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Title: Gender, diet quality and obesity : economic and social determinants, and their interactions, in older adults
Author: Conklin, Annalijn Ida
ISNI:       0000 0004 6057 7450
Awarding Body: University of Cambridge
Current Institution: University of Cambridge
Date of Award: 2014
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Public health still needs to better understand how older people’s life circumstances influence key risk factors for chronic disease, and also how women and men differ in their exposures and outcomes. This dissertation aimed to examine, separately for women and men, the role and inter-relationships of factors describing the economic and social contexts in relation to healthful eating and adiposity. A systematic review of economic determinants of diet in the elderly indicated that longitudinal evidence remains limited and focused on employment-related changes affecting diet. Thus, novel economic variables concerning financial hardship (FH) were examined in over-50s from the population-based EPIC-Norfolk cohort for associations with quantity and variety of fruit and vegetable intake, as proxies for healthful eating. FH was inversely associated with variety, more than quantity, independent of socioeconomic status (SES). Given the importance of social contexts for diet, it was notable that three aspects of structural social relationships were each associated with variety differently for women and men and, when combined, differed across categories of a second social tie. The next study of EPIC data investigated inter-relations between multiple economic variables, including FH, and social ties, demonstrating a magnification of unit differences in variety when economic and social disadvantage occurred simultaneously. Obesity is another chronic disease risk factor with known social gradients; thus a fourth study in EPIC examined associations of FH and SES with objectively measured obesity. All three FH measures were independently associated with general and central obesity, with the strongest relationships between greatest level of difficulty paying bills and central obesity in women, and general obesity in men. Finally, a longitudinal study of civil servants (Whitehall II) showed a strong association of persistent FH with 11-year adjusted mean weight change, and excess gain, in women only, which was not explained by any of the six potential mechanisms examined in mediation analyses. In sum, everyday financial troubles constituted a unique economic influence on diet quality and obesity in older adults, and the influence of a given economic or social factor on diet quality was modified when another social factor was also considered. Unique aspects of economic or social circumstances, and their different combinations, must be considered separately in future public health research and practice as each reflects a distinct process of social differentiation and hence adds to our understanding of contextual influences on chronic disease risk factors.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral