Browsing by Author "McLaren, Lindsay"
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- ItemOpen AccessA Canadian Population-based Study of the Relationship between Fluoride Exposure and Indicators of Cognitive and Thyroid Functioning; Implications for Community Water Fluoridation(2016) Barberio, Amanda; McLaren, Lindsay; Quiñonez, Carlos; Hosein, ShaunConcerns exist regarding potential harms of community water fluoridation. The study objective was to examine the association between fluoride exposure and indicators of two health outcomes for which concerns have been expressed, cognitive and thyroid functioning, among a population-based sample of Canadians. Data were analyzed from Cycles 2 and 3 of the Canadian Health Measures Survey. Logistic regression and multinomial logistic regression were used to examine associations between fluoride exposure (from urine and tap water) and indicators of cognitive and thyroid functioning, adjusting for covariates. There was no evidence of any relationship between fluoride exposure and thyroid functioning. Higher urinary fluoride was associated with having some cognitive problems (versus none), but this finding disappeared when the sample was constrained to those for whom we could discern fluoride exposure from drinking water. Future research should continue to utilize this high quality data source to explore other potential harms.
- ItemOpen AccessA History of the Social Determinants of Health in Canada through the Lens of the Canadian Public Health Association, 1910-2010: Implications for Present and Future Population Health in Canada(2017) Lucyk, Kelsey; McLaren, Lindsay; Stahnisch, Frank W.The 2008 final report of the WHO’s Commission on Social Determinants of Health (SDOH) marked a watershed in the history of the SDOH for bringing together decades of evidence and theory on the social causes of illness from the diverse health research landscape. Yet, a rich history predates this and other contributions (e.g., 1974 Lalonde Report) that are widely credited as the start of the SDOH approach. This history is revealed through casting the contemporary interpretive lens of the SDOH onto the past. I gained a nuanced understanding of the emergence and evolution of the SDOH in Canada by analyzing the archives of the Canadian Public Health Association (CPHA) from 1910 to 2010. I applied a social history and critical public health perspective while exploring this data using methods of thematic content analysis. To situate my findings with relevance to the contemporary landscape of population and public health (PPH), I complemented my analysis of archival sources with that of published and grey SDOH literature, print news articles, and oral history interviews with PPH leaders. My findings show that as a way of thinking, the SDOH approach is complex and diffuse. This, coupled with the inherently political nature of the SDOH, presents challenges in terms of communicating key messages of the SDOH to decision-makers and the public. Additionally, the history of the SDOH is non-linear and changes alongside social, economic, and political events. Economic recession and growth, for example, at times brought more and less urgency to act on the SDOH within the Canadian PPH community. However, despite that ebb and flow, the foundations of health equity and social justice have remained firm throughout the history of the SDOH. These foundations, combined with the growth and increasing disciplinary coherence of PPH, suggest that action on the SDOH will remain a core commitment of PPH.
- ItemOpen AccessA mixed-methods study of peer influences and body-related attitudes and behaviours in young adolescents attending an overnight summer camp(2011) Linder, Jordana; McLaren, LindsayThis research is presented in a manuscript-based format, meaning that it has been divided into three separate, yet connected, manuscripts. Following a global introduction section and literature review, the three manuscripts are included as separate chapters, followed by a global conclusion chapter that completes the dissertation. Authorship and Publication Status of Manuscripts Standard authorship criteria (from the International Committee of Medical Journal Editors) were used to establish authorship on the three manuscripts included in my dissertation. According to these criteria, "Authorship credit should be based on 1) substantial contribution to conception and design, acquisition of data, or analysis and interpretation of data; 2) drafting the article or revising it critically for important intellectual content; and 3) final approval of the version to be published. Authors should meet conditions 1, 2, and 3" (http://www.icmje.org/ethical_lauthor.html). As there are co-authors on each of the manuscripts, I have outlined below the contributions of myself and all co-authors for each manuscript included in this dissertation. As the student, I took the lead role in all manuscripts. Specifically, I led the design and execution of the study, collected and conducted the analysis of the data, and led the writing, under the guidance of my supervisor and with contributions from supervisory committee members. Efforts have been made to publish this research and details of submissions are described below. Please note that the manuscripts are formatted in accordance with the guidelines of the University of Calgary, Graduate Studies. The citation for manuscript one (chapter 3) is: Linder, J, Adair CE., Russell-Mayhew, S., & McLaren, L. Body dissatisfaction and body change behaviours in early adolescent boys and girls at summer camp. For this paper, I conceptualized the study, gained access to the study site, obtained consent from parents and assent from participants, designed the questionnaire, completed the data collection, analyzed the data, interpreted the results and prepared the first draft of the manuscript. Dr. McLaren assisted in and oversaw all of the above activities. Dr. Adair assisted in the conceptualization of the study, questionnaire development and the editing of the manuscript. She also provided specific assistance in the pre-test and the analysis. Dr. Russell-Mayhew assisted in the conceptualization of the study, questionnaire development and the editing of the final manuscript.
- ItemOpen AccessAssessment of the magnitude of geographic variation and socioeconomic contextual effects on children’s dental caries: a multilevel cross-sectional analysis of a population-based sample(2019-02-22) Shi, Congshi; McLaren, Lindsay; Faris, Peter D.; Aparicio-Ting, Fabiola E.; Patterson, Steven M.Background: Revealing geographic variation and assessing area contextual influences are important for reducing social inequalities in dental caries. The objective of this study was to investigate area contextual effects on children’s dental caries. Methods: This cross-sectional study included data from Grade 1 and 2 school children attending schools in the Public or Catholic school systems in the urban areas of Calgary and Edmonton in 2013/2014, in Canada. Three sources of data were used: (a) open mouth examinations, (b) parents’ questionnaires, and (c) Pampalon Material Deprivation Index derived from census data. Two dental caries outcomes were considered: (1) presence of dental caries, and (2) caries experience. Data were analyzed using multilevel modelling with two levels: school children (level 1) and dissemination area in which the child’s school was located (level 2). Results: The analytic sample included 5,677 school children attending school in 220 DAs. The study confirmed the existence of geographic variation; levels of dental caries were significantly higher among children attending schools in the most materially-deprived DAs than among those in the least materially-deprived DAs. After controlling for different population compositions in those areas, the DA-level variance represented a small but significant part (5-9%) of total variance in dental caries. Although the highest risk of having dental caries was found in the most materially-deprived DAs, the largest number of children at risk were more thinly spread across all deprivation quintiles. Conclusions: The school DA’s context may have an impact on children’s dental caries, beyond individual- and family-level factors. The study findings are relevant to Alberta Health Services’ practice of basing their selection of targeted areas for dental public health programming on school-DA’s material deprivation level and delivering preventive services to children attending schools in those selected DAs. Specifically, although risk of dental caries is highest in the most deprived quintiles, strategies focusing exclusively on the highest deprivation areas would miss many of the vulnerable children. Multilevel interventions are thus necessary to reduce social inequalities in children’s dental caries.
- ItemOpen AccessCanadian Senate Report on Obesity: Focusing on Individual Behaviours versus Social Determinants of Health May Promote Weight Stigma(2018-07-02) Alberga, Angela S.; McLaren, Lindsay; Russell-Mayhew, Shelly; von Ranson, Kristin M.Very little attention has been given to unintended consequences of government reporting on obesity. This paper argues that the 2016 Senate report, “Obesity in Canada: A Whole-Of-Society Approach,” exemplifies the systemic public health issue of weight stigma. The purpose of this viewpoint is to critique the approach taken in the Report, by illustrating that it (1) takes a weight-centric approach to health, (2) does not acknowledge important limitations of the definition and measurement of obesity, (3) reifies obesity as a categorical phenomenon that must be prevented, and (4) uses aggressive framing and disrespectful terminology. The Report perpetuates a focus on the individual, thereby failing to recognize the role that governments can play in reducing weight stigma and addressing social determinants of health. If steps are taken to avoid propagating weight stigma, future reports could more constructively address health promotion, equity, and social determinants of health in their policies.
- ItemOpen AccessChildhood obesity: Preceptions of the Calgary public(2005) Potestio, Melissa Lee; Robinson-Vollman, Ardene L.; McLaren, Lindsay
- ItemOpen AccessCorrection to: Developing a framework to inform scale-up success for population health interventions: a critical interpretive synthesis of the literature(2020-06-05) Nguyen, Duyen T K; McLaren, Lindsay; Oelke, Nelly D; McIntyre, LynnAn amendment to this paper has been published and can be accessed via the original article.
- ItemOpen AccessDeterminants of childhood weight status in Canadian boys and girls(2011) Potestio, Melissa Lee; McIntyre, Lynn; McLaren, Lindsay
- ItemOpen AccessDeveloping a framework to inform scale-up success for population health interventions: a critical interpretive synthesis of the literature(2020-04-29) Nguyen, Duyen T K; McLaren, Lindsay; Oelke, Nelly D; McIntyre, LynnAbstract Background Population health interventions (PHIs) have the potential to improve the health of large populations by systematically addressing underlying conditions of poor health outcomes (i.e., social determinants of health) and reducing health inequities. Scaling-up may be one means of enhancing the impact of effective PHIs. However, not all scale-up attempts have been successful. In an attempt to help guide the process of successful scale-up of a PHI, we look to the organizational readiness for change theory for a new perspective on how we may better understand the scale-up pathway. Using the change theory, our goal was to develop the foundations of an evidence-based, theory-informed framework for a PHI, through a critical examination of various PHI scale-up experiences documented in the literature. Methods We conducted a multi-step, critical interpretive synthesis (CIS) to gather and examine insights from scale-up experiences detailed in peer-reviewed and grey literatures, with a focus on PHIs from a variety of global settings. The CIS included iterative cycles of systematic searching, sampling, data extraction, critiquing, interpreting, coding, reflecting, and synthesizing. Theories relevant to innovations, complexity, and organizational readiness guided our analysis and synthesis. Results We retained and examined twenty different PHI scale-up experiences, which were extracted from 77 documents (47 peer-reviewed, 30 grey literature) published between 1995 and 2013. Overall, we identified three phases (i.e., Groundwork, Implementing Scale-up, and Sustaining Scale-up), 11 actions, and four key components (i.e., PHI, context, capacity, stakeholders) pertinent to the scale-up process. Our guiding theories provided explanatory power to various aspects of the scale-up process and to scale-up success, and an alternative perspective to the assessment of scale-up readiness for a PHI. Conclusion Our synthesis provided the foundations of the Scale-up Readiness Assessment Framework. Our theoretically-informed and rigorous synthesis methodology permitted identification of disparate processes involved in the successful scale-up of a PHI. Our findings complement the guidance and resources currently available, and offer an added perspective to assessing scale-up readiness for a PHI.
- ItemOpen AccessEthnic disparities in children’s oral health: findings from a population-based survey of grade 1 and 2 schoolchildren in Alberta, Canada(2018-01-04) Shi, Congshi; Faris, Peter; McNeil, Deborah A; Patterson, Steven; Potestio, Melissa L; Thawer, Salima; McLaren, LindsayAbstract Background Although oral health has improved remarkably in recent decades, not all populations have benefited equally. Ethnic identity, and in particular visible minority status, has been identified as an important risk factor for poor oral health. Canadian research on ethnic disparities in oral health is extremely limited. The aim of this study was to examine ethnic disparities in oral health outcomes and to assess the extent to which ethnic disparities could be accounted for by demographic, socioeconomic and caries-related behavioral factors, among a population-based sample of grade 1 and 2 schoolchildren (age range: 5-8 years) in Alberta, Canada. Methods A dental survey (administered during 2013-14) included a mouth examination and parent questionnaire. Oral health outcomes included: 1) percentage of children with dental caries; 2) number of decayed, extracted/missing (due to caries) and filled teeth; 3) percentage of children with two or more teeth with untreated caries; and 4) percentage of children with parental-ratings of fair or poor oral health. We used multivariable regression analysis to examine ethnic disparities in oral health, adjusting for demographic, socioeconomic and caries-related behavioral variables. Results We observed significant ethnic disparities in children’s oral health. Most visible minority groups, particularly Filipino and Arab, as well as Indigenous children, were more likely to have worse oral health than White populations. In particular, Filipino children had an almost 5-fold higher odds of having severe untreated dental problems (2 or more teeth with untreated caries) than White children. Adjustment for demographic, socioeconomic, and caries-related behavior variables attenuated but did not eliminate ethnic disparities in oral health, with the exception of Latin American children whose outcomes did not differ significantly from White populations after adjustment. Conclusions Significant ethnic disparities in oral health exist in Alberta, Canada, even when adjusting for demographic, socioeconomic and caries-related behavioral factors, with Filipino, Arab, and Indigenous children being the most affected.
- ItemOpen AccessExploring Parental Views on Community Water Fluoridation and Alternative Policy Options in the Context of Cessation(2018-08-15) Lang, Rebecca; McLaren, Lindsay; Weijs, Cynthia A.; Blue, Gwendolyn; Figueiredo, Rafael L. F.Background and Rationale: Instances of cessation of community water fluoridation (hereafter ‘fluoridation’), such as the decision to cease fluoridation in Calgary in 2011, have raised broader questions about the acceptability, to members of the public, of population-level preventive measures in public health. In the wake of fluoridation cessation in Calgary, it is important to gain an understanding of how members of the public view population-level interventions in dental health, to ensure that future policies best align with the views of those served by those policies. Conceptual Frameworks: We approached this work through the lenses of public health ethics and public engagement of science. Public health ethics focuses on populations, considering the collective rather than the individual. A public engagement with science lens explores the roles of the scientific community and of the public in framing scientific discussion. Research Objective: We sought to explore perspectives on several possible population-level dental public health interventions held by parents of young children in Calgary, Canada, where fluoridation was previously but is no longer in place. Methods: The target population was parents of young children. Using focus groups and pre- and post-focus group questionnaires, four policy approaches to preventive dental health for populations (i.e., municipal-level fluoridation; state/provincial-level fluoridation; universal dental care; and salt or milk fluoridation) were introduced and discussed. Focus group data were analyzed using thematic analysis. Results: Three themes were developed: 1. Expert/lay relations explores how the public regards and behaves toward others who are understood to have different levels of expertise, knowledge, or credentials, vis-à-vis dental public health policy; 2. Ways of knowing explores how people use different forms and sources of information to determine whether a belief is valid; and 3. Values in public health focuses on people’s core principles regarding the importance and worth of dental public health interventions. Conclusion: Our research confirms the importance of engaging these publics in developing dental public health policies. We also found that of the four policy options presented, universal dental care was preferred, which provides some insight into attributes of population-level interventions that are acceptable to members of the public in Calgary.
- ItemOpen AccessInteractions between Neighbourhood Urban Form and Socioeconomic Status and Their Associations with Anthropometric Measurements in Canadian Adults(2017-09-05) McCormack, Gavin R.; Friedenreich, Christine; McLaren, Lindsay; Potestio, Melissa; Sandalack, Beverly; Csizmadi, IlonaNeighbourhood-level socioeconomic composition and built context are correlates of weight-related behaviours. We investigated the relations between objective measures of neighbourhood design and socioeconomic status (SES) and their interaction, in relation to self-reported waist circumference (WC), waist-to-hip ratio, and body mass index (BMI) in a sample of Canadian adults ( from 12 Calgary neighbourhoods). WC and BMI were higher among residents of disadvantaged neighbourhoods, independent of neighbourhood design (grid, warped grid, and curvilinear street patterns) and individual-level characteristics (sex, age, education, income, dog ownership, marital status, number of dependents, motor vehicle access, smoking, sleep, mental health, physical health, and past attempts to modify bodyweight). The association between neighbourhood-level SES and WC was modified by neighbourhood design; WC was higher in disadvantaged-curvilinear neighbourhoods and lower in advantaged-grid neighbourhoods. Policies making less obesogenic neighbourhoods affordable to low socioeconomic households and that improve the supportiveness for behaviours leading to healthy weight in low socioeconomic neighbourhoods are necessary.
- ItemOpen AccessIs there an association between spatial access to parks/green space and childhood overweight/obesity in Calgary, Canada?(BioMed Central, 2009-11-20) Potestio, Melissa L.; Patel, Alka B.; Powell, Christopher D.; McNeil, Deborah A.; Jacobson, Dan; McLaren, Lindsay
- ItemOpen AccessMajor Depression, Antidepressant Medication and the Risk of Obesity(Karger, 2009) Patten, Scott B.; Williams, Jeanne V.A.; Lavorato, Dina H.; Brown, Lauren; McLaren, Lindsay; Eliasziw, MichaelBackground: Cross-sectional studies have reported an association between episodes of major depression (MDE) and obesity. The objective of this longitudinal analysis was to determine whether MDE increases the risk of becoming obese over a 10 year period. Method: We used data from the Canadian National Population Health Survey (NPHS), a longitudinal study of a representative cohort of household residents in Canada. The incidence of obesity, defined as a body mass index (BMI) of ≥ 30 kg/m2 was evaluated in respondents who were 18 years or older at the time of a baseline interview in 1994. MDE was assessed using a brief diagnostic instrument. Results: The risk of obesity was not elevated in association with MDE, either in unadjusted or covariate-adjusted analyses. The strongest predictor of obesity was a BMI in the overweight (but not obese) range. Effects were also seen for (younger) age, (female) sex, a sedentary activity pattern, low income and exposure to antidepressant medications. Unexpectedly, significant effects were seen for serotonin reuptake inhibiting antidepressants and venlafaxine, but not for tricyclic antidepressants nor antipsychotic medications. Conclusions: MDE does not appear to increase the risk of obesity. The cross-sectional associations that have been reported, albeit inconsistently, in the literature probably represent an effect of obesity on MDE risk. Pharmacologic treatment with antidepressants may be associated with an increased risk of obesity, and strategies to offset this risk may be useful in clinical practice.
- ItemOpen AccessPerceptions of the social determinants of health by two groups more and less affiliated with public health in Canada(BioMed Central, 2013-07-01) McIntyre, Lynn; Shyleyko, Robert; Nicholson, Cherie; Beanlands, Hope; McLaren, Lindsay
- ItemOpen AccessPopulation-level determinants of obesity in Canada: application of econometric techniques(2014-07-28) Dutton, Daniel James; McLaren, LindsayObesity is a significant public health problem in Canada. Increasingly, factors that are beyond the individual are being identified as important drivers of the current obesity epidemic. Drivers like prices, taxes, and government policy are jointly identified as population-level determinants of obesity that have resulted in its rapid growth. While these population-level determinants have been identified as important, their impact has not been explicitly quantified in Canada. The geographic distribution of obesity prevalence in Canada is one issue that could potentially highlight the important role that population-level determinants of obesity play. This dissertation’s objective is to assess the importance of population-level determinants of obesity in Canada by quantifying their impact on individuals living in different regions of the country. Canada has, roughly, an east to west gradient of obesity, with the Atlantic provinces exhibiting the highest prevalence of obesity. I characterize the difference between the Atlantic provinces and other regions of Canada (Quebec, Ontario, the Prairies, and British Columbia) in two ways: the difference in average body mass index (BMI) and the difference in BMI distributions. To estimate the contribution of the population-level determinants to these differences I apply Blinder-Oaxaca decompositions and quantile regression to national level data from the Canadian Community Health Survey. I show that the population-level determinants are important in describing cross-regional differences in obesity in Canada and their importance becomes larger at high percentiles of the BMI distribution, especially in females. I explain how this is consistent with the ecological model of obesity’s portrayal of the population-level determinants of obesity. Parallel to meeting the overall objective of this dissertation, I assess the added value of corrected BMI values in obesity research. Correction equations are generally used to adjust self- iii reported BMI values so they resemble measured BMI values on aggregate. I assess their usefulness by establishing a new correction equation and comparing that correction to established Canadian correction equations, measured BMI, and self-reported BMI. I determine that corrected BMI is not always superior to self-reported BMI and discuss the settings where corrected BMI is useful.
- ItemOpen AccessPublic and health professional opposition to community water fluoridation: An investigation of trust and perceived risk in the context of new, local research findings(2018-08-23) Fundytus, Katrina Ann; McLaren, Lindsay; Lucas, Jack; Musto, Richard J.; Curran, DeanBackground: Community water fluoridation (CWF) has remained a highly-debated topic among the public since it was introduced in 1945. Since then, several studies have provided support for the safety and effectiveness of CWF, although there are limitations to both the quantity and quality of the current evidence base. Despite the available scientific data, there exists a divide on public views toward CWF. Purpose: The purpose of this study was to understand how health professionals and members of the public in Calgary, who self-identify as opposed to CWF, make sense of locally-relevant and recent research evidence on fluoridation cessation and tooth decay in the city of Calgary. I sought to gain insights into fluoridation specifically and public health initiatives more generally. Methods: I undertook a critical qualitative study, informed by theories of risk perception and trust in authority figures and the scientific community. Four health professionals were purposively recruited to participate in one-on-one interviews based on their self-identified opposition to CWF. Participants were asked to discuss their views on CWF and public health research in general, with a focus on publications from a study of the short-term implications for children’s dental caries of terminating CWF in Calgary in 2011. To supplement interview responses, I analyzed online comments pertaining to the Calgary fluoridation cessation study. Results: Overall, I observed three prominent and overlapping themes: (1) Fluoridation research criticisms, which describes criticisms and negative comments from interviewees and online commenters about the Calgary fluoridation study specifically, and fluoridation research in general. (2) Selective Mistrust expressed by interviewees and online commenters toward the Calgary fluoridation cessation study, health research, and researchers, and (3) the Individualization of health, wherein interviewees and online commenters were skeptical toward health and government authority figures and their ability to make appropriate health decisions for the public, which led to the perception that the responsibility for oral health lies with the individual. Conclusions: With the publication of local research on fluoridation cessation, this study provided a ‘real time’ opportunity to gain a contemporary, nuanced understanding of what characterizes fluoridation opposition among some health professionals and members of the public.
- ItemOpen AccessScaling Up [to] a Population Health Intervention: A Readiness Assessment Framework(2016) Nguyen, Duyen Thi Kim; McIntyre, Lynn; McLaren, Lindsay; Emery, Herb; Oelke, NellyBackground: Attempts to scale up a population health intervention (PHI) have achieved variable success, which, in part, is attributable to limited knowledge of scale up and lack of systematic guidance to support successful scale up. The concept of readiness is underrepresented in scale up and its consideration may improve the likelihood of success. Objective: To develop and assess a conceptual framework focused on the successful scale up of a PHI, which may be employed to gauge a PHI’s readiness for scale up success. Theoretical framework: This study integrated diffusion of innovations, organizational readiness for change, and complex adaptive systems theories. Methods and Results: The Scale Up Readiness Assessment Framework was developed and refined through a primarily qualitative methods design with three complementary studies, which were informed by the theoretical and empirical literature. Study one used a critical interpretive synthesis of the literature to develop the Framework. The synthesis identified 11 important actions in the successful scale up of a PHI, which were organized into three phases: Groundwork, Implementation, and Sustainment. Key components and hallmarks of a successful scale up approach were also determined. Study two used a modified Delphi method to assess content and face validity of the Framework’s actions and phases. A panel of PHI and scale up experts agreed all phases and actions were important; the Groundwork phase and six actions were representative of a successful scale up; and all were logically presented. Experts’ assessments guided the Framework’s second version. Study three involved pilot tests with potential users of the Framework (version 2.0), who commented how the Framework’s utility, value, and face validity might apply to their PHI. Participants concluded the Framework was informative, offered valuable guidance, and may serve multiple purposes beyond readiness assessment. Pilot feedback led to a final Framework revision (version 3.0). Conclusion: This research provides important conceptual advancements and insights regarding the practice of successful scale up. The research produced a usable product, the Framework, which may be used by academic and government PHI stakeholders for scale up readiness assessment and planning. Learnings from this framework have potentially diverse applications beyond its initial intended purpose.
- ItemOpen AccessSocioeconomic 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, LindsayBackground: 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.
- ItemOpen AccessSweating it out: exercise, quality of life, and the perimenopause experience for women in Calgary(2009) Stocker, Nancy Lee; McLaren, Lindsay