Health Disparities
Do Depressive Symptoms and Social Cohesion Mediate the Association Between Income Inequality and Adolescent Overweight/Obesity? Luc Sauze* Luc Sauze Jason Were Karen Patte Valerie Carson Scott Leatherdale Roman Pabayo
Objectives Previous research has identified associations between income inequality and adolescent weight status, although the mediators in this association remain relatively unknown. This study explored mechanisms in the association between income inequality and overweight/obesity among Canadian secondary school students, with an added objective of identifying potential sex differences.
Methods Cross-sectional data from 47,370 students within 40 census divisions across Canada was obtained from the 2017-2018 wave of the Cannabis, Obesity, Mental health, Physical activity, Alcohol, Smoking, and Sedentary behaviour (COMPASS) study. Sex-stratified multilevel path analyses were conducted to determine if depressive symptoms and social cohesion mediated the association between census-division level income inequality and adolescent overweight/obesity (defined using WHO age- and sex-specific z-BMI scores).
Results Higher census-division level income inequality was associated with greater depressive symptoms for both sexes (Boys: ß = 0.350, 95% CI = 0.065 – 0.636; Girls: ß = 0.444, 95% CI = 0.157 – 0.731). Subsequently, higher depressive symptoms were associated with increased odds of overweight/obesity in boys (OR = 1.008, 95% CI = 1.000 – 1.015) and girls (OR = 1.021, 95% CI = 1.015 – 1.027). The indirect depression path was significant only for girls (OR = 1.009; 95% CI = 1.003 – 1.016). The social cohesion path revealed a significant association between higher social cohesion and reduced odds of overweight/obesity among girls (OR = 0.979, 95% CI = 0.967 – 0.990).
Conclusion The association between Census-division level income inequality and overweight/obesity appears to be mediated by depressive symptoms in adolescent girls, but not among adolescent boys. School-based interventions aimed at addressing depression and enhancing social cohesion could help alleviate the burden of overweight/obesity among Canadian adolescents.
