Canadian Forces Health and Lifestyle Information Survey 2004 Reserve Force Report

A-MD-015-FHP/AF-003 Canadian Forces Health and Lifestyle Information Survey 2004 Reserve Force Report (ENGLISH) Cette publication est disponible en français sous le numéro A-MD-015-FHP/AF-004. HQ December 2006

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Table of Contents Table of Contents... 3 Executive Summary... 5 HLIS 2004 Introduction and Methods... 9 HLIS Participants... 9 Reserve Population... 9 Survey Content and Distribution... 10 Results... 11 Distribution of Reserve Members by Reserve Class... 13 Overall Health Status... 15 Self-assessed Health Status... 15 Bed Rest and Decreased Ability to Perform Normal Activities Due to Health Problems... 16 Bed Rest Due to Illness or Injury... 16 Decreased Normal Activities Due to Illness or Injury... 17 Health Conditions That Limit Employment and Deployment... 18 Health Conditions That Limit Employment... 18 Health Conditions That Limit Deployment... 18 Chronic Conditions... 19 Occupational Health and Other Work-Related Issues... 21 Lost Time From Work... 21 Time Away From Home... 22 Job Satisfaction... 22 Hearing and Exposure to Noise... 23 Noise in the Work Environment... 25 Health Promotion and Public Health Intervention... 29 Health Promotion Beliefs and Intent... 29 Obstacles to Health Promotion... 31 Deployment Related Preventive Health Practices... 33 Eating Habits at Local Restaurants... 34 Biting Insects and Use of Insect Repellents... 34 Stress and Mental Health... 35 Worry and Stress... 35 Coping With Stress... 36 Factors Contributing to Stress... 36 Dealing With Stress... 36 Social Support... 37 Mental Wellness... 38 Depression... 39 Depression in the CF... 39 Suicidal Ideation... 39 Consultation With a Health Professional About Emotional Health in the Last 12 Months... 40 3 A-MD-015-FHP/AF-003

Family Violence... 41 Health Care Services... 43 Health Care Utilization and Satisfaction... 43 Preventive Health Care... 44 Cervical Screening... 45 Colorectal Cancer Screening... 47 Periodic Health Assessment... 48 Oral Health... 48 Nutrition, Obesity, Physical Activity, Physical Fitness... 51 Nutrition and Diet... 51 Body Weight... 54 Physical Activity... 56 Exercise Environment at Work... 58 Sedentary Activity... 59 Physical Activity at Work... 60 CF EXPRES Test... 61 Use of Tobacco and Alcohol... 65 Tobacco Use... 65 Alcohol Consumption... 69 Injuries... 73 Repetitive Strain Injuries... 73 Acute Injuries (Excluding Repetitive Strain Injuries)... 75 Allergies, Use of Medications and Health Products... 79 Side Effects From Medication... 79 Medication Usage... 79 Discussion... 81 Conclusion... 83 Appendix Survey Content... 84 Survey Distribution... 85 4 A-MD-015-FHP/AF-003

Executive Summary This report is a broad overview of the results of the Health and Lifestyle Information Survey 2004 for Canadian Forces Reserve members. Further analysis will be completed at a later date as needed to support the needs of CF Health Services elements with prevention or treatment mandates. The results of this survey are intended to guide the prioritization of health resource allocation; the planning, implementation, and evaluation of health promotion and disease prevention programs; and monitoring the effectiveness of health care interventions. A summary of the findings in each survey section follows. Overall Health Status: The vast majority of CF Reservists (97%) reported excellent, very good, or good self-reported health status. Time spent in bed for health related reasons in the previous two weeks was unchanged at 6% from the HLIS 2000 results. This is more likely to be due to accidents or injuries in males than in females. A similar relationship was seen among the 11% who decreased their normal activities due to illness or injury with accidents or injuries being a more common cause in males. Health Related Employment/Deployment Limitations: The proportion of Reservists with health conditions that limited deployability did not change significantly for both sexes in the previous four years. Approximately 7% of males and 11% of females had health conditions that limited their ability to deploy. Chronic Conditions: The most common chronic conditions for CF Reserve Force members were allergies and back problems. Approximately 18% of Reservists had a history of allergies excluding food allergies compared to 22% in 2000. Half as many (9%) had back problems, not significantly changed from the survey 4 years prior. Lost Time from Work, Time Away from Home, Job Satisfaction: CF Reserve Force members missed on average 4.0 days of work (military and/or civilian) each year due to illness or disability. Another 4 days were lost due to school or educational leave. On average, Reservists annually spent nearly one sixth of their time away from home on military duties. Deployments were only responsible for 17% of this time away. Over four-fifths (83%) of Reservists were very or somewhat satisfied with their job over the past year. Males were slightly more satisfied with their jobs than females. Hearing and Exposure to Noise: Thirty-nine percent of Reservists reported that their hearing was worse since enrolment. Thirty-five percent of CF Reserve Force members who worked in a noisy environment never wore hearing protection. Reservists were more likely to wear hearing protection when exposed to loud noises at work than when they were exposed to them at home. A-MD-015-FHP/AF-003 5

Health Promotion: Increased exercise and an improved diet were the changes most often cited by CF Reserve Force members as actions that would improve their own health. Ninety percent of those who identified diet and activity-related health problems expressed an intent to make these changes. CF Reservists found that the biggest obstacles to health promotion were the related problems of not having enough time and not being motivated. Awareness of the Strengthening the Forces health promotion program tripled in the previous four years. Deployment Related Preventive Medicine Practices: Eighty-four percent of CF Reserve Force members received a health briefing prior to deployment and the majority of personnel found it useful in helping to prevent disease and illness. In practice however, only half of Reservists were always careful about what they ate in local restaurants while on deployment. Nearly one half (45%) applied insect repellent a little of the time or none of the time when it was indicated. Worry and Stress: One third of Reservists found that their worry and stress were mainly due to work, a similar number found that they were due equally to work and home issues. Ninety-five percent of CF Reserve Force members rated their ability as good to excellent in handling day-to-day demands or unexpected and difficult problems. The three main factors contributing to stress were time pressures, personal financial situation, and school. The vast majority of Reservists reported that they dealt with stress in a positive manner; the most common method was to try and solve the problem. Mental Health: Levels of mental distress did not change appreciably in the previous four years. Fifteen percent of CF female Reservists and 7% of CF male Reservists spoke with a health professional about their emotional or mental health in the year prior to the survey. The prevalence of depression remained unchanged from the survey in 2000 at approximately 4%. As in the Canadian population, the rate in females (7%) was higher than the male rate (3%). Family Violence: Approximately 11% of CF Reservists had experienced family violence within the past five years. Direct comparison with surveys of the general Canadian population cannot be made due to survey mode differences, however the results were close enough such that the HLIS 2004 results are quite plausible. Health Care Utilization and Satisfaction: A minority (37%) of CF Reserve Force members sought medical attention from a CF medical facility in the previous year (including visits for periodic health assessments). Continuity of care in terms of seeing the same practitioner was very important for nearly half of Reservists. Only 9% reported always seeing the same practitioner. Seventeen percent did not feel that local clinic hours met their needs. The majority of these concerns related to the lack of evening and weekend hours. 6 A-MD-015-FHP/AF-003

Preventive Health Care Interventions: Forty-four percent of Reservists aged 40 or older had not received a periodic health assessment within the previous two years. Only a quarter of CF Reserve Force members aged 50 or older at the time of their last military PHA reported having been offered a recommended colorectal cancer-screening test. Women s Health: In comparison to younger CF female Reservists, females aged 40 and over were more likely to report that their last Pap test was more than 3 years ago (14% vs. 5%). Oral Health: Reservists rated their oral health better than does the Canadian population. Only 2% of the Reservists reported pain often in their teeth or gums in the month prior to the survey. Nutrition and Diet: Although 84% of CF Reserve Force members rated their eating habits as good or better, 59% of them reported eating less than the recommended minimum 5 servings of fruit or vegetables a day. Thirty-three percent of Reservists reported that they changed their diet on their own in the previous year with the goal of losing weight. Overweight and Obesity: It is recognized that highly muscular individuals may not be at the level of health risk indicated by their body mass index (BMI) category. This confounds the interpretation of the health risk of CF males in the BMI range from 25 to 30, classified as overweight. Obesity (BMI over 30) is associated with increased health risk. Fifteen percent of all CF Reserve males were obese as were 15% of all CF Reserve females. Overall, the prevalence of obesity in the CF Reserve Force population remained stable over the previous 4 years. Of the 39% of Reservists who were not happy with their current weight, 96% were in agreement that exercise and diet are important in losing or gaining weight. Lack of knowledge did not appear to be the problem. Physical and Sedentary Activity: Only 40% of the CF Reserve Force was physically active, this is an activity level equivalent to walking at least 60 minutes per day. Watching television was the most popular sedentary activity among CF members; the average time spent doing this activity was 11 hours per week. Less than 1 in 5 Reservists reported having a highly or very highly active job. CF EXPRES Test: Excluding those who were exempt or medically excused, the majority of CF Reserve Force members (53%) did not perform their annual CF EXPRES Test. Eighty-seven percent of Reservists who did take the CF EXPRES Test passed it. Tobacco Use: Only 26% of CF Reserve Force members were current smokers, a decrease of 2% over the previous four years. The use of forms of tobacco other than cigarettes in the CF was not common. Nearly 2/3 of smokers (60%) were seriously considering quitting in the next six months. Of concern, 15% of Reservists who smoked stated they started smoking during basic training. A-MD-015-FHP/AF-003 7

Alcohol Consumption: Only 49% of Reservists followed the Low Risk Drinking Guidelines produced by the Centre for Addictions and Mental Health, which recommend no more than two alcoholic drinks on any day of the week. Binge drinking, defined as more than five drinks at any one time, increased slightly among Reservists in keeping with the changes seen among the general Canadian population. One quarter of CF Reserve Force members drank at a hazardous level using the World Health Organization s AUDIT score. This also increased slightly over the previous four years. Injuries: The rate of repetitive strain injuries increased slightly for both males and females over past four years to 17% overall in 2004. The acute injury rate in CF Reserve Force members of 19% was unchanged over the previous four years. Approximately 55% of acute injuries were due to sprains and strains; fractures were reported by 10%. Use of Medications and Health Products: Approximately 6% of CF Reserve Force members have experienced side effects from prescribed or over the counter medication in the previous year. A small percentage (8%) received a prescription in the past year but never had it filled by the pharmacist. Only 18% of Reservists reported using dietary supplements such as vitamins, protein powders and herbal products. The reported use of anabolic steroids by Reservists was very uncommon. 8 A-MD-015-FHP/AF-003

HLIS 2004 Introduction and Methods The Health and Lifestyle Information Survey (HLIS) is the only population health survey of Canadian Forces (CF) members. National health surveys conducted by Statistics Canada specifically exclude people living on CF bases. The last HLIS conducted in 2000 was an attempted census of the entire CF population and had a strong focus on occupational health issues. The 2004 survey was created, administered, and analyzed by the (DFHP), Canadian Forces Health Services Group Headquarters. The HLIS 2004 had four goals: a. Assess the physical and mental health status of CF members; b. Measure the prevalence of behavioural risk factors among CF members; c. Measure the utilization of previous health promotion programs and assess the potential for future programs; d. Measure health care utilization of and satisfaction with the CF health care system. This survey will assist DND in prioritizing health resource allocation and in monitoring the effectiveness of health promotion programs and health care interventions. HLIS Participants A stratified random sample was taken from the Human Resources Management System (HRMS), often referred to as PeopleSoft, for both the Regular and Reserve forces. Females were oversampled for both forces to achieve minimum 95% confidence intervals of ±3%. Regular Force members that recently deployed were also oversampled. This required about 2500 people for the Regular Force and approximately 1900 people for the Reserves. Since only a 50% response rate was achieved with the Regular Force version of the HLIS 2000, the sample was doubled to ensure a large enough sample size. Reserve Population The HLIS 2004 was administered to both the Regular and Reserve Forces, although questions varied slightly for each component to address unique population differences and issues related to service. In order to provide context to assist with the interpretation of study results, distinctions between the Regular and Reserve Forces, and the different Reserve classes of service are provided below. Throughout the report, observed differences between Reserve classes are presented when relevant, except when numbers are too small to provide stable estimates. In contrast to the Regular Forces, Reserve service is voluntary and for an indefinite period of time. There are currently three classes of Reserve service: Class A, B, and C. In the future, Reserve service will be re-classed to full-time and part-time service. Compensation and benefits vary for the three different Classes and the type of employment. A-MD-015-FHP/AF-003 9

Class A Class A service is the most common class of Reserve service and is part-time in nature, and usually involves working one day per week and one weekend per month. In general terms, Class A Reservists are entitled to CF healthcare and dental benefits to treat an injury or emergency attributable to military service. Otherwise, Class A Reservists receive their health care through the Canadian healthcare system. Class B Class B service involves full-time temporary service that is not operational (i.e. deployments) in nature. Class B Reservists employed for a period over 180 days are entitled to CF health care and dental benefits equal to that provided to Regular Force members during their period of employment. Similar to Class A Reservists, Class B Reservists employed for a period of 180 days or less are provided CF healthcare and dental benefits to treat an injury or emergency attributable to military service. Class C Class C service is also full-time, but it is considered to be equivalent to Regular Forces in terms of pay, and the health care and dental benefits provided by the CF. Class C service normally entails service for approved contingency, routine, domestic or international operations. It should be noted that these classifications are not static and that it is common for CF Reservists to move between the three Reserve classes of service, and between the Regular and Reserve Forces throughout their career. Survey Content and Distribution Much of the HLIS 2004 survey content was based on the HLIS 2000. The in-depth occupational and deployment information collected in 2000 was not repeated since significant change was not expected within four years. Considerable emphasis was placed on questions pertaining to behavioural risk factors such as smoking since additional health promotion activities in many of these areas have recently been developed. There was also a need to identify barriers to lifestyle changes and to measure current practices in order to assist with the setting of goals for the future. The HLIS 2004 continued to use questions from national Canadian health surveys whenever possible and from validated standardized instruments. A difficulty arises in that the HLIS 2004 was a mail out mail back survey while the main national Canadian health survey, the Canadian Community Health Survey (CCHS), is a direct person-toperson interview and telephone survey. Different survey modes have been shown to affect responses to survey questions. As a result, direct quantitative comparison of HLIS results to CCHS results would not be valid and have not been made in this report. Trends in HLIS results, however, are compared to trends in the general Canadian population. The HLIS 2004 required approximately 45 minutes to complete. There were four versions of this survey, two for the Regular Force (French and English) and two for the Reserve Force with only minor differences between the Regular and Reserve versions. 10 A-MD-015-FHP/AF-003

This report deals only with the Reserve Force survey. Authorization to conduct the survey was received from the Directorate of Human Resources Research and Evaluation (DHRRE) (authorization number 287/03) and from the three environmental commands. The survey was approved by an independent external research ethics board (Ethica Clinical Inc of Montreal). Significant effort was made to increase the response rate from that achieved with the HLIS 2000. Techniques promoted by Dillman 1, such as sending reminder notices and the resending of surveys to non-responders, were used whenever possible. A Reserve advisor in CF H Svcs Gp HQ was instrumental in ensuring an accurate list of Reservists was used and that Reservists were given time to complete the survey. Command staff OPIs (officeof-primary-interest) vetted the initial sample list as HRMS was not completely accurate at that time. A message was sent to all Reserve unit Commanding Officers requesting the naming of OPIs within each Reserve unit to assist with the distribution of the survey. The survey was mailed to these OPIs in April 2004. Surveys were accepted back until approximately mid-november 2004. Further details of the survey content and distribution can be found in the Appendix. Results Reserve Force surveys were mailed to 3580 Reservists and 1932 responses were received for a gross response rate of 54%. However, 197 Reservists did not receive their surveys for valid reasons such as address was unknown despite multiple attempts or the Reservist had been released. 32 surveys had a high probability of being duplicates or had multiple missing data and were removed as a result. Correcting for surveys that could not be delivered, the response rate was 56%, based on 1900 survey responses out of 3383 surveys that were assumed to have been delivered. Respondent demographics were compared to the sample demographics in order to evaluate non-response bias. Weighted respondent demographics were compared to respondent demographics for the HLIS 2000 in order to determine if there was a need for age standardization when comparing HLIS 2000 and 2004 results. 1 Dillman DA. Mail and Internet Surveys, 2nd ed. John Wiley and Sons Inc., Toronto, 2000. A-MD-015-FHP/AF-003 11

TABLE 0.1: Sample and Respondent Demographic Comparison Characteristic HLIS 2004 Sample (%) Class A Class B/C HLIS 2004 Respondents (%) Class A Class B/C HLIS 2004 Respondents Weighted (%) Class A Class B/C HLIS 2000 Respondents (%) Class A Class B/C Sex Male 53 45 50 39 83 75 76 59 Female 47 55 50 61 17 25 24 41 Mother tongue English 76 72 71 74 72 75 70 75 French 24 28 29 26 28 25 29 25 Age 17-19 17 3 9 3 20 9 -- -- 20-29 44 32 43 33 44 40 48 31 30-34 12 16 12 15 12 13 13 20 35-39 8 14 8 15 6 12 11 15 40-44 8 16 9 15 6 13 11 14 45-54 10 17 17 16 11 12 17 20 55-60 1 3 3 3 2 2 -- -- Rank Pte/OS to MCpl/MS 73 59 65 58 71 61 61 57 Sgt/PO2 to CWO/CPO1 13 23 16 25 12 22 18 22 OCDT to Capt/Lt(N) 12 13 14 12 14 12 15 14 Maj/LCdr to Gen/Adm 3 5 5 4 4 5 6 7 Element Air 10 20 16 19 11 14 15 27 Sea 17 19 19 18 17 18 17 13 Land 73 61 65 63 72 69 67 59 *Note the HLIS 2004 used a stratified sample, the HLIS 2000 was an attempted census. Numbers may not add to 100 due to rounding. The sample and respondent demographic results were relatively comparable. However, a lower proportion of Class A Reservists responded compared to the proportion in the original sample (Table 0.2). The problem of obtaining responses from younger lower ranked personnel in the army remained the same as in the HLIS 2000. Obtaining responses from Class A Reserves may also be related to age, as this group tends to be younger. Also, despite efforts to reach all members sampled, the lower response could be because they never received their survey due to irregular or intermittent work attendance. 12 A-MD-015-FHP/AF-003

Distribution of Reserve Members by Reserve Class As mentioned earlier, the large majority of CF Reservists were Class A. As can be seen in Table 0.2, there was a high rate of non-response among Class A Reservists, which may impact overall estimates. For both males and females there was an overrepresentation of Class B respondents, and this was greater for females than males. However, Class A Reservists still represented the majority of respondents; therefore, overall estimates (not broken down by Class) were likely to be weighted more heavily toward the Class A responses. TABLE 0.2: Distribution of Sample and Respondents by Reserve Class Class Unweighted HLIS 2004 Sample (n=3580) Unweighted HLIS 2004 Respondents (n=1844)* t Males % Females % Total % Males % Females % Total % A 86 81 83 61 50 55 B 11 17 14 32 46 40 C 3 2 3 7 4 6 *56 respondents missing because missing either sex or class t Numbers do not add up to 100% due to rounding To account for the stratified complex sampling used, weighting was applied to the responses. Weighting variables were based on age and sex. Respondents who had out of range ages or did not respond to questions about their age (question 11.1) or sex (question 11.2) were removed as weighting could not be applied to their results. As a result, 20 surveys were deleted leaving 1880 surveys available for analysis. Analytic results based on fewer than 20 respondents were not reported due to statistical instability. This report only provides the results of univariate and bivariate analyses done to date. In other words, it assesses the association between one factor and one health outcome at a time. However, most health outcomes are due to the effect of multiple risk factors and further multivariate analyses will therefore need to be done to examine the independent effect of individual risk factors. It should also be noted that associations between a risk factor and an outcome can be modified by a third factor. For example, most studies have shown that males are more prone to binge drinking than females. If one looks at the association between element of service and binge drinking without controlling for other factors, one may find that land force personnel are more likely to binge drink. However, this may be an invalid finding entirely due to the fact that there are fewer females proportionately in the land forces compared to the other two services. It would also be a mistake to assume that a valid association indicates that an exposure of some type causes the outcome. For example, there may be a clear association between coffee drinking and smoking, but that does not indicate that one causes the other. There are additional criteria of causation to be met before one should reach a conclusion of that nature. A-MD-015-FHP/AF-003 13

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1 Overall Health Status This section addresses self-assessed health status, activity limitations due to health problems, health conditions limiting deployment and employment, and chronic conditions. Self-assessed Health Status Overall, 97% of CF Reservists reported having excellent, very good, or good health status. Officers were more likely to report excellent or very good health compared to Non-Commissioned Members (NCMs). Overall health status was measured by asking respondents to rate their health as being excellent, very good, good, fair, or poor. Self-assessed health has been found to be a reliable and valid indicator of health status and has been shown to be highly predictive of mortality. In this study, 97% of Reservists reported having excellent, very good, or good health status. Officers were more likely to report excellent or very good health compared to NCMs (77% vs. 69%), and within each of those groups, junior ranking individuals were more likely to report excellent or very good health status compared to those in senior ranks. Individuals less than 29 years of age were more likely to report excellent health (26%) compared to those older than 29 years (15%). There was no difference in health status between males and females. The proportion of reserves that reported having excellent health decreased by approximately 4% since 2000; however, this decrease was offset by an increase in the proportion of reserves that reported having very good or good health; there was no change in the proportion that reported having fair or poor health status. A-MD-015-FHP/AF-003 15

FIGURE 1.1: Prevalence of Self-assessed Health Status* 60% 50% 46% 49% 40% 30% 20% 25% 21% 26% 27% HLIS 2000 HLIS 2004 10% 3% 3% 0% EXCELLENT VERY GOOD GOOD FAIR/POOR *Age and sex-standardized to the 2004 CF reserve population Bed Rest and Decreased Ability to Perform Normal Activities Due to Health Problems 6% of CF Reservists reported staying in bed in the past two weeks due to illness or injury. Bed rest and reduced normal activities due to health problems are indicators of overall health status and can limit the operational effectiveness of the CF by reducing available manpower. A two-week prevalence of any bed confinement and reduced activity were measured by asking Reservists if they had spent time in bed or cut down on normal activities because of illness or injury in the past two weeks. Bed Rest Due to Illness or Injury Overall, 6% of CF Reservists reported staying in bed due to illness or injury in the past two weeks. Class B and C Reservists were more likely to take sick leave than class A Reservists (8% vs. 5%). There were no clear trends between stays in bed due to health problems and age and sex. Among CF Reservists that reported staying in bed in the past 2 weeks, over one-quarter did so because of an accident or injury. Of those that reported staying in bed in the past 2 weeks for health reasons, approximately 26% did so due to an accident or injury. This rate was higher in males at 30% compared to females at 14%. An explanation for this difference may be that CF male Reservists are more likely to participate in physically demanding occupations and sports activities that are associated with higher rates of injury. On the other hand, 16 A-MD-015-FHP/AF-003

this difference may be simply because females stay in bed disproportionately longer for illnesses, thereby lowering the percentage of stays in bed that injuries represent of all causes. Decreased Normal Activities Due to Illness or Injury Overall, 11% of Reservists reported cutting down on normal activities in the past two weeks because of illness or injury; rates were higher for females compared to males (15% vs. 10%) (Figure 1.2). Anglophone Reservists were more likely to cut down on normal activities than Francophone Reservists (12% vs. 8%). Likewise, Class B and C Reservists were more likely to cut down on normal activities in the past 2 weeks compared to Class A Reservists (14% vs. 9%). The median number of reduced activity days was 4; however, 21% of those with reduced activities did so for the entire 14 days. A consistent relationship between age and health-related decreased normal activities was not observed. A higher proportion of CF male Reservists that reported cutting down on normal activities did so because of an accident or injury compared to females (51% vs. 33%). There did not appear to be a clear relationship between age and cutting down on normal activities because of accidents and injuries. FIGURE 1.2: Decrease in Normal Activities Due to Illness or Injury* 40% 35% 30% 25% 20% 15% 10% 5% 0% 15% 13% 10% 8% MALE FEMALE CF 2000 CF 2004 *Standardized to the 2004 CF Population A-MD-015-FHP/AF-003 17

Health Conditions That Limit Employment and Deployment Approximately 8% of CF Reserve Force members had health conditions limiting their deployability. Health Conditions That Limit Employment Overall, 7% of CF Reservists had health conditions that limited their employability. The proportion of Reservists with employment limitations increased with age and was higher among females compared to males (9% vs. 6%) (Figure 1.3). Since 2000, the proportion of Reservists with health conditions that limit their employability remained stable. Class B and Class C Reservists were more likely to have employment health limitations compared to Class A Reservists (9% vs. 5%). FIGURE 1.3: Presence of Health Conditions That Limit Employment* 40% 35% 30% 25% 20% 15% 10% 5% 5% 6% 8% 9% CF 2000 CF 2004 0% MALES FEMALES *Standardized to the 2004 CF Population Health Conditions That Limit Deployment Overall, 8% of Reservists suffered from health conditions that limited their deployability, with the likelihood increasing with age. The proportion of CF Reservists that were unable to deploy because of a health condition remained roughly the same since 2000 (Figure 1.4). Females were more likely to have health conditions that prevented them from deploying than males (11% vs. 7%). Air reserves had the highest rate of health conditions that limited deployment (11%), compared to the land (7%) and naval reserves (5%). Likewise, Class B and Class C reserves (10%) were more likely to have a health condition that prevented them from deploying compared to Class A reserves (6%). Widowed, separated, and divorced Reservists were more likely to have health related deployment limitations (17%), 18 A-MD-015-FHP/AF-003

followed by those in a partnered relationship (11%); single Reservists were the least likely to have any deployment limitations (4%); this may be due to the age of these subgroups. FIGURE 1.4: Presence of Health Conditions that Limit Deployment* 40% 35% 30% 25% 20% CF 2000 CF 2004 15% 10% 5% 5% 7% 10% 11% 0% MALES FEMALES *Age-standardized to the 2004 CF Population Chronic Conditions The three most prevalent chronic conditions for Reservists were: non-food allergies (18%), back problems (9%) and asthma (4%). Reservists were asked to indicate if they had ever been diagnosed by a physician as having any of the chronic conditions listed in Table 1.1. Overall, the prevalence of individual chronic conditions remained the same since 2000, with the exception of bronchitis and other conditions. The decrease in other conditions might be partly explained by the inclusion of additional chronic condition options in the 2004 survey. The most prevalent conditions for CF Reserve Force members were non-food allergies (18%) and back problems (9%). CF female Reservists were more likely to suffer from chronic conditions than CF male Reservists (53% vs. 34%), especially non-food allergies, back problems, migraine headaches, and asthma. Due to small numbers for many of the chronic conditions (Table 1.1), rates cannot be reported, as they would be unstable. A-MD-015-FHP/AF-003 19

TABLE 1.1: Chronic Health Conditions* HLIS 2000 HLIS 2004 Chronic Conditions Total % M % F % Total % M % F % Other allergies 22 20 31 18 16 27 Back problems 11 11 14 9 9 13 Arthritis or rheumatism 4 3 5 3 3 4 High blood pressure 4 4 3 4 4 3 Migraine headaches 4 2 11 4 --- 9 Mood disorder *** *** *** 3 2 5 Lipid problems *** *** *** 3 3 2 Food allergies 10 8 16 3 3 6 Asthma 4 4 8 4 3 8 Anxiety disorder *** *** *** 1 --- 2 Stomach/intestinal ulcers 1 1 1 1 --- --- Diabetes 1 1 --- --- --- --- Bowel disorder 1 1 2 1 --- 2 Thyroid condition 2 1 5 1 --- 4 Fibromyalgia --- --- --- --- --- --- Chronic bronchitis or emphysema 1 1 --- --- --- --- Epilepsy --- --- --- --- --- --- Heart disease 0 1 0 --- --- --- Cancer 0 0 --- --- --- --- Effects of a stroke --- --- --- --- --- --- Urinary incontinence 0 --- --- --- --- --- Cataracts 0 1 --- --- --- --- Glaucoma 0 0 --- --- --- --- Chronic fatigue syndrome *** *** *** --- --- --- Other** 50 43 75 6 6 7 *Standardized to the 2004 CF population. **These values do not include CF Reservists >54 as there were no valid values in this age category. ***The following chronic conditions were included on HLIS 2004, but not in the HLIS 2000: chronic fatigue syndrome, mood disorder, anxiety disorder, and lipid problems. All values are rounded. Values of 0 indicate less than 1% prevalence of disease. --- Numbers too small to report 20 A-MD-015-FHP/AF-003

2 Occupational Health and Other Work-Related Issues This section addresses lost time from work (military and civilian), time away from home, job satisfaction, and hearing and exposure to noise. Lost Time From Work CF Reserve Force members missed on average 4.0 days of work (military and/or civilian) each year due to illness or disability. The most common reason for CF Reserve Force members to miss work was vacation, missing on average 1.2 days per month. The next most common reason was school or educational leave at slightly over 4 days per year. Personal illness or disability caused a loss on average of 4 days per year. The cost of this lost time is not known as this is the total lost time from both military and civilian employment. Lost work time due to illness or disability is a complex outcome of the rate of illness/disability, job satisfaction, compensation policies for illness, and other factors. TABLE 2.1: Lost Time From Work Cause of Days Away From Work Average Days Average Days per Month per Year Vacation 1.2496 15.0 School or educational leave 0.3622 4.35 Own illness or disability 0.3368 4.04 Other personal or family 0.1984 2.38 responsibilities Maternity leave 0.1369 1.64 Caring for children 0.0831 1.0 Caring for elders 0.0145 0.17 Other 0.2977 3.57 Total 2.6792 32.2 A-MD-015-FHP/AF-003 21

Time Away From Home On average, CF Reserve Force members reported spending 1/6 of their time away from home on military-related duties. Only 17% of this time away was due to deployment. The average length of time spent away from home due to military-related activities for Reserve Forces members in the past two years was 4.1 months but this figure is skewed upward by a relatively small number of very high values. The median time away was 3 months over a two-year period. This was only slightly less than median time away for the CF Regular Force of 4 months. Time away was due to the following: courses (25%), temporary duty (TD) (22%), training (21%), deployment (17%), exercises (10%), and others (6%). No definitions were given for activities such as deployment, training and exercise. It is possible that different meanings exist for different elements. For example, to members in the land element, deployment implies operations (peacekeeping, aid to civil power, war), while in the sea element, ships deploy when they leave the home port and may or may not participate in exercises. It is unknown if there is an optimal time away from home. Job Satisfaction The majority of CF Reserve Force members were very satisfied or somewhat satisfied with their military job over the past year, which was essentially unchanged from the previous survey. Those in the sea element reported being least satisfied with their job. Over four-fifths (83%) of CF Reserve Force members reported being very satisfied or somewhat satisfied with their military job in the past 12 months. Males reported being slightly more satisfied than females and job satisfaction decreased slightly with increases in education. There was no change in job satisfaction by age. By rank, senior officers (91%) stated being the most satisfied with their job while approximately 82% of all other ranks were satisfied. Officers with a higher rank might represent a select population that choose to stay in the military and/or have a higher sense of control in their jobs; hence, higher job satisfaction would be expected in this population. Class C Reservists appeared slightly less satisfied than Class A or B Reservists. There was a slight difference in job satisfaction ( very satisfied and somewhat satisfied ) by element as shown in Figure 2.1. 22 A-MD-015-FHP/AF-003

FIGURE 2.1: Percentage of Job Satisfaction by Element, 2004 Very or Somew hat Satisfied Not too or Not at all Satisfied 90% 86% 84% 80% 77% 70% 60% Percentage 50% 40% 30% 23% 20% 10% 14% 16% 0% Air Sea Land Element There was little reported change in job satisfaction compared to the HLIS 2000 survey. Eighty-three percent of Reserve Force members stated being very or somewhat satisfied in 2004 compared to 86% in 2000. This decrease was more pronounced among female members of the Reserve Force (a decrease of 6% vs. 3%). Hearing and Exposure to Noise Thirty-nine percent of CF Reserve Force members perceived that their hearing was worse since joining the CF. Thirty-five percent of Reservists who worked in a noisy environment reported never wearing hearing protection. Sixty-one percent of CF Reserve Force members noted that their hearing had not changed (or had improved) since joining the CF. Twenty-eight percent perceived that their hearing was slightly worse and 11% perceived that their hearing was moderately worse to much worse since joining the CF. There was a substantial difference in the crude rates of selfreported hearing loss by sex and age; male Reservists were much more likely to report a A-MD-015-FHP/AF-003 23

change in hearing (42%) compared to female Reservists (28%) (Figure 2.2) and the proportion of Reservists reporting a loss in hearing increased with age from 31% of members aged 20 to 29 to 66% of members aged 45 to 54 (Figure 2.3). Reservists in the air (58%) and land (40%) elements were more likely to report a loss in hearing compared to Reservists in the sea element (26%). Senior NCMs (61%) and senior officers (63%) also reported more hearing loss compared to all other ranks (junior NCMs (33%), junior officers (39%)). FIGURE 2.2: Perceived Hearing Change Since Joining the CF, by Sex, 2004 80% 70% 72% 60% 58% 50% 40% 30% 29% 23% Male Female 20% 13% 10% 0% NO CHANGE OR IMPROVED SLIGHTLY WORSE MODERATELY/MUCH WORSE 5% 24 A-MD-015-FHP/AF-003

FIGURE 2.3: Perceived Hearing Loss Since Joining the CF, by Age, 2004 70% 66% 60% 50% 50% 43% 49% 40% 30% 31% 20% 10% 0% 20-29 30-34 35-39 40-44 45-54 Noise in the Work Environment An equal proportion of male CF Reserve Force members (15%) indicated that they regularly (often or constantly) worked in a noisy environment compared to female Reservists (16%). The proportion of Reservists who reported working in a noisy environment decreased as rank increased but no consistent change was seen with age. A higher proportion of Reservists in the air element (31%) indicated that they were either often or constantly working in a noisy environment compared to the land (12%) and sea (15%) elements. Class C Reservists appeared much more likely to be exposed to noise at work (26%) compared to Class A (15%) and Class B (13%). Female Reservists appeared much less likely to wear hearing protection in noisy environments than male CF members, whether at work or at home. Of the Reservists who indicated that they worked in a noisy work environment at least occasionally, 35% never wore hearing protection and only 25% wore hearing protection all of the time (Figure 2.4). There was no significant trend seen with age. Francophones indicated that they were more likely to never wear hearing protection (40%) compared to Anglophones (33%). A substantially higher proportion of females (60%) reported never wearing hearing protection in a noisy work environment compared to males (29%). A higher percentage of members with some secondary or high school (42%) reported never using hearing protection in a noisy work environment compared to members with completion of secondary education (32%). The frequency of wearing hearing protection all the time was comparable in all 3 elements. A-MD-015-FHP/AF-003 25

Fifty-seven percent of CF Reserve Force members who used any hearing protection reported wearing earplugs, 26% reported wearing earmuffs, and 16% reported wearing earplugs and muffs. Earplugs were much more likely to be used by those in the land element (69%) than in the air element (30%) or the sea element (24%). FIGURE 2.4: Percentage of Reservists Using Hearing Protection at Work and During Leisure Time When Exposed to Loud Noise 40% 35% 35% 36% 35% 30% 25% 20% 15% 19% 21% 15% 25% 14% Work Leisure Time 10% 5% 0% NEVER LESS THAN HALF THE TIME MORE THAN HALF THE TIME ALL THE TIME Less than half (42%) of Reservists reported being exposed to loud sounds during their free time (45% for males, 30% for females). Male Reservists stated they were more likely to be exposed to noise from power tools, guns, and rock music while female Reservists stated they were more likely to be exposed to noise from music and disco/dance bars (Figure 2.5). 26 A-MD-015-FHP/AF-003

FIGURE 2.5: Sources of Loud Noise During Leisure Time or Civilian Employment, by Sex 60% 50% 40% 30% 53% 32% 49% 28% 24% 47% 47% 41% 40% 34% 44% Male Female 20% 10% 15% 14% 14% 8% 8% 0% POWER TOOLS GUNS OFF-ROAD VECHICLES MOTORCYCLES SNOWMOBILES ROCK MUSIC DISCO/DANCE BAR OTHER *Among those exposed to loud sounds during free time or with civilian employment CF Reserve Force members were asked if they wore hearing protection during noisy activities during leisure time: never, sometimes (less than half the time and more than half the time), or always. More than one third (36%) of Reservists reported never wearing hearing protection during noisy leisure activities, which is roughly the same that reported never wearing hearing protection during noisy work activities (35%). However, a higher percentage of Reservists reported always wearing hearing protection during noisy work activities (25%) compared to leisure activities (14%) (Figure 2.4). Analogous to work related noise, a higher proportion of females (58%) reported never wearing hearing protection during noisy leisure activities compared to males (32%). Contrary to when working in a noisy environment, 20 to 29 year olds (44%) reported being more likely to never wear hearing protection compared to older ages (for example 24% for those aged 45 to 54) during noisy leisure activities. Members in the sea element reported being most likely to never wear hearing protection during noisy leisure activity (46%) compared to air (28%) and land elements (34%). For hearing protection during leisure activities, 59% of CF Reserve Force members reported using earplugs, 24% reported using earmuffs, and 14% reported using earplugs and muffs. A minority (39%) of CF Reserve Force members perceived that their hearing was worse since joining the CF. A survey of this type is unable to differentiate between hearing loss associated with aging from that due to noise exposure, and individual perception of a noisy environment may differ from that measured objectively. It is a concern that only 25% of Reservists who worked in a noisy environment reported always wearing hearing protection and that an even lower percentage (14%) reported always using hearing protection during leisure time noisy activities. Unfortunately, it is not yet a cultural norm for people to use hearing protection during leisure time activities. A-MD-015-FHP/AF-003 27

28 A-MD-015-FHP/AF-003

3 Health Promotion and Public Health Intervention This section examines beliefs about health promotion, intent to make personal changes to improve health, obstacles to health promotion, participation in and rating of health promotion programs and deployment related prevention practices. Health Promotion Beliefs and Intent Awareness of actions, which can be taken to improve physical or mental health, is a key requirement for Reservists to take control of their own health. Increased exercise and an improved diet were the changes most often cited by Reservists as actions that would improve their own health. Intent to make these changes was approximately 90% for those who identified themselves as having these problems. Table 3.1 below indicates which actions Reservists believed would improve their health. Knowledge is one step and intention to make the change is the next. Of those who believed that a change would improve their health, the percentage that intended to make the change in the next year is also shown in the table. The responses from the HLIS 2000 are provided for comparison. A-MD-015-FHP/AF-003 29

TABLE 3.1: Health Promotion Beliefs and Intent Health Promotion Action Percent Saying it Would Improve Own Health HLIS 2000 % HLIS 2004 % Of Those, Percent Intending to Make Change HLIS 2000 % HLIS 2004* % a. Reduce or quit smoking 25 24 66 85 b. Exercise more or start to exercise 77 81 82 95 c. Improve my diet 64 66 76 89 d. Lose weight 47 43 84 97 e. Cut down on drinking alcohol 17 19 52 52 f. Manage or reduce cholesterol 26 22 68 78 g. Take better care of my teeth and gums 38 42 77 90 h. Reduce the amount of stress in my life 53 48 69 78 i. Spend more time with family and/or friends 51 50 74 88 j. Learn to relax more and worry less 52 46 73 86 k. Change jobs 22 21 73 83 l. Have a medical check up 27 26 74 84 m. Have my cholesterol checked 24 23 71 83 n. Have my blood pressure checked 24 22 73 87 o. Change my sexual behaviour to reduce the risk of sexually 6 7 55 55 transmitted diseases p. Work less/play more 36 37 62 71 q. Learn to cope better with worry, nerves, or stress 45 41 75 86 r. Retire 11 9 34 28 *Non-response considered missing, not standardized 30 A-MD-015-FHP/AF-003

Obstacles to Health Promotion Reservists found that the biggest obstacles to health promotion were not having enough time and not being motivated. Obstacles to health promotion must be minimized in order to encourage and facilitate appropriate lifestyle changes. The main obstacles are listed in descending order of importance for 2004. The HLIS 2000 results are not shown as there has been no clinically significant change. TABLE 3.2: Obstacles to Health Promotion Obstacle to Making Change HLIS 2004 % Not enough time 38 Not motivated 31 The problem isn t serious, there s no rush 30 Too many other demands 28 Not enough money 26 Not enough energy 12 No support from CF 11 I don t know how to get started 9 Too much stress 7 Not sure that I can do it 5 I don t know where to go for help 4 No support from civilian employer 3 No support from family or friends 3 It s too hard 2 Other reasons 9 I don t know 10 One means of improving CF health is through CF-sponsored health promotion programs. The percentage of respondents who participated in these various programs and the proportion that found them very or fairly helpful are shown in Table 3.3. A-MD-015-FHP/AF-003 31

TABLE 3.3: Attendance and Rating of Health Promotion Programs CF-Sponsored Health Promotion Program Percent Who Attended Percent Who Found Program Very or Fairly Helpful Alcohol and Drug Education 16 50 Butt Out 3 53 March 1st I Quit! Challenge 3 --- Other Smoking Cessation Programs 1 --- Stress Management 10 65 Suicide Awareness 9 71 Suicide Intervention 8 71 Weight Wellness Program 2 61 Other Weight Loss Programs 1 76 Other Healthy Lifestyle Programs 4 70 Injury Prevention 8 74 --- Numbers too small to report Strengthening the Forces has been the name of the CF s health promotion program since 1994. It has undergone rejuvenation with the creation of the Directorate of Force Health Protection. In the HLIS 2000, only 6% of CF Reserve Force members stated having heard of Strengthening the Forces, in 2004 it was much higher at 18%. The key communication modes for increasing awareness of the program included pamphlets, brochures, and posters (Table 3.4). TABLE 3.4: Means of Awareness of Strengthening the Forces Medium Percentage Pamphlets, brochures and/or posters 13 Base newspaper or other CF publications 7 Webpage 2 Word of mouth 3 CF presentation and/or workshops 2 Other 1 32 A-MD-015-FHP/AF-003

Increased exercise and improved diet were the two actions most often cited by CF Reserve Force members which would improve their health and the intention to make these changes was very high. The main reported obstacles did not change significantly since the HLIS 2000: not enough time, lack of motivation, and a lack of sense of urgency. Not having enough time is a common complaint across Canadian society early in the 21 st century. Some of the obstacles may be due to perceived rather than real barriers, as will be shown later in this report (the average Reservist watches 11 hours of TV a week). Although increased awareness of Strengthening the Forces programs and activities may improve this through education, skills training, and provision of healthy lifestyle programs, further improvement would depend on cultural, institutional, and environmental changes beyond the control of. Deployment Related Preventive Health Practices The following questions pertain to Reservists who had been deployed outside Canada, the United States, Australia, New Zealand or Western Europe for longer than a month in the last 12 months. Four percent of CF Reserve Force members (5% male, 3% female) reported being so deployed. Eighty-four percent of CF Reserve Force members reported receiving a health briefing prior to deployment and the majority of personnel reported finding it useful in helping them to prevent disease and illness. Eighty-four percent of CF Reserve Force members indicated having received a health briefing prior to deployment. The proportion of Reservists who found that these briefings prepared them very well or well was similar for all four preventive health topics ranging from 71% to 76% (Table 3.5). TABLE 3.5: Extent That Medical Briefing Enabled Reservist to Take Preventive Action Extent That Briefing Helped Prepare You in Preventing the Following Problem (%) Diarrhea from eating unsafe food and drinking unsafe water Very Well, Well (%) Some, Little, Not at All (%) 76 24 Being bitten by insects 73 27 Getting malaria 75 25 Acquiring a sexually transmitted disease 71 29 A-MD-015-FHP/AF-003 33