Stress-Related Poor Diet Quality Does Not Explain Socioeconomic Inequities in Health: A Structural Equation Mediation Analysis of Gender-Specific Pathways.

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Publisher: Elsevier Science Publishers
Document Type: Report
Length: 744 words

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Keywords Health inequities; Materialist perspective; Psychosocial perspective; Psychosocial stress; Diet quality Abstract Background 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. Author Affiliation: (1) Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada (2) School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada (3) Université Laval École de Nutrition, Centre Nutrition, Santé et Société (Centre NUTRISS), Québec, Québec, Canada (4) Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia (5) Department of Medicine, Department of Community Health Sciences, Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary Foothills Medical Centre, Calgary, Alberta, Canada (6) School of Planning, Faculty of Environment, University of Waterloo, Waterloo, Ontario, Canada * Address correspondence to: Dana Lee Olstad, PhD, RD, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Teaching, Research, and Wellness Building, 3280 Hospital Dr, NW, Calgary, AB T2N 4Z6 Canada. Article History: Received 16 March 2021; Accepted 30 September 2021 (footnote) Supplementary materials: is available at www.jandonline.org(http://www.jandonline.org) (footnote) STATEMENT OF POTENTIAL CONFLICT OF INTEREST K. M. Livingstone reports personal fees from HeadUp Labs outside the submitted work. No potential conflict of interest was reported by the other authors. (footnote) FUNDING/SUPPORT The International Food Policy Study was funded by the Canadian Institutes of Health Research (PJT-162167). The current analysis was funded by a Canadian Institutes of Health Research Operating Grant (FRN 156728). D. L. Olstad has received financial support from a Petro-Canada Young Innovator Award in Community Health. S. Nejatinamini was supported by a Libin Cardiovascular Research Institute of Alberta / Cumming School of Medicine Postdoctoral Award. K. M. Livingstone was supported by a National Health and Medical Research Council Emerging Leadership Fellowship (APP1173803). The study funders had no role in designing the study, in the collection, analysis or interpretation of the data, in the writing of the article, or in the decision to submit it for publication. (footnote) AUTHOR CONTRIBUTIONS D. L. Olstad conceived of and designed the analyses and wrote the manuscript. S. Nejatinamini performed the analyses and created the tables and figures. S. I. Kirkpatrick, L. Vanderlee, and D. Hammond designed the International Food Policy Study and collected the data. All authors contributed to study conception and design; data interpretation; and read, edited, and approved the final manuscript. (footnote)* Certified in Canada. Byline: Dana Lee Olstad, PhD, RD [dana.olstad@ucalgary.ca] (1,*,*), Sara Nejatinamini, PhD (1), Sharon I. Kirkpatrick, PhD RD (2,*), Lana Vanderlee, PhD (3), Katherine M. Livingstone, PhD (4), David J.T. Campbell, PhD, MD, FRCPC (5), Karen Tang, MSc, MD, FRCPC (1), Leia M. Minaker, PhD (6), David Hammond, PhD (2)

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Gale Document Number: GALE|A694141999