Browsing by Author "Kushlyk, Kristan"

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    Is Subjective Social Status Associated with Maternal and Child Allostatic Load and Maternal Mental Health in Rural Nicaragua?
    (2022-01) Kushlyk, Kristan; Wilson, Warren; Ross, Kharah; Venkataraman, Vivek
    The marginalisation of women and children is manifest in disproportionately poor maternal and child health (MCH) outcomes cross-culturally. Subjective social status (SSS), a measure of one’s perceived rank relative to others within the social hierarchy, has been found to be more predictive of health than objectives measures of socioeconomic status (OSS) in some contexts, but a paucity of data exists on the topic outside of high-income countries (HICs). This cross-sectional study aims to help fill this gap by investigating the association between SSS and measures of maternal and child physical health, conceptualised as allostatic load (AL), and maternal mental health (MMH) in Los Robles, Nicaragua. Multiple regression modelling was carried out to test the hypotheses that SSS would be associated with weighted indices of maternal and child AL, and also common mental disorder (CMD) risk, as assessed using a screening questionnaire. A high prevalence of probable CMDs (22.8%) was documented among mothers in the sample. Higher SSS was significantly associated with an increased risk for CMDs (adj R2 = 0.25, p < 0.001) among mothers in Los Robles but, inconsistent with most other research on the topic, was not significantly associated with maternal (adj R2 = 0.024, p = 0.096) or child (adj R2 = 0.014, p = 0.17) AL. These findings indicate that SSS has important implications for MMH and that findings in HICs concerning predictors of physical health may not be applicable to low-and-middle-income countries.
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    Relationship between food security and dietary diversity in Nicaraguan households
    (2022-03-23) McClennon, Steph; Piperata, Barbara A; Schmeer, Kammi K; Hoehn, Natasha; Brown, Garielle; Kushlyk, Kristan; Wilson, Warren M
    In 2020, nearly one-in-three people globally lacked access to adequate food; that is, they were food insecure. Food insecurity (FI) has four dimensions – availability, access, utilization, and stability – and is linked to poor health outcomes. Our understanding of the relationship between FI and health, however, is compromised by the fact that most research on FI focuses on the access dimension. This has resulted in a poor understanding of the utilization dimension; that is, how people cope with inadequate access to food as manifest by food choice. Here, we explore the relationship between maternal perceptions of food access and food choice, measured as dietary diversity, in 706 Nicaraguan households across urban, peri-urban and rural settings, and hypothesize that as food access worsens, dietary diversity will decline. Access was measured using the Latin American and Caribbean Food Security Scale. Dietary data were collected via a locally-developed, 7-day food-frequency questionnaire and converted to a household dietary diversity score (HDDS). The relationship was analyzed via multiple regression and ANOVA. We found that 82% of households experienced insufficient access to food and had a mean HDDS=10.9±1.2 out of a maximum score of 12. As access to food worsened, dietary diversity declined (r2=0.15, p<0.001), and the effect of food access on HDDS varied across settings (F=3.53, p=0.02). While we found a relationship between food access and HDDS, the high prevalence of insufficient access to food combined with a high average HDDS suggests that HDDS is too blunt an instrument to capture the lived experience.