Political Orientation and Public Attributions for the Causes and Solutions of Physical Inactivity in Canada: Implications for Policy Support

Association of the newly proposed dietary index for gut microbiota and depression: the mediation effect of phenotypic age and body mass index

BACKGROUND

Gut microbiota and depression have garnered attention. The dietary index for gut microbiota (DI-GM) is a newly proposed index that reflects the diversity of gut microbiota, yet its association with depression remains unstudied.

METHODS

Data from the National Health and Nutrition Examination Survey were analyzed. Depression was assessed using Patient Health Questionnaire (PHQ-9). Dietary recall data were used to calculate the DI-GM (including components beneficial and unfavorable to gut microbiota). Multivariable weighted logistic and linear regression were employed to investigate the association of DI-GM with depression and total PHQ-9 score. The potential mediating role of phenotypic age and body mass index (BMI) was explored. Secondary analyses included subgroup analyses, restricted cubic spline (RCS), and multiple imputation.

RESULTS

A higher DI-GM and beneficial gut microbiota score were associated with a lower prevalence of depression (DI-GM: OR = 0.94, 95% CI = 0.89, 0.99; beneficial gut microbiota score: OR = 0.88, 95% CI = 0.82, 0.94) and lower total PHQ-9 score (DI-GM: β=-0.09, 95% CI=-0.14, -0.04; beneficial gut microbiota: β=-0.15, 95% CI=-0.21, -0.08). RCS indicated a non-linear relationship between DI-GM and depression. A significant mediating effect of phenotypic age (proportion of mediation: 19.81%, 95% CI: 12.86-63.00%) and BMI (proportion of mediation: 16.49%, 95% CI: 12.87-62.00%) was observed.

CONCLUSIONS

The newly proposed DI-GM was negatively associated with the prevalence of depression and total PHQ-9 score. Mediation analyses demonstrated a significant mediating effect of phenotypic age and BMI.

Dietary inflammatory index and all-cause mortality in adults with COPD: a prospective cohort study from the NHANES 1999-2018

Background

Chronic inflammation is closely linked to Chronic Obstructive Pulmonary Disease (COPD); however, the impact of the Dietaryq Inflammatory Index (DII) on mortality among COPD patients remains uncertain.

Objective

To assess the correlation between the DII and all-cause mortality in COPD patients using data from the National Health and Nutrition Examination Survey (NHANES).

Methods

We conducted a retrospective cohort study on 1,820 COPD patients from the NHANES dataset (1999-2018). The influence of DII on mortality was evaluated using multivariate Cox regression, smoothing spline fitting, and threshold effect analysis. Additionally, Kaplan-Meier survival analysis was performed to compare survival curves among different DII groups. Subgroup analyses and E-values identified sensitive cohorts and assessed unmeasured confounding.

Results

Over an average follow-up of 91 months, multivariate Cox regression models revealed a significant positive correlation between DII scores and mortality risk, with each unit increase in DII associated with a 10% higher risk of death (HR: 1.10, 95% CI: 1.03-1.16; P = 0.002). Among the DII tertiles, individuals in the second tertile (T2: 1.23-2.94) experienced a 67% increase in mortality risk compared to those in the lowest tertile (T1: -5.28-1.23) (HR: 1.67, 95% CI: 1.26-2.21; p < 0.001). The third tertile (T3) did not show a statistically significant increase in mortality risk (HR: 1.30, 95% CI: 0.98-1.72; p=0.074). A restricted cubic spline analysis indicated a significant nonlinear association between DII and all-cause mortality (p = 0.021). Threshold effect analysis further revealed that below a DII of 2.19, there was a significant increase in all-cause mortality risk (HR = 1.19, 95% CI: 1.07-1.33; p = 0.002), while at or above this threshold, the risk increase was not statistically significant (HR=0.89, 95% CI: 0.68-1.15; p = 0.380). Kaplan-Meier analysis revealed significant differences in survival curves among DII tertiles (p < 0.001), with the lowest DII tertile showing the highest survival probability. Both subgroup and sensitivity analyses confirmed the robustness of these findings.

Conclusion

DII is positively correlated with mortality risk in COPD patients, showing nonlinear characteristics and threshold effects, underscoring its prognostic value.

Association Between the Inflammatory Potential of Diet and Constipation Among Adults in the United States: A Cross-sectional Study

OBJECTIVE

To investigate the potential association between Dietary Inflammatory Index (DII) scores and constipation among a sample of adults in the United States.

METHODS

This cross-sectional study used data from adult participants in the 2005 to 2010 National Health and Nutrition Examination Survey (ie, "NHANES"). Self-reported information was used to identify cases of constipation. The DII was used to assess inflammatory potential of the diet. Odds ratios (ORs) and corresponding 95% CIs for the association between the DII and constipation were determined using multivariate logistic regression modeling. Stratified analyses explored whether there was effect modification to influence the relationship between DII and constipation.

RESULTS

Of 8272 subjects, 759 reported constipation, and 7513 did not, corresponding to a prevalence of 9.2%. After adjusting for age, gender, race/ethnicity, marital status, education level, smoking status, alcohol consumption, physical activity, body mass index (BMI), cardiovascular diseases (CVD), hypertension, stroke, diabetes, energy intake, carbohydrate intake, and selective serotonin reuptake inhibitor (SSRI) use. Compared with lower DII scores group T1 (-5.28 to ≤0.72), the adjusted OR values for DII scores and constipation in T2 (>0.72 to ≤2.50) and T3 (>2.50 to 5.24) were 1.27 (95% CI: 1.02-1.58, P=0.029) and 1.43(95% CI: 1.14-1.8, P=0.002). Subgroup analyses showed that there were effect modification of gender and physical activity factors on DII scores and constipation.

CONCLUSIONS

Results of this cross-sectional study suggest that a higher dietary inflammatory index score was associated with increased risk of constipation after adjustment for confounding in a multivariable analysis. gender and physical activity were found to be an effect modifier of this relationship.

Phthalate and gallstones: the mediation of insulin

Background

Exposure to a mixture of environmental chemicals may cause gallstone, but the evidence remains equivocal. The current study aims to investigate the association between phthalate metabolites and gallstones, and to explore their mediators.

Methods

Data from the National Health and Nutrition Examination Survey 2017-2018 on U.S. adults (≥20 years) were analyzed to explore the association between phthalate metabolites and gallstones by employed survey-weighted logistic regression, restricted cubic spline (RCS), weighted quantile sum (WQS) regression, and Bayesian kernel machine regression (BKMR). Mediation analyses examined the role of oxidative stress markers, inflammatory markers, metabolic syndrome, body composition, diabetes, and insulin.

Results

The current study included 1,384 participants, representing 200.6 million U.S. adults. Our results indicated a significant association between phthalate metabolites, particularly high molecular weight metabolites such as Di(2-ethylhexyl) phthalate (DEHP) and 1,2-Cyclohexane dicarboxylic acid diisononyl ester (DINCH), and gallstones. Furthermore, mediation analyses indicated that phthalate metabolites may play a role in the development of gallstones by influencing insulin secretion. Subgroup analyses did not reveal significant interaction.

Conclusion

The association between exposure to phthalates and the occurrence of gallstones, potentially mediated by hyperinsulinemia from a nationally representative epidemiological perspective. These insights contribute to a better understanding of the potential health implications of plasticizers, emphasizing the need for proactive management measures.

Assessing Support for Policy Actions With Co-Benefits for Climate Change and Physical Activity in Canada

BACKGROUND

Calls to action addressing the interconnections between physical (in)activity and the climate crisis are increasing. The current study aimed to investigate public support for policy actions that potentially have co-benefits for physical activity promotion and climate change mitigation.

METHODS

In 2023, a survey through the Angus Reid Forum was completed by 2507 adults living in Canada. Binary logistic regressions were conducted. Separate models were created to reflect support or opposition to the 8 included policy items. Several covariates were included in the models including age, gender, political orientation, physical activity levels, income, urbanicity climate anxiety, and attitudes surrounding physical activity and climate change. The data were weighted to reflect the gender, age, and regional composition of the country.

RESULTS

Most individuals living in Canada strongly or moderately supported all actions (ranging from 71% to 85%). Meeting the physical activity guidelines, higher self-reported income, and scoring high on personal experience of climate change were associated with higher odds of supporting the policy actions related to climate actions.

CONCLUSIONS

Most adults living in Canada support policies that align with the recommended policy actions related to physical activity and climate change. National campaigns enhancing awareness and understanding of the bidirectional relationship between physical activity and climate change are warranted, and these should consider the consistent demographic differences (eg, gender, age, and political orientation) seen in public support for physical activity-related policies.

Association of Dietary Live Microbes and Nondietary Prebiotic/Probiotic Intake With Cognitive Function in Older Adults: Evidence From NHANES

BACKGROUND

The current study aims to examine association of dietary live microbes and nondietary prebiotic/probiotic intake with cognitive function among older U.S. adults, examining heterogeneity across demographic characteristics and diseases.

METHODS

Participants from the National Health and Nutrition Examination Survey 2011-2014 cycles were selected and administered 3 cognitive function tests: the Consortium to Establish a Registry for Alzheimer's Disease Word Learning subtest (CERAD W-L, including immediate [CERAD-IRT] and delayed [CERAD-DRT] memory), the Animal Fluency Test (AFT), and the Digit Symbol Substitution Test (DSST). Test-specific and global cognition z-score was created. Based on their estimated dietary live microbes intake, participants were categorized into three groups: low, medium, and high. Text mining was employed to identify nondietary prebiotic/probiotic usage by examining the names and ingredients of dietary supplements or drugs.

RESULTS

Participants in the medium (including AFT) and high (including global cognition, AFT, DSST, and CERAD-IRT) dietary live microbes intake group had significantly higher z-score of cognitive function compared to those in the low intake group. Among participants with cardiovascular disease history, nondietary prebiotic intake was associated with higher z-score in global cognition and CERAD-DRT compared to those who did not consume prebiotic. Additionally, probiotic intake was linked to higher z-score in global cognition, AFT, and DSST, particularly in participants with diabetes mellitus or hypertension.

CONCLUSIONS

Our study suggests that the intake of dietary live microbes and nondietary probiotic/prebiotic was associated with better cognitive function in older adults, particularly in specific disease states.

When and Why Do People Accept Public-Policy Interventions? An Integrative Public-Policy-Acceptance Framework

The successful introduction of public policies to prompt behavior change hinges on the degree to which citizens endorse the proposed policies. Although there is a large body of research on psychological determinants of public policy acceptance, these determinants have not yet been synthesized into an integrative framework that proposes hypotheses about their interplay. In this article, we develop a review-based, integrative public-policy-acceptance framework that introduces the desire for governmental support as a motivational foundation in public-policy acceptance. The framework traces the route from problem awareness to policy acceptance and, ultimately, policy compliance. We propose this relationship to be mediated by a desire for governmental support. We integrate numerous key variables assumed to qualify the relationship between problem awareness and the desire for governmental support, such as control attributions, trust, and value fit, as well as the relationship between the desire for governmental support and policy acceptance, such as perceived policy effectiveness, intrusiveness, and fairness. We exemplify the use of the proposed framework by applying it to climate policies.

Re-assessing the social climate of physical (in)activity in Canada

Social-ecological models suggest that a strategy for increasing population physical activity participation is to reconstruct the "social climate" through changing social norms and beliefs about physical activity (PA). In this study, we assessed whether the PA social climate in Canada has changed over a five-year period after controlling for sociodemographic factors and PA levels. Replicating a survey administered in 2018, a sample of adults in Canada (n = 2,507) completed an online survey assessing social climate dimensions, including but not limited to descriptive and injunctive norms. Descriptive statistics were calculated, and binary logistic regressions were conducted to assess the associations of sociodemographic factors and year of the survey with social climate dimensions. Results suggest some social climate constructs are trending in a positive direction between 2018 and 2023. Physical inactivity was considered a serious public health concern by 49% of respondents, second to unhealthy diets (52%). Compared to those who participated in the 2018 survey, participants in 2023 were less likely to see others walking or wheeling in their neighbourhood (OR = 1.58, 95% CI: 1.41, 1.78), but more likely to see people exercising (OR = 0.82, 95% CI: 0.73, 0.92) and kids playing in their neighbourhood (OR = 0.75, 95% CI: 0.66, 0.85). No changes were reported between 2018 and 2023 in individuals' perceptions of whether physical inactivity is due to individual versus external factors (OR = 0.99, 95% CI: 0.87, 1.13). The findings of this work indicate a modest positive shift in some measured components of the social climate surrounding PA although attributing causes for these changes remain speculative.

Pandemic threat and group cohesion: national identification in the wake of COVID-19 is associated with authoritarianism

Authoritarianism emerges in times of societal threat, in part driven by desires for group-based security. As such, we propose that the threat caused by the COVID-19 pandemic was associated with increased authoritarian tendencies and that this can be partially explained by increased national identification. We tested this hypothesis by collecting cross-sectional data from three different countries in April 2020. In Study 1, data from Ireland (N = 1276) showed that pandemic threat predicted increased national identification, which in turn predicted authoritarianism. In Study 2, we replicated this indirect effect in a representative UK sample (N = 506). In Study 3, we used an alternative measure of authoritarianism and conceptually replicated this effect among USA citizens (N = 429). In this US sample, the association between threat and authoritarian tendencies was stronger among progressives compared to conservatives. Findings are discussed and linked to group-based models of authoritarianism.

United We Stand, Divided We Fall: Sociopolitical Predictors of Physical Distancing and Hand Hygiene During the COVID-19 Pandemic

Most health models emphasize individual factors in predicting health behavior. However, in the context of COVID-19 where the immediate response to stopping the spread of the virus requires collective efforts and change, other sociopolitical factors need to be considered. Prior research points to health behaviors being impacted by neighborhood and national social relations, social identification, confidence in government and political orientation. This research, though, is generally piecemeal (or specific), tends to be cross-sectional, and is usually not oriented to pandemics. These issues are addressed in the current research. A two-wave study with a representative sample of Australians (N _{Wave 1} = 3028) gathered during COVID-19 examined sociopolitical factors at the local and national level as predictors of health behaviors one month later. Four models were tested. These encapsulated geographic levels (local or national) and two health behaviors (hand hygiene or physical distance). In the three of the four models, social identification was a significant predictor of health behavior, while controlling for sociodemographic and individual-level measures. There were more mixed results for social relations and confidence in government. There is evidence that to better promote health behaviors sociopolitical factors need to be more prominent in public policy and health behavior models.

How to fairly allocate scarce medical resources? Controversial preferences of healthcare professionals with different personal characteristics

The scarcity of medical resources is widely recognized, and therefore priority setting is inevitable. This study examines whether Portuguese healthcare professionals (physicians vs nurses): (i) share the moral guidance proposed by ethicists and (ii) attitudes toward prioritization criteria vary among individual and professional characteristics. A sample of 254 healthcare professionals were confronted with hypothetical prioritization scenarios involving two patients distinguished by personal or health characteristics. Descriptive statistics and parametric analyses were performed to evaluate and compare the adherence of both groups of healthcare professionals regarding 10 rationing criteria: waiting time, treatment prognosis measured in life expectancy and quality of life, severity of health conditions measured in pain and immediate risk of dying, age discrimination measured in favoring the young over older and favoring the youngest over the young, merit evaluated positively or negatively, and parenthood. The findings show a slight adherence to the criteria. Waiting time and patient pain were the conditions considered fairer by respondents in contrast with the ethicists normative. Preferences for distributive justice vary by professional group and among participants with different political orientations, rationing experience, years of experience, and level of satisfaction with the NHS. Decision-makers should consider the opinion of ethicists, but also those of healthcare professionals to legitimize explicit guidelines.

Who or what is to blame? Examining sociodemographic relationships to beliefs about causes, control, and responsibility for cancer and chronic disease prevention in Alberta, Canada

BACKGROUND

Beliefs about causes and responsibility for chronic diseases can affect personal behaviour and support for healthy policies. In this research we examined relationships between socio-demographics (sex, age, education, employment, political alignment, perceived health, household income, household size) and perceptions of causes and responsibility for health behaviour, chronic disease correlates, and attitudes about cancer prevention and causes.

METHODS

Using data from the 2016 Chronic Disease Prevention survey in which participants (N = 1200) from Alberta, Canada responded to items regarding how much they believed personal health behaviours, prevention beliefs, and environmental factors (i.e., healthy eating, physical activity, alcohol, smoking, and where a person lives or works) are linked to getting cancer. Participants also responded to questions about causes and responsibility for obesity, alcohol, and tobacco (i.e., individual or societal). Relationships were examined using multinomial logistic regression on socio-demographics and survey items of interest.

RESULTS

Men (compared to women) were less likely to link regular exercise, or drinking excessive alcohol, to reducing or increasing cancer risk. Similarly, men were less likely to link environmental factors to cancer risk, and more likely to agree that cancer was not preventable, and that treatment is more important than prevention. Finally, men were more likely to believe that alcohol problems are an individual's fault. Left and central voters were more likely to believe that society was responsible for addressing alcohol, tobacco, and obesity problems compared to right voters. Those with less than post-secondary education were less likely to believe that regular exercise, maintaining a healthy body weight, or eating sufficient fruits and vegetables were linked to cancer - or that society should address obesity - compared to those with more education. Households making above the median income (versus below) were more likely to link a balanced diet with cancer and were less likely to think that tobacco problems were caused by external circumstances.

CONCLUSIONS

These results provide insight into the importance of health literacy, message framing, and how socio-demographic factors may impact healthy policy. Men, those with less education, and those with less income are important target groups when promoting health literacy and chronic disease prevention initiatives.