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OBJECTIVES: Morbidity and mortality from cardiovascular diseases (CVDs) are higher among individuals with a lower, compared to those with a higher socioeconomic position (SEP). However, the contribution of modifiable risk factors to these inequities is not known. This study aimed to examine whether and to what extent modifiable risk factors mediate associations between SEP and CVD morbidity and mortality in a nationally representative sample of Canadian adults. METHODS: We used a population-based prospective observational cohort design whereby participants who completed the Canadian Community Health Survey (2000–2011; n = 289,800) were followed longitudinally for CVD morbidity and mortality using administrative health and mortality data in the Discharge Abstract Database and the Canadian Mortality Database until 31 March 2013. Participants were included if they were at least 35 years of age and did not self-report CVD at the time of survey administration. The exposure of interest was SEP, which was measured as a latent variable consisting of annual household income and educational attainment. Potential mediators included smoking, physical inactivity, obesity, diabetes, and hypertension. The primary outcome of interest was CVD morbidity and mortality, which was defined as the first fatal or nonfatal CVD event that occurred during follow-up (6.2 years). Generalized structural equation modeling was used to test the mediating effects of modifiable risk factors in associations between SEP and CVD morbidity and mortality. RESULTS: SEP was associated with CVD morbidity and mortality. Modifiable risk factors mediated 80% of associations between SEP and CVD morbidity and mortality. Smoking was the most important mediator of these associations. Obesity mediated associations between SEP and CVD individually and jointly with diabetes or hypertension. CONCLUSIONS: These findings point to modifiable risk factors as potential targets for interventions to reduce inequities in CVD morbidity and mortality. Knowledge of pathways linking SEP with CVD is essential to inform targeted interventions to reduce socioeconomic inequities in CVD morbidity and mortality. FUNDING SOURCES: This study was funded by a Libin Cardiovascular Research Institute of Alberta Innovation Seed Grant and the Petro-Canada Young Innovator Award in Community Health.

OBJECTIVES: Diet quality is a key determinant of chronic disease and shares a similar socioeconomic patterning. Inequities in diet quality are stable or widening in the US, however these trends have not been examined in other nations. Moreover, prior US studies only examined differences in diet quality between the most and least disadvantaged groups in absolute terms. Quantifying trends in relative terms and along the full socioeconomic gradient according to multiple indicators of socioeconomic position (SEP) can provide a more comprehensive perspective to inform optimal points of intervention. The purpose of this study was to quantify nationally representative trends in absolute and relative gaps and gradients in diet quality between 2004 and 2015 according to three indicators of SEP among adults living in Canada. METHODS: 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. SEP was classified based on annual gross household income (quintiles), education (5 categories) and neighborhood deprivation (quintiles). Dietary intake data from interviewer-administered 24-hour recalls were used to derive Healthy Eating Index-2015 scores. Dietary inequities were quantified using four indices: absolute gaps, relative gaps, absolute gradients (slope index of inequality) and relative gradients (relative index of inequality). Sex-stratified multivariable linear regression models examined trends in HEI-2015 scores between 2004 and 2015. RESULTS: Mean HEI-2015 scores improved significantly from 55.3 in 2004 to 59.0 in 2015 (maximum 100 points); however these trends were not consistently equitable. While inequities in HEI-2015 scores were stable in females, the absolute gap and gradient in HEI-2015 scores according to household income increased in males, as did the absolute gradient according to education. CONCLUSIONS: Absolute and relative gaps and gradients in diet quality remained stable or widened between 2004 and 2015 in Canada. Novel policies are needed to tackle these avoidable inequities. Providing universal access to resources with a scale and intensity proportionate to need (i.e., proportionate universalism) may reduce inequities in diet quality and thus, chronic disease risk. FUNDING SOURCES: Not applicable.

OBJECTIVES: The prevalence of household food insecurity increases in the summer when school meals are no longer accessible, which can negatively impact children's health and wellbeing. Summer food programs, such as I Can for Kids (IC4K) in Calgary, Alberta, Canada, aim to reduce food insecurity in low income households with school-aged children during the summer months. Qualitative studies have not yet examined whether or how grocery gift cards (GGC) can reduce experiences of food insecurity among low-income households. We explored recipients’ and agency staff experiences and perceived outcomes of receiving or distributing GGC from IC4K. METHODS: This study used qualitative descriptive methodology. Data generation and analysis were guided by Freedman et al's theoretical framework of nutritious food access. Semi-structured interviews were conducted between August and November 2020 with 38 primary caregivers (i.e., GGC recipients) and 17 agency staff who distributed GGC. Directed content analysis was used to analyze the data from each set of interviews using a deductive-inductive approach. Codes were combined into themes that summarized GGC recipients’ and agency staff's experiences and perceived outcomes of receiving or distributing GGC, and feedback to improve program delivery. RESULTS: Three themes were generated from the data. The first theme was Financial Relief and reflected increased self-efficacy, improved diet quality, and reduced household stress from receiving GGC. The second theme was Social Connectedness and described enriched family relationships, enhanced rapport between staff and recipients, and increased recipient social capital. The last theme was Program Enhancements and described feedback to improve program delivery by extending program duration, increasing strategic direction to staff on GGC distribution, and additional promotional efforts to increase awareness of GGC availability. CONCLUSIONS: GGC recipients and agency staff perceived that GGC offered financial relief and enhanced social connections for recipients, and suggested areas for program improvements. Study findings can inform improvements to summer food programs that deliver GGC to reduce food insecurity among low-income households in the summer. FUNDING SOURCES: Funding provided by the O'Brien Institute for Public Health at the University of Calgary.