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Cook EE. Anthropological and sociological perspectives on food allergy. Clin Exp Allergy 2023; 53:989-1003. [PMID: 37649424 DOI: 10.1111/cea.14387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 08/17/2023] [Accepted: 08/19/2023] [Indexed: 09/01/2023]
Abstract
This review explores the anthropological and sociological literature on food allergy and identifies four primary areas of research to date. The first explores the relationality and management of risk, uncertainty and stigma among parents and sufferers of food allergies. The second analyses the influence of intersectionality, specifically the effects of class, gender, race/ethnicity and disability on experiences of food allergy. The third discusses diagnostic difficulties and the impact these have on legitimacy and believability, both in the context of clinician-patient relations and in managing food allergies in public spaces. The fourth explores the ethics and uncertainties in food allergy treatments and how scientific knowledge of emerging treatments is constructed. This body of research illustrates that although an individual disease, food allergy experiences are significantly affected by socio-cultural structures, institutions, ideologies and discourses. The review concludes with four primary recommendations. First, there should be more incorporation of anthropological or sociological methodologies and perspectives into studies of food allergy. Second, studies are needed from more countries exploring lived experience of food allergy. Third, research on food allergy needs to incorporate an analysis of intersectional factors such as gender, class and race/ethnicity, and should explore the experiences of minority populations. Fourth, more research is needed on the interactions between biomedicine and local systems of knowledge, as well as the factors that shape what treatments become available, for whom it becomes available, experiences of treatment and aspects (including biases) that influence patient-clinician interactions.
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Affiliation(s)
- Emma E Cook
- Modern Japanese Studies, Hokkaido University, Sapporo, Japan
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Smith M. Historical and social science perspectives on food allergy. Clin Exp Allergy 2023; 53:902-910. [PMID: 37309241 PMCID: PMC10946501 DOI: 10.1111/cea.14360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 04/20/2023] [Accepted: 05/17/2023] [Indexed: 06/14/2023]
Abstract
This article provides an overview of the insights social scientists, historians and other health humanities scholars have made to our understanding of food allergies. It shows how humanities and social science scholars have tended to address three pivotal issues related to food allergies: first, they have addressed the epidemiology of food allergies, including the apparent rise in the rate of food allergies and the emergence of theories that purport to explain why food allergies may be increasing. These include theories related to changes in food consumption and the hygiene hypothesis. Second, humanities and social science scholars have researched how risks related to food allergies have been constructed, understood, experienced and mitigated. Third, humanities and social science scholars have investigated the experiences of food allergy sufferers and those who care for them, providing valuable qualitative insights that can inform how we respond to food allergy and our understanding of the aetiology of food allergy. The article concludes with three recommendations. First, there should be a more interdisciplinary approach to food allergy research that involves social scientists and health humanities scholars. Second, humanities and social sciences scholars should be more willing to unpack and scrutinise the theories put forward to explain the aetiology of food allergies, rather than accepting them at face value. And finally, humanities and social sciences scholars can play a major role in ensuring that the experiences of patients and their carers are articulated and fed into debates about food allergy, including its causes and how to respond to it.
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Sedney C, Cowher A, Turiano NA, Cox S, Dekeseredy P, Haggerty T. Understanding the Intersectional Relationship of Pain Stigma, Weight Bias Internalization, and Clinical Indicators in a Rural Population with Back Pain: A Survey-Based Study. World Neurosurg 2023; 171:e846-e851. [PMID: 36603648 DOI: 10.1016/j.wneu.2022.12.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 12/28/2022] [Accepted: 12/29/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND Stigma is understood to be intersectional, meaning multiple characteristics can be stigmatizing, and they may be both overlapping and coconstitutive. Chronic pain and overweight are common complaints in the spinal surgery clinic. Since being overweight may relate to back pain in a complex fashion, we sought to understand if there is a moderating effect between weight bias and pain stigma. METHODS This study involves a survey-based, quantitative, cross-sectional, observational design using previously validated measures and demographic and clinical information. There were 192 participants. Statistical calculations were done with statistical package for the social sciences. RESULTS Pain stigma was not significantly correlated with BMI (body mass index), and weight bias was not significantly correlated with back pain. There was a strong positive correlation between weight bias and pain stigma. There was a strong positive correlation between weight bias and BMI when pain stigma was also high. CONCLUSIONS Given the relationship between weight stigma and pain, the intersection of weight and pain stigma is important because it indicates the vulnerability of patients with higher BMI to other forms of stigma, such as stigma for their pain complaints. Clinicians should be mindful of expressing pain stigma more significantly amongst patients with higher BMI.
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Affiliation(s)
- Cara Sedney
- Department of Neurosurgery, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, West Virginia, USA.
| | - Abigail Cowher
- School of Medicine, West Virginia University, Morgantown, West Virginia, USA
| | - Nicholas A Turiano
- Department of Psychology, West Virginia University, Morgantown, West Virginia, USA
| | - Stephanie Cox
- Behavioral Medicine & Psychiatry, West Virginia University, Morgantown, West Virginia, USA
| | - Patricia Dekeseredy
- Department of Neurosurgery, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, West Virginia, USA
| | - Treah Haggerty
- Department of Family Medicine, West Virginia University, Morgantown, West Virginia, USA
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Memauri TD, Golding MA, Gerdts JD, Simons E, Abrams EM, Elliott SJ, Roos LE, Kim H, Protudjer JL. The perceived impact of pediatric food allergy on mental health care needs and supports: A pilot study. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. GLOBAL 2022; 1:67-72. [PMID: 37780589 PMCID: PMC10509884 DOI: 10.1016/j.jacig.2022.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 01/14/2022] [Accepted: 01/21/2022] [Indexed: 10/03/2023]
Abstract
Background Evidence suggests a mental health impact of food allergy on affected children and their families; however, little is known about health care professionals' understanding of these impacts and the resources available to patients and their families. Objective Our aim was to conduct a pilot study examining health care professionals' perceptions of the psychosocial and financial burden of food allergy to identify gaps in education and resources and thus better support families with food allergy moving forward. Methods Between February 20 and November 19, 2020, we conducted audiorecorded interviews (n = 6) and profession-specific focus groups (n = 2 [representing 7 individuals]). The participants included pediatric allergists, allergy nurse educators, and clinical dietitians who were directly involved in pediatric food allergy care. The interviews were recorded and transcribed verbatim. Thematic analysis was subsequently applied to identify the main themes. Results Our study consisted of an interdisciplinary group of Manitoban health care providers (N = 13) who were directly involved with pediatric food allergy care. We identified 3 main themes from these interviews: anxiety among families with food allergy, which is a common comorbidity; limited resources available within current public infrastructure; and empowerment through education. These themes describe issues surrounding access to information and resources and how this can affect anxiety and parenting styles among families with food allergy. Conclusions Health care professionals perceive that many families experience anxiety as a result of their child's food allergy. They further advocate that access to information and suitability of public resources be considered when planning for related programs.
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Affiliation(s)
- Tessa D. Memauri
- Children’s Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
- Department of Food and Human Nutritional Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Michael A. Golding
- Children’s Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
- University of Western Ontario, London, Ontario, Canada
| | - Jennifer D. Gerdts
- Section of Allergy and Immunology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Elinor Simons
- Children’s Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
- University of Western Ontario, London, Ontario, Canada
| | - Elissa M. Abrams
- Children’s Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
- University of Western Ontario, London, Ontario, Canada
| | - Susan J. Elliott
- Department of Psychology, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Harold Kim
- University of Waterloo, Waterloo, Ontario, Canada
| | - Jennifer L.P. Protudjer
- Children’s Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
- Department of Food and Human Nutritional Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- University of Western Ontario, London, Ontario, Canada
- George and Fay Yee Centre for Healthcare Innovation, Winnipeg, Manitoba, Canada
- Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden
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Fong AT, Ahlstedt S, Golding MA, Protudjer JLP. The Economic Burden of Food Allergy: What We Know and What We Need to Learn. CURRENT TREATMENT OPTIONS IN ALLERGY 2022; 9:169-186. [PMID: 35502316 PMCID: PMC9046535 DOI: 10.1007/s40521-022-00306-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2022] [Indexed: 02/04/2023]
Abstract
Purpose of Review Food allergy management and treatment require dietary modification, are associated with significant burdens, and affect food choices and behaviours. Emerging therapies, such as oral immunotherapy (OIT), provide a glimmer of hope for those living with the condition. Some burdens have received substantial focus, whereas many knowledge gaps on the significance of other impacts, including economic burden, remain. Recent Findings Evidence from many countries, but disproportionately from the United States, supports that food allergy carries significant healthcare and societal costs. Early introduction for the prevention of food allergies is theoretically cost-effective, but remains largely undescribed. Unique considerations, such as those to cow’s milk protein allergy, which affects a substantial proportion of infants, and adrenaline autoinjectors, which have a high cost-per-use, require a balance between cost-effectiveness to the healthcare system and adverse outcomes. Household costs have largely been explored in two countries, but owing to different healthcare structures and costs of living, comparisons are difficult, as are generalisations to other countries. Stock epinephrine in schools may present a cost-effective strategy, particularly in economically disadvantaged areas. Costs relating to OIT must be examined within both immediate benefits, such as protection from anaphylaxis, and long-term benefits, such as sustained unresponsiveness. Summary Although the absolute costs differ by region/country and type of food allergy, a consistent pattern persists: food allergy is a costly condition, to those who live with it, and the multiple stakeholders with which they interact. Supplementary Information The online version contains supplementary material available at 10.1007/s40521-022-00306-5.
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Affiliation(s)
| | - Staffan Ahlstedt
- Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden
| | - Michael A. Golding
- The Children’s Hospital Research Institute of Manitoba, 501G-715 McDermot Avenue, Winnipeg, MB R3E 3P4 Canada
- Department of Pediatrics and Child Health, The University of Manitoba, 501G-715 McDermot Avenue, Winnipeg, MB R3E 3P4 Canada
| | - Jennifer L. P. Protudjer
- Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden
- The Children’s Hospital Research Institute of Manitoba, 501G-715 McDermot Avenue, Winnipeg, MB R3E 3P4 Canada
- Department of Pediatrics and Child Health, The University of Manitoba, 501G-715 McDermot Avenue, Winnipeg, MB R3E 3P4 Canada
- George and Fay Yee Centre for Healthcare Innovation, 501G-715 McDermot Avenue, Winnipeg, MB R3E 3P4 Canada
- Food and Human Nutritional Sciences, The University of Manitoba, 501G-715 McDermot Avenue, Winnipeg, MB R3E 3P4 Canada
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Golding MA, Gunnarsson NV, Middelveld R, Ahlstedt S, Protudjer JLP. A scoping review of the caregiver burden of pediatric food allergy. Ann Allergy Asthma Immunol 2021; 127:536-547.e3. [PMID: 33971359 DOI: 10.1016/j.anai.2021.04.034] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 04/26/2021] [Accepted: 04/28/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Although a number of articles have described the psychosocial impact of raising a child with a food allergy, recent attempts at synthesizing this literature have been narrow in focus or methodologically limited. Consequently, this study aimed to synthesize both the quantitative and qualitative literature to achieve a better understanding of the psychosocial and financial burdens faced by families who raise children with food allergy. DATA SOURCES Searches were performed on PubMed, Scopus, PsycInfo, and Cumulative Index to Nursing and Allied Health Literature databases for articles related to the psychosocial and financial burden experienced by individuals who care for a child with food allergy. STUDY SELECTIONS English language, original research articles were included in this review. RESULTS A total of 54 articles were deemed eligible for review. Results from the quantitative literature revealed that parents of children with food allergy (ie, food allergy and food protein-induced enterocolitis, proctocolitis, and enteropathy) consistently reported lower quality of life than their comparison groups. Within-group analyses suggest that this burden is increased for parents who manage multiple food allergies, severe food allergy, and comorbid allergic conditions. Thematic synthesis of the qualitative literature suggests that the psychosocial burden shouldered by parents of children with food allergy stems, in part, from the unpredictable threat of exposure and the practical and social burdens of managing a food allergy. In addition to psychosocial burdens, a small but growing body of literature suggests that families with food allergy also incur greater financial costs. CONCLUSION Findings suggest that pediatric food allergy imposes considerable burdens on parents both quantitatively and qualitatively.
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Affiliation(s)
- Michael A Golding
- Children's Hospital Research Institute of Manitoba, Winnipeg, Canada; Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada
| | - Nina V Gunnarsson
- Department of Social Work, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Roelinde Middelveld
- Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden; Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Staffan Ahlstedt
- Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden; Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Jennifer L P Protudjer
- Children's Hospital Research Institute of Manitoba, Winnipeg, Canada; Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada; Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden; George and Fay Yee Centre for Healthcare Innovation, Winnipeg, Canada; Department of Food and Human Nutritional Sciences, University of Manitoba, Winnipeg, Canada.
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Golding MA, Simons E, Abrams EM, Gerdts J, Protudjer JLP. The excess costs of childhood food allergy on Canadian families: a cross-sectional study. Allergy Asthma Clin Immunol 2021; 17:28. [PMID: 33691771 PMCID: PMC7943937 DOI: 10.1186/s13223-021-00530-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 02/19/2021] [Indexed: 12/21/2022] Open
Abstract
Background The impact of childhood food allergy on household costs has not been examined in Canada. The current study sought to examine differences in direct, indirect, and intangible costs among Canadian families with and without a food-allergic child. Methods Families with a child with a specialist-diagnosed food allergy (cases) were recruited from two tertiary pediatric allergy clinics in the Province of Manitoba, Canada, and matched, based on age and sex, to families without a food-allergic child (controls). Cost data for the two groups were collected via an adapted version of the Food Allergy Economic Questionnaire (FA-EcoQ). Consideration was given to income, defined as above vs. below the provincial annual median income. Results Results from 35 matched case/control pairs revealed that while total household costs did not significantly differ between cases and controls, food-allergic families did incur higher direct costs ($12,455.69 vs. $10,078.93, p = 0.02), which were largely attributed to spending on food. In contrast, cases reported lower, but not statistically significant, total indirect costs compared to controls ($10,038.76 vs. $12,294.12, p = 0.06). Families also perceived their food-allergic child as having poorer quality of life relative to their healthy peers. Lastly, stratification of the analyses by annual income revealed several differences between the higher and lower income groups. Conclusions Relative to families without a food-allergic child, food-allergic families incurred higher direct costs across a number of different areas. Supplementary Information The online version contains supplementary material available at 10.1186/s13223-021-00530-9.
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Affiliation(s)
- Michael A Golding
- The Children's Hospital Research Institute of Manitoba, 501G-715 McDermot Avenue, Winnipeg, MB, R3M 3P4, Canada.,Department of Pediatrics and Child Health, The University of Manitoba, Winnipeg, MB, Canada
| | - Elinor Simons
- The Children's Hospital Research Institute of Manitoba, 501G-715 McDermot Avenue, Winnipeg, MB, R3M 3P4, Canada.,Department of Pediatrics and Child Health, The University of Manitoba, Winnipeg, MB, Canada
| | - Elissa M Abrams
- The Children's Hospital Research Institute of Manitoba, 501G-715 McDermot Avenue, Winnipeg, MB, R3M 3P4, Canada.,Department of Pediatrics and Child Health, The University of Manitoba, Winnipeg, MB, Canada.,Division of Allergy & Immunology, Department of Pediatrics, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | | | - Jennifer L P Protudjer
- The Children's Hospital Research Institute of Manitoba, 501G-715 McDermot Avenue, Winnipeg, MB, R3M 3P4, Canada. .,Department of Pediatrics and Child Health, The University of Manitoba, Winnipeg, MB, Canada. .,George and Fay Yee Centre for Healthcare Innovation, Winnipeg, MB, Canada. .,Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden. .,Food and Human Nutritional Sciences, The University of Manitoba, Winnipeg, MB, Canada.
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Atiim GA, Elliott SJ. The Global Epidemiologic Transition: Noncommunicable Diseases and Emerging Health Risk of Allergic Disease in Sub-Saharan Africa. HEALTH EDUCATION & BEHAVIOR 2017; 43:37S-55S. [PMID: 27037146 DOI: 10.1177/1090198115606918] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Globally, there has been a shift in the causes of illness and death from infectious diseases to noncommunicable diseases. This changing pattern has been attributed to the effects of an (ongoing) epidemiologic transition. Although researchers have applied epidemiologic transition theory to questions of global health, there have been relatively few studies exploring its relevance especially in the context of emerging allergic disorders in sub-Saharan Africa (SSA). In this article, we address the growing burden of noncommunicable diseases in sub-Saharan Africa through the lens of epidemiologic transition theory. After a brief review of the literature on the evolution of the epidemiologic transition with a particular emphasis on sub-Saharan Africa, we discuss existing frameworks designed to help inform our understanding of changing health trends in the developing world. We subsequently propose a framework that privileges "place" as a key construct informing our understanding. In so doing, we use the example of allergic disease, one of the fastest growing chronic conditions in most parts of the world.
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Affiliation(s)
- George A Atiim
- Department of Geography and Environmental Management, University of Waterloo, Waterloo, Ontario, Canada
| | - Susan J Elliott
- Department of Geography and Environmental Management, University of Waterloo, Waterloo, Ontario, Canada
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Majowicz SE, Meyer SB, Kirkpatrick SI, Graham JL, Shaikh A, Elliott SJ, Minaker LM, Scott S, Laird B. Food, health, and complexity: towards a conceptual understanding to guide collaborative public health action. BMC Public Health 2016; 16:487. [PMID: 27277001 PMCID: PMC4898364 DOI: 10.1186/s12889-016-3142-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 05/14/2016] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND What we eat simultaneously impacts our exposure to pathogens, allergens, and contaminants, our nutritional status and body composition, our risks for and the progression of chronic diseases, and other outcomes. Furthermore, what we eat is influenced by a complex web of drivers, including culture, politics, economics, and our built and natural environments. To date, public health initiatives aimed at improving food-related population health outcomes have primarily been developed within 'practice silos', and the potential for complex interactions among such initiatives is not well understood. Therefore, our objective was to develop a conceptual model depicting how infectious foodborne illness, food insecurity, dietary contaminants, obesity, and food allergy can be linked via shared drivers, to illustrate potential complex interactions and support future collaboration across public health practice silos. METHODS We developed the conceptual model by first conducting a systematic literature search to identify review articles containing schematics that depicted relationships between drivers and the issues of interest. Next, we synthesized drivers into a common model using a modified thematic synthesis approach that combined an inductive thematic analysis and mapping to synthesize findings. RESULTS The literature search yielded 83 relevant references containing 101 schematics. The conceptual model contained 49 shared drivers and 227 interconnections. Each of the five issues was connected to all others. Obesity and food insecurity shared the most drivers (n = 28). Obesity shared several drivers with food allergy (n = 11), infectious foodborne illness (n = 7), and dietary contamination (n = 6). Food insecurity shared several drivers with infectious foodborne illness (n = 9) and dietary contamination (n = 9). Infectious foodborne illness shared drivers with dietary contamination (n = 8). Fewer drivers were shared between food allergy and: food insecurity (n = 4); infectious foodborne illness (n = 2); and dietary contamination (n = 1). CONCLUSIONS Our model explicates potential interrelationships between five population health issues for which public health interventions have historically been siloed, suggesting that interventions targeted towards these issues have the potential to interact and produce unexpected consequences. Public health practitioners working in infectious foodborne illness, food insecurity, dietary contaminants, obesity, and food allergy should actively consider how their seemingly targeted public health actions may produce unintended positive or negative population health impacts.
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Affiliation(s)
- Shannon E Majowicz
- School of Public Health and Health Systems, University of Waterloo, 200 University Ave. West, Waterloo, N2L 3G1, ON, Canada.
| | - Samantha B Meyer
- School of Public Health and Health Systems, University of Waterloo, 200 University Ave. West, Waterloo, N2L 3G1, ON, Canada
| | - Sharon I Kirkpatrick
- School of Public Health and Health Systems, University of Waterloo, 200 University Ave. West, Waterloo, N2L 3G1, ON, Canada
| | - Julianne L Graham
- School of Public Health and Health Systems, University of Waterloo, 200 University Ave. West, Waterloo, N2L 3G1, ON, Canada
| | - Arshi Shaikh
- Social Development Studies, Renison University College-University of Waterloo, 240 Westmount Road North, Waterloo, N2L 3G4, ON, Canada
| | - Susan J Elliott
- School of Public Health and Health Systems, University of Waterloo, 200 University Ave. West, Waterloo, N2L 3G1, ON, Canada
- Department of Geography & Environmental Management, University of Waterloo, 200 University Ave. West, Waterloo, N2L 3G1, ON, Canada
| | - Leia M Minaker
- Propel Centre for Population Health Impact, University of Waterloo, 200 University Ave. West, Waterloo, N2L 3G1, ON, Canada
| | - Steffanie Scott
- Department of Geography & Environmental Management, University of Waterloo, 200 University Ave. West, Waterloo, N2L 3G1, ON, Canada
| | - Brian Laird
- School of Public Health and Health Systems, University of Waterloo, 200 University Ave. West, Waterloo, N2L 3G1, ON, Canada
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