about TC and TSE. Significant predictors of intention to perform TSE include knowledge and awareness of TC/TSE, perceived value of health promotion, and attitudes. Significant predictors of promotional tool preferences differed among generalized pamphlets, personalized messages, and group training sessions. The authors recommend that researchers tailor promotional messages in TC/TSE awareness campaigns with an individual’s preference for promotional tool.

“Normative Content” and Health Inequity Enculturation A Logic Model of Men’s Health Advocacy

Epidemiologic studies and related literature consistently report that males have fewer years of life expectancy than females. Moreover, males experience fewer quality years of life in that they tend to live with greater rates of morbidity such as heart disease, cancer, and diabetes among other conditions. Causal evidence traditionally highlights the role of biology in determining the life course for males. However, emerging literature suggests that social determinants of health play a more central role in male morbidity and mortality, and thus contribute to health inequities between the sexes. The purpose of this article is to explore core concepts of social determinants of health as they pertain to male health inequities and provide a systematic conceptualization of how society has become encultured to view these inequities as “normative.” Strategies to improve male health are discussed using a logic model to illustrate male health advocacy in the face of the social climes of encultured health inequities.

Interventions Promoting Testicular Self-Examination (TSE) Performance A Systematic Review

Testicular cancer is one of the greatest threats to health and wellness among 15- to 40-year old males. A concerted effort in the literature promoting awareness, risk factors, and preventative measures is warranted. There is limited discussion on the validity of interventions aimed at promoting testicular self-examination (TSE) performance; the existing body of evidence offers little discussion on what specific factors motivate performance. To assist in making Healthy People 2020 an all-inclusive success, a comprehensive assessment of existing evidence is necessary to assist in closing this research gap. A systematic review of interventions promoting TSE performance discovered moderate levels of effectiveness among 10 studies promoting the behavior. Concerning methodological quality, nine were of average quality and one was of high quality. In terms of significant TSE reporting between intervention and control/comparison groups, 3 out of 10 did not achieve the statistical causal threshold. Based on our assessment of TSE intervention quality and outcomes pertaining to behavior adoption, a best-practices guideline is presented for researchers in the field to consult as they design their interventions. This guideline aims to improve on internal and external validity of TSE promotion research in order to make them more effective.

Off-Label Usage of Testicular Self-Examination (TSE): Benefits Beyond Cancer Detection.

Testicular cancer (TCa) is the most common cancer among 15- to 34-year-old males. Treatments are highly effective, which help foster approximately 98% 5-year survival rate. There are very few known causal factors of the disease (e.g., cryptorchidism and family history), thus possibly limiting primary prevention methods. Secondary preventative measures, on the other hand, most notably testicular self-examination (TSE), are well-known and are promoted to help prevent late-stage diagnosis of TCa. However, debate ensues as to whether or not TSE provides any benefit. In light of a recent systematic review conducted by these authors assessing the effectiveness of TSE promotion interventions, we propose that the behavior can serve as a tool not just for detection of TCa, but other male-specific urogenital health concerns, including varicoceles, hydroceles, among others. Furthermore, we suggest that TSE can also help foster informed decision-making skills among males with regard to health concerns and treatment options. However, our advocacy is in direct conflict with U.S. Preventive Services Task Force’s influential “D” rating of TSE and others who recommend against performing TSE. This article offers an overview of the dispute over TSE’s purpose and net benefit. We conclude that TSE is a behavior that is beneficial beyond detecting cancer. These proposed “off-label” uses of the procedure make for an effectual means to promote testicular health, self-awareness, and wellness among males. Recommendations for future research and advocacy are presented to the academy.

The adolescent body image satisfaction scale for males: exploratory factor analysis and implications for strength and conditioning professionals.

Abstract Leone, JE, Mullin, EM, Maurer-Starks, SS, and Rovito, MJ. The adolescent body image satisfaction scale for males: Exploratory factor analysis and implications for strength and conditioning professionals. J Strength Cond Res 28(9): 2657–2668, 2014—The purpose of this study was to determine whether there is evidence of reliability and validity for the Adolescent Body Image Satisfaction Scale (ABISS), an instrument previously developed to measure adolescent body image. A sample (N = 330) of adolescent males, aged 14–19 years, completed the ABISS to determine current body image satisfaction. Data were analyzed for measures of instrument composite reliability and initial content and construct validity. Exploratory factor analysis supported a 3-factor solution (16 total items), which explained 42.7% of variance in the model. Composite reliability for the subscales, body competence, body inadequacy, and internal conflict ranged from 0.64 to 0.82. Exploratory factor analysis of the ABISS provides initial psychometric support for a valid and reliable measure for assessing adolescent male body image, which also can be used as a needs assessment tool. Strength and conditioning professionals should be aware of their athlete and client psychological attributes, many of whom are adolescents. Understanding how adolescents view their bodies and their body image will assist professionals in designing appropriate, health-promotive strength programs, while at the same time monitoring for signs of body image dissatisfaction. Assessing body image can help heighten awareness and possibly encourage preventative programming to help avert negative health practices (e.g., performance-enhancing drug use, exercise addictions, disordered eating). The ABISS seems to have preliminary psychometric support to be a valid and reliable instrument that helps gauge at-risk populations.

Recommendations for Treating Males: An Ethical Rationale for the Inclusion of Testicular Self-Examination (TSE) in a Standard of Care:

The phrase “standard of care” is primarily a legal term representing what procedure a reasonable person (i.e., health practitioner) would administer to patients across similar circumstances. One major concern for health practitioners is delivering and advocating for treatments not defined as a standard of care. While providing such treatments may meet certain ethical imperatives, doing so may unwittingly trigger medical malpractice litigation fears from practitioners. Apprehension to deviate, even slightly, from the standard of care may (seem to) put the practitioner at significant risk for litigation, which, in turn, may limit options for treatment and preventive measures recommended by the practitioner. Specific to testicular treatment, certain guidelines exist for cancer, torsion, vasectomy, and scrotal masses, among others. As it relates to screening, practitioner examination is expected for patients presenting with testicular abnormalities. Testicular self-examination (TSE) advocacy, however, is discouraged by the U.S. Preventive Services Task Force, which may prompt a general unwillingness among health practitioners to promote the behavior. Considering the benefits TSE has beyond cancer detection, and the historical support it has received among health practitioners, it is paramount to consider the ethical implications of its official “exclusion” from preventive health and clinical care recommendations (i.e., standard of care). Since good ethics should lead practitioner patient care guidelines, not fear of increased malpractice risks, we recommend the development of a standard of care for counseling males to perform TSE.

Development and Testing of a Conceptual Model Regarding Men’s Access to Health Care

Epidemiologic data suggest men often experience excessive morbidity and early mortality, possibly compromising family and community health over the lifespan. Moreover, the negative financial/economic consequences affected by poor male health outcomes also has been of great concern in the United States and abroad. Early and consistent access to preventative health care may improve health outcomes; however, men are far less likely to access these services. The purpose of this study was to understand what factors preclude men from accessing health care. We surveyed 485 participants using a 58-item online survey built from a conceptual model previously developed by the researchers using hegemonic masculinity theory, the theory of normative contentment, and the health belief model. For men, three items significantly (ps < .05) predicted whether they had seen a health care provider in the past year: “I/Men do not access healthcare because I do not think there is anything wrong with me,” “My health is only about me,” and “I/Men do not access healthcare because most men in my family do not access healthcare.” Other correlations of practical significance also were noted. Results suggest gender norms and masculine ideals may play a primary role in how men access preventative health care. Future programming targeting males should consider barriers and plan programs that are gender-sensitive in addition to being gender-specific. Clinical implications are discussed.

Performing Testicular Self-Examination, Driving Automobiles, and Anxiety: What Is the Logical Link?:

The debate of whether testicular self-examination (TSE) should be promoted among males generally centers on a harm–benefit corollary. The benefits of TSE include improving health outcomes, inclusive of an increase in both quality of life and knowledge/awareness of potential health concerns, as well as promoting proactivity in achieving wellness. The harms include claims that false-positive results can increase anxiety and produce costs via unnecessary treatments and therapies. Further claims point to the lack of evidence suggesting TSE decreases testicular cancer mortality. This commentary primarily discusses the anxiety portion of this debate from a logic-based perspective. The argument that TSE should not be promoted among males due to the risk of inciting false-positive anxiety appears to be flawed. A 5-point perspective is presented on the illogical discouragement of TSE due to theorized levels of false-positive anxiety while existing evidence suggests late-stage testicular cancer is associated with anxiety and depression.

From ‘D’ to ‘I’: A critique of the current United States preventive services task force recommendation for testicular cancer screening

In 2004, the United States Preventive Services Task Force (USPSTF) gave testicular cancer (TCa) screening a ‘D’ recommendation, discouraging the use of this preventive service. The USPSTF suggested that screening, inclusive of testicular self-examination (TSE) and clinician examination, does not reduce TCa mortality rates and that the high risk of false positives could serve as a detriment to patient quality of life. Others suggests that TCa screening is ineffective at detecting early-stage cases of TCa and readily highlights a lack of empirical evidence demonstrating said efficacy. These assertions, however, stand in stark contrast to the widely held support of TCa screening among practicing public health professionals, advocacy groups, and clinicians. In this present study, a review was conducted of the methods and processes used by the USPSTF in their 2011 reaffirmation of the ‘D’ grade recommendation. The evidence base and commentary offered as to why TSE, as part of the overall recommendation for TCa screening, was given a ‘D’ grade were analyzed for logical reasoning and methodological rigor. Considering the methodological flaws and the veritable lack of evidence needed to grant a conclusive recommendation, the question is raised if the current ‘D’ grade for TCa screening (i.e. discourage the use of said service) should be changed to an ‘I’ statement (i.e. the balance of benefits and harms is indeterminate). Therefore the purpose of this paper is to present the evidence of TCa screening in the context of efficacy and prevention in order for the field to reassess its relative value.