Browsing by Author "Olstad, Dana Lee"

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    A Qualitative Descriptive Exploration of the Determinants of Subjective Social Status and the Pathways Through Which Subjective Social Status Shapes Health and Well-Being
    (2024-03-26) Naser, Aruba; Olstad, Dana Lee; Tang, Karen; McClain, Amanda
    Abstract Introduction: Socioeconomic position (SEP) is traditionally measured using objective indicators (i.e. income, occupation, education) which may not capture the many pathways through which health inequities are generated. The MacArthur Scale of Subjective Social Status (SSS) is a subjective measure of SEP thought to reflect individuals’ perceptions of their social position, with high predictive utility for health. Despite the scale’s utility, there is limited research investigating the factors and reference groups that shape SSS. The mechanisms through which SSS shapes health also remain unclear, with literature suggesting both materialistic and psychosocial explanations. Objectives: Our study explored the factors and reference groups that working-aged adults consider when evaluating their SSS, and the pathways through which they perceive these factors shape their health and well-being. Methods: Our study employed qualitative descriptive methodology. We recruited 25 adults living in Alberta, aged 30-50, to participate in think-aloud style, semi-structured interviews. Data was analyzed using a semi-deductive, directed content analysis approach. Results: Four major themes summarized participants’ experiences: 1) The significance of reference groups in shaping SSS; 2) The big 3 determinants of SSS - Income, occupation, education; 3) Unique circumstances lead to unique conceptualizations of SSS; and 4) SSS affects mental wellbeing Conclusions: The primary determinants of SSS in working-aged adults in Canada are income, occupation and education. Additional determinants include gender, health and disability, and racial identity. Reference groups also significantly shaped SSS and differed across individuals. Study findings demonstrated that SSS shaped mental well-being through both materialist and psychosocial pathways, which suggests that researchers and policymakers must act upon structural SDH, especially income, education, and occupation, as well as upon the psychosocial stress resulting from social comparisons to reduce inequities in health.
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    A Systematic Review and Theoretical Economic Analysis of the Impacts of Providing Material Benefits to Improve Food Access in People with Diabetes
    (2023-07-21) Steer, Kieran James Daniel; Spackman, Eldon; Olstad, Dana Lee; Beall, Reed Francis; Campbell, David John Thomas
    Background: Providing material benefits to increase access to healthy food (e.g., food coupons/vouchers, free food, or financial subsidies/incentives) for people with diabetes may be an effective healthcare intervention to improve food insecurity, dietary patterns, clinical parameters, and ultimately health outcomes. There are several studies that have investigated the impact of providing material benefits to improve food access among people with diabetes. There is also interest in Alberta, Canada in potentially implementing a healthy food prescription incentive for people with type 2 diabetes mellitus (T2DM) and food insecurity, which is being investigated in the “Food Rx” trial (NCT04725630). However, there has not been a systematic review or cost-effectiveness analysis on the impacts of providing material benefits to improve food access among people with diabetes. Thesis studies: a systematic review on the impacts of providing material benefits to improve food access on food insecurity, dietary patterns, and clinical parameters in people with diabetes; and a theoretical economic analysis to determine the minimum A1C improvement required for the Food Rx intervention to be cost-effective from the third-party healthcare payer perspective. Results: The systematic review showed that providing material benefits to improve food access for people with diabetes may improve household food insecurity, fruit and vegetable intake, and overall diet quality but is less likely to change clinical parameters and whole grain intake. The evidence from randomized controlled trials was limited to only six studies at high risk of bias, most commonly due to unblinded subjective outcomes measurement and high participant attrition. The economic threshold analysis showed that providing a healthy food prescription incentive to people with T2DM and food insecurity was unlikely to be cost-effective at $50,000/QALY, when projecting health outcomes from improvements in A1C and diabetes-related clinical parameters. Conclusion: The evidence of clinical effectiveness from providing material benefits to improve food access among people with T2DM is highly uncertain, and a healthy food prescription incentive for people with T2DM and food insecurity in Alberta has a low likelihood of cost-effectiveness, when measuring outcomes from improvements in diabetes-related clinical parameters
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    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.
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    Associations between Neighbourhood Built Environment and Leisure and Transportation Physical Activity among Canadian-Born Residents and Recent and Established Immigrants in Canada
    (2024-10-22) Masihay Akbar, Hasti; McCormack, Gavin Robert; Turin, Tanvir Chowdhury; Olstad, Dana Lee
    Despite well-established health benefits, nearly half of adults in Canada do not engage in enough physical activity for optimal health benefits. In Canada there are differences in physical activity levels among immigrants and non-immigrants. The built environment has the potential to reduce or widen inequalities if its effects on physical activity differ among population subgroups. While evidence has highlighted potential differences in how the built environment is associated with physical activity across various population subgroups, some equity-seeking groups, such as immigrants, have received little research attention. Globally, most studies examining this association among immigrants have been conducted in the U.S., with inconsistent findings. The study presented in this thesis addresses these knowledge gaps, guided by two relevant theoretical perspectives, including the socioecological model and acculturation theory. The aim of this research was to generate novel evidence regarding the associations between the neighbourhood built environment, specifically objectively-measured walkability, and physical activity according to residency status (Canadian-born, recent immigrants, and established immigrants). Our objectives were 1) to estimate and compare TPA and LPA participation and duration between Canadian-born, recent and established immigrant adults and determine whether neighbourhood walkability accounts for any observed residency group differences, and 2) to estimate and compare the direction and magnitude of associations between neighbourhood walkability and TPA and LPA participation and duration between these groups. The study included cross-sectional analysis of nationally representative data from Canadian Community Health survey (CCHS 2017-2018) linked with 2016 Can-ALE data. We found that recent and established immigrants were more likely than Canadian-born to participate in TPA, but these differences attenuated after controlling for walkability. Moreover, recent and established immigrants were less likely to participate in LPA and undertook fewer LPA minutes, compared to Canadian-born individuals. However, the differences in LPA minutes attenuated after controlling for walkability. Walkability was positively associated with TPA participation and duration in all residency status groups, but the magnitude of these associations differed between these groups. Findings from this thesis suggest that improving neighbourhood walkability could have broad public health benefits, but tailored strategies are essential to address the needs of immigrant populations.
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    Experiences and Perceived Outcomes of Low-Income Adults During and After Participating in the British Columbia Farmers' Market Nutrition Coupon Program: A Longitudinal Qualitative Study
    (Elsevier, 2022-03-28) Caron-Roy, Stéphanie; Lee, Yun Yun; Sayed, Sayeeda Amber; Lashewicz, Bonnie; Milaney, Katrina; Dunn, Sharlette; O'Hara, Heather; Leblanc, Peter; Prowse, Rachel J L; Fournier, Bonnie; Raine, Kim D; Elliott, Charlene; Olstad, Dana Lee
    The British Columbia Farmers' Market Nutrition Coupon Program (FMNCP) is a farmers' market food subsidy program that provides low-income households with coupons valued at $21/wk for 16 weeks to purchase healthy foods at participating BC Association of Farmers' Markets members' markets.
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    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.
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    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.
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    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.
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    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.
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    The British Columbia Farmers' Market Nutrition Coupon Program reduces short-term household food insecurity among adults with low incomes: a pragmatic randomized controlled trial.
    (ELSEVIER, 2023-10-06T06:00:00Z) Aktary, Michelle L; Dunn, Sharlette; Sajobi, Tolulope; O'Hara, Heather; Leblanc, Peter; McCormack, Gavin R; Caron-Roy, Stephanie; Lee, Yun Yun; Reimer, Raylene A; Minaker, Leia M; Raine, Kim D; Godley, Jenny; Downs, Shauna; Nykiforuk, Candace I J; Olstad, Dana Lee
    The British Columbia Farmers' Market Nutrition Coupon Program (BC FMNCP) provides households with low incomes with coupons to purchase healthy foods from farmers' markets.
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    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.
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    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.