Browsing by Author "Nejatinamini, Sara"

Now showing 1 - 8 of 8
  • Thumbnail Image
    ItemOpen Access
    Are stress-related pathways of social status differentiation more important determinants of health inequities in countries with higher levels of income inequality?
    (Foundation for the Sociology of Health and Illness [Associate Organisation], Wiley [Commercial Publisher], 2022-03-08) Olstad, Dana Lee; Nejatinamini, Sara; Vanderlee, Lana; Livingstone, Katherine M; Campbell, David J. T.; Tang, Karen; Minaker, Leia M.; Hammond, David
    We explored socioeconomic gradients in self-rated overall health (SROH) using indicators of materialist (educational attainment and perceived income adequacy) and psychosocial perspectives (subjective social status (SSS)) among adults living in countries with varying levels of income inequality, and the importance of psychosocial stress in mediating these associations. If psychosocial processes at the individual and societal levels correspond, associations between SSS and SROH should be higher among adults in countries with higher income inequality, and psychosocial stress should be a more important mediator of these associations. We used multigroup structural equation models to analyse cross-sectional data from the International Food Policy Study of adults (n = 22,824) in Australia, Canada, Mexico, the UK and the United States. Associations between SSS and SROH were not higher in more unequal countries, nor was psychosocial stress a more important mediator of these associations. Inequities in SROH in more unequal countries may not predominantly reflect stress-related pathways of social status differentiation.
  • Thumbnail Image
    ItemOpen Access
    Do food-related capabilities, opportunities and motivations of adolescents mediate the association between socioeconomic position in adolescence and diet quality in early adulthood?
    (2023-06-12) Livingstone, Katherine M.; Olstad, Dana L.; McNaughton, Sarah A.; Nejatinamini, Sara; Dollman, James; Crawford, David; Timperio, Anna
    Abstract Background Socio-economic position (SEP) in adolescence may influence diet quality over the life course. However, knowledge of whether individual and environmental determinants of diet quality mediate the longitudinal association between SEP and diet quality is limited. This study examined whether and to what extent food-related capabilities, opportunities and motivations of adolescents mediated the longitudinal association between SEP in adolescence and diet quality in early adulthood overall and by sex. Methods Longitudinal data (annual surveys) from 774 adolescents (16.9 years at baseline; 76% female) from ProjectADAPT (T1 (baseline), T2, T3) were used. SEP in adolescence (T1) was operationalized as highest level of parental education and area-level disadvantage (based on postcode). The Capabilities, Opportunities and Motivations for Behaviour (COM-B) model was used as a framework to inform the analysis. Determinants in adolescence (T2) included food-related activities and skills (Capability), home availability of fruit and vegetables (Opportunity) and self-efficacy (Motivation). Diet quality in early adulthood (T3) was calculated using a modified version of the Australian Dietary Guidelines Index based on brief dietary questions on intake of foods from eight food groups. Structural equation modelling was used to estimate the mediating effects of adolescents’ COM-B in associations between adolescent SEP and diet quality in early adulthood overall and by sex. Standardized beta coefficients (β) and robust 95% confidence intervals (CI) were generated, adjusted for confounders (T1 age, sex, diet quality, whether still at school, and living at home) and clustering by school. Results There was evidence of an indirect effect of area-level disadvantage on diet quality via Opportunity (β: 0.021; 95% CI: 0.003 to 0.038), but limited evidence for parental education (β: 0.018; 95% CI: -0.003 to 0.039). Opportunity mediated 60.9% of the association between area-level disadvantage and diet quality. There was no evidence of an indirect effect via Capability or Motivation for either area-level disadvantage or parental education, or in males and females separately. Conclusions Using the COM-B model, the home availability of fruit and vegetables (Opportunity) of adolescents explained a large proportion of the association between area-level disadvantage in adolescence and diet quality in early adulthood. Interventions to address poor diet quality among adolescents with a lower SEP should prioritize environmental determinants of diet quality.
  • Thumbnail Image
    ItemOpen Access
    Impact of a farmers’ market healthy food subsidy on the diet quality of adults with low incomes in British Columbia, Canada: a pragmatic randomized controlled trial
    (Elsevier, 2023-02-01) Aktary, Michelle L.; Dunn, Sharlette; Sajobi, Tolulope; O'Hara, Heather; Leblanc, Peter; McCormack, Gavin R.; Caron-Roy, Stephanie; Ball, Kylie; Lee, Yun Yun; Nejatinamini, Sara; Reimer, Raylene A.; Pan, Bo; Minaker, Leia M.; Raine, Kim D.; Godley, Jenny; Downs, Shauna; Nykiforuk, Candace I.J.; Olstad, Dana Lee
    Adults with low incomes have lower diet quality than their higher income counterparts. In Canada, the British Columbia Farmers’ Market Nutrition Coupon Program (FMNCP) provides coupons to low-income households to purchase healthy foods in farmers’ markets.
  • Thumbnail Image
    ItemOpen Access
    Quantifying the contribution of modifiable risk factors to socio-economic inequities in cancer morbidity and mortality: a nationally representative population-based cohort study
    (International Epidemiological Association [Associate Organisation], Oxford University Press [University Publisher], 2021-04-12) Nejatinamini, Sara; Godley, Jenny; Minaker, Leia M; Sajobi, Tolulope T; McCormack, Gavin R; Cooke, Martin J; Nykiforuk, Candace I J; Koning, Lawrence de; Olstad, Dana Lee
    Compared with those with a higher socio-economic position (SEP), individuals with a lower SEP have higher cancer morbidity and mortality. However, the contribution of modifiable risk factors to these inequities is not known. This study aimed to quantify the mediating effects of modifiable risk factors to associations between SEP and cancer morbidity and mortality. Methods: This study used a prospective observational cohort design. We combined eight cycles of the Canadian Community Health Survey (2000/2001-2011) as baseline data to identify a cohort of adults (≥35 years) without cancer at the time of survey administration (n = 309 800). The cohort was linked to the Discharge Abstract Database and the Canadian Mortality Database for cancer morbidity and mortality ascertainment. Individuals were followed from the date they completed the Canadian Community Health Survey until 31 March 2013. Dates of individual first hospitalizations for cancer and deaths due to cancer were captured during this time period. SEP was operationalized using a latent variable combining measures of education and household income. Self-reported modifiable risk factors, including smoking, excess alcohol consumption, low fruit-and-vegetable intake, physical inactivity and obesity, were considered as potential mediators. Generalized structural equation modelling was used to estimate the mediating effects of modifiable risk factors in associations between low SEP and cancer morbidity and mortality in the total population and stratified by sex. Results: Modifiable risk factors together explained 45.6% of associations between low SEP and overall cancer morbidity and mortality. Smoking was the most important mediator in the total population and for males, accounting for 15.5% and 40.2% of the total effect, respectively. For females, obesity was the most important mediator. Conclusions: Modifiable risk factors are important mediators of socio-economic inequities in cancer morbidity and mortality. Nevertheless, more than half of the variance in these associations remained unexplained. Midstream interventions that target modifiable risk factors may help to alleviate inequities in cancer risk in the short term. However, ultimately, upstream interventions that target structural determinants of health are needed to reduce overall socio-economic inequities in cancer morbidity and mortality.
  • Thumbnail Image
    ItemOpen Access
    Socioeconomic inequities in diet quality among a nationally representative sample of adults living in Canada: an analysis of trends between 2004 and 2015
    (Oxford University Press, 2021-09-03) Olstad, Dana Lee; Nejatinamini, Sara; Victorino, Charlie; Kirkpatrick, Sharon I; Minaker, Leia M; McLaren, Lindsay
    Background: Socioeconomic inequities in diet quality are stable or widening in the US, however these trends have not been well characterized in other nations. Moreover, purpose-developed indices of inequities that can provide a more comprehensive and precise perspective of trends in absolute and relative dietary gaps and gradients using multiple indicators of socioeconomic position have not yet been used, and can inform strategies to narrow dietary inequities. Objective: We quantified nationally representative trends in absolute and relative gaps and gradients in diet quality between 2004 and 2015 according to three indicators of socioeconomic position among adults in Canada. Design: Adults (≥18 years) who participated in the nationally representative, cross-sectional Canadian Community Health Survey-Nutrition in 2004 (n=20,880) or 2015 (n=13,970) were included. Socioeconomic position was classified using household income (quintiles), education (five categories) and neighborhood deprivation (quintiles). Dietary intake data from 24-hour recalls were used to derive Healthy Eating Index-2015 (HEI-2015) scores. Dietary inequities were quantified using absolute and relative gaps (between most and least disadvantaged), and absolute (Slope Index of Inequality) and relative gradients (Relative Index of Inequality). Overall and sex-stratified multivariable linear regression and generalized linear models examined trends in HEI-2015 scores between 2004 and 2015. Results: Mean HEI-2015 scores improved from 55.3 to 59.0 (maximum 100); however, these trends were not consistently equitable. While inequities in HEI-2015 scores were stable in the total population and in females, the absolute gap [1.60 (95% CI 0.09, 3.10) to 4.27 (2.20, 6.34)] and gradient [SII=2.09 (0.45, 3.73) to SII=4.84 (2.49, 7.20)] in HEI-2015 scores for household income, and the absolute gradient for education [SII=8.06 (6.41, 9.71) to SII=10.52 (8.73, 12.31)], increased in males. Conclusions: Absolute and relative gaps and gradients in overall diet quality remained stable or widened between 2004 and 2015 among adults in Canada.
  • Thumbnail Image
    ItemOpen Access
    Stress-Related Poor Diet Quality Does Not Explain Socioeconomic Inequities in Health: A Structural Equation Mediation Analysis of Gender-Specific Pathways
    (Elsevier, 2021-10-07) Olstad, Dana Lee; Nejatinamini, Sara; Kirkpatrick, Sharon I; Vanderlee, Lana; Livingstone, Katherine M; Campbell, David J T; Tang, Karen; Minaker, Leia M; Hammond, David
    Psychosocial stress and diet quality individually mediate associations between socioeconomic position (SEP) and health; however, it is not known whether they jointly mediate these associations. This is an important question because stress-related unhealthy eating is often invoked as an explanation for diet-related health inequities, particularly among women, seemingly with no empirical justification. Objective: This study examined whether psychosocial stress and diet quality jointly mediated associations between SEP and self-rated health in women and men. Design: Multiple mediating pathways were modeled using data from the cross-sectional International Food Policy Study. Participants and setting: Data were collected from 5,645 adults (aged 18 years or older) in Canada during 2018 and 2019. Main outcome measures: Participants reported SEP using indicators of materialist (educational attainment and perceived income adequacy) and psychosocial pathways (subjective social status), along with psychosocial stress, dietary intake (to assess overall diet quality via Healthy Eating Index-2015 scores), and self-rated health. Statistical analyses performed: Structural equation modeling modeled pathways linking SEP (ie, educational attainment, perceived income adequacy, and subjective social status) with self-rated health mediated by psychosocial stress and diet quality, stratified by gender. Results: There was no evidence that psychosocial stress and diet quality jointly mediated associations between SEP and self-rated health in women or men. Diet quality mediated associations between educational attainment and self-rated health in women and men, with some evidence that it mediated associations between subjective social status and self-rated health in men (P = 0.051). Psychosocial stress mediated associations between perceived income adequacy and self-rated health in women and men, and between subjective social status and self-rated health in women. Conclusions: Although often invoked as an explanation for diet-related health inequities, stress-related poor diet quality did not mediate associations between SEP and self-rated health in women or men. Psychosocial stress and diet quality individually mediated some of these associations, with some differences by gender.
  • Thumbnail Image
    ItemOpen Access
    The contribution of modifiable risk factors to socioeconomic inequities in cardiovascular disease morbidity and mortality: a nationally representative population-based cohort study
    (Elsevier, 2023-04-12) Nejatinamini, Sara; Campbell, David JT; Godley, Jenny; Minaker, Leia M; Sajobi, Tolulope T; McCormack, Gavin R; Olstad, Dana Lee
    This study examined the individual and joint effects of modifiable risk factors mediating the associations between socioeconomic position (SEP) and morbidity and mortality from cardiovascular diseases (CVD) in a nationally representative sample of adults in Canada. Participants in the Canadian Community Health Survey (n=289,800) were followed longitudinally for CVD morbidity and mortality using administrative health and mortality data. SEP was measured as a latent variable consisting of household income and individual educational attainment. Mediators included smoking, physical inactivity, obesity, diabetes and hypertension. The primary outcome was CVD morbidity and mortality, defined as the first fatal/nonfatal CVD event during follow-up (median 6.2 years). Generalized structural equation modeling tested the mediating effects of modifiable risk factors in associations between SEP and CVD in the total population and stratified by sex. Lower SEP was associated with 2.5 times increased odds of CVD morbidity and mortality (OR: 2.52, 95% CI: 2.28, 2.76). Modifiable risk factors mediated 74% of associations between SEP and CVD morbidity and mortality in the total population and were more important mediators of associations in females (83%) than males (62%). Smoking mediated these associations independently and jointly with other mediators. The mediating effects of physical inactivity were through joint mediating effects with obesity, diabetes or hypertension. There were additional joint mediating effects of obesity through diabetes or hypertension in females. Findings point to modifiable risk factors as important targets for interventions along with interventions that target structural determinants of health to reduce socioeconomic inequities in CVD.
  • Thumbnail Image
    ItemOpen Access
    Trends in Socioeconomic Inequities in Diet Quality between 2004 and 2015 among a Nationally Representative Sample of Children in Canada
    (Oxford University Press, 2021-09-13) Olstad, Dana Lee; Nejatinamini, Sara; Victorino, Charlie; Kirkpatrick, Sharon; Minaker, Leia M; McLaren, Lindsay
    Background: Dietary inequities in childhood may shape dietary and health inequities across the life course. Quantifying the magnitude and direction of trends in absolute and relative gaps and gradients in diet quality according to multiple indicators of socioeconomic position (SEP) can inform strategies to narrow these inequities. Objectives: We examined trends in absolute and relative gaps and gradients in diet quality between 2004 and 2015 according to 3 indicators of SEP among a nationally representative sample of children in Canada. Methods: Data from children (aged 2-17 y; n = 18,670) who participated in the cross-sectional Canadian Community Health Survey-Nutrition in 2004 or 2015 were analyzed. SEP was based on total household income, household educational attainment, and neighborhood deprivation. Dietary intake data from 1 interviewer-administered 24-h dietary recall were used to derive a Healthy Eating Index-2015 (HEI-2015) score for each participant as a measure of diet quality. Inequities in diet quality were quantified using 4 indices: absolute and relative gaps (between highest and lowest SEP) and absolute (Slope Index of Inequality) and relative gradients (Relative Index of Inequality). Overall and age-stratified multivariable linear regression and generalized linear models examined trends in HEI-2015 scores between 2004 and 2015. Results: Although mean HEI-2015 total scores improved from 52.3 to 57.3 (maximum 100 points; P < 0.001), absolute and relative gaps and gradients in diet quality remained mostly stable for all 3 SEP indicators. However, among children aged 6-11 y, absolute and relative gradients in diet quality according to household educational attainment and neighborhood deprivation widened. Conclusions: The diet quality of children in Canada was poor and inequitably patterned in 2004 and 2015. Although mean diet quality improved between 2004 and 2015, absolute and relative gaps and gradients in diet quality persisted, with some evidence of widening absolute and relative gradients among 6- to 11-y-olds.