Annalijn Conklin
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Gender differences in symptoms and outcomes of patients living with COPD;
Gender, social determinants and metabolic outcomes
Excellent written communication skills; Strong quantitative background; Experience in research projects preferred; Excellent academic standing; Shared research interests
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Postdoctoral Fellows
Graduate Student Supervision
Doctoral Student Supervision
Dissertations completed in 2010 or later are listed below. Please note that there is a 6-12 month delay to add the latest dissertations.
Few high-quality studies link dietary diversity to type 2 diabetes (T2D), and no studies examine protein diversity by source. I examined the prospective association of five diversity scores with the 10-year risk of T2D, and assessed differences by sex/gender, obesity, and socioeconomic status (SES). I used the EPIC-InterAct case-cohort study, which included 10,363 incident T2D cases and a representative subcohort of 13,937 individuals, sampled from a cohort of 340,234 participants in 8 European countries (1993-2007). I derived five scores from self-reported diet data (gr/day): diversity between food groups (range: 0—5) and diversity within subtypes of vegetables (0—4), meats/alternatives (0—6), animal protein (0—8) and plant protein (0—5). I estimated country-specific hazard ratios (HRs) and 95% confidence intervals (95% CI) using Prentice-weighted Cox regression and then pooled estimates using mixed-effects models; I also stratified these models based on sex/gender. For obesity and SES subgroups, I used simple Prentice-weighted Cox regression due to smaller sample sizes. Daily intake of five food groups (versus ≤three) was linked to lower T2D incidence (HR 0.86 [95%CI 0.75, 0.98]), particularly in women, and Europeans who were single, married, employed, had technical and primary school education, or were not obese. Daily intake of 3-4 subtypes of vegetables (relative to 0-1 subtype) was inversely associated with T2D among men (0.85 [0.73, 0.99]), and Europeans with primary school education (0.78 [0.65, 0.93]), who were employed (0.82 [0.68, 0.99]), or were single (0.39 [0.20, 0.76]). Greater plant-protein diversity was inversely associated with T2D among women (3 subtypes: 0.75 [0.62, 0.90]), and Europeans without obesity (4-5 subtypes: 0.82 [0.68, 1.00]), or were university-educated (3 subtypes: 0.65 [0.45, 0.95]). By contrast, greater meat/alternatives diversity, and animal-protein diversity, were positively associated with T2D in Europeans without obesity (≥2 subtypes: HR range: 1.29 to 1.39), or had low education (6-8 subtypes: 1.77 [1.10, 2.85]). Diabetes prevention may benefit not only from a diet consisting of five different food groups but also from a diet diverse in vegetables and plant-based protein. However, lower disease incidence associated with greater diet diversity was observed only in specific Europeans subpopulations.
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Master's Student Supervision
Theses completed in 2010 or later are listed below. Please note that there is a 6-12 month delay to add the latest theses.
The objectives of this thesis were to: (1) examine the sex/gender-specific impacts that employment status change (employment transitions, ETs) have on body weight and waist circumference (WC) changes in middle- and older-age adults and (2) assess the contribution of changes in health behaviours (HBs: sleep duration and quality, smoking status, alcohol consumption, and physical activity) in the association between ETs and anthropometric changes.Chapter 1: Eight bibliometric databases were systematically searched, with citations followed up. Twelve studies were included. All studies examined retirement but reported mixed results. Retirement either led to weight gain or did not alter weight compared to non-retirement. Occupation type modified the association: weight gain was more commonly reported among retirees from physically demanding occupations. Two included studies also examined job-loss and results were also mixed. Key confounders and commonly studied HBs were identified.Chapter 2 & 3: Two waves of data from the Canadian Longitudinal Study on Aging were used to classify 10,117 working women and men into three ET groups: stayed working, entered retirement, and stopped working. The outcomes were change in weight and WC on continuous scales, and change as categories (≥5% gain, ≥5% loss, no change). Multivariable linear and multinomial logistic regressions were adjusted for confounders and HBs.Multivariable linear regression models showed that weight changes did not differ across ETs in women, although changes in WC showed different directions across ET. By contrast, men who entered retirement lost more weight and had greater reductions in WC relative to men who stayed working (-0.59 kg, [95% CI: -1.11, -0.08] and -0.83 cm, [95% CI: -1.46, -0.20]). Final multinomial logistic regression models did not show significant associations; however, the direction of the effects remained. In models that included HB change variables, estimates were not attenuated. Retirement may result in small amounts of weight loss in middle-aged and older Canadian men. Work stoppage appears to lead to more WC increases in women, but the evidence is uncertain. Contrary to hypotheses that place HBs along the pathway between ETs and anthropometric change, the findings from the empirical study suggest that they are independent risk factors instead.
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Food insecurity, diet-related chronic illnesses, and climate change have become more prominent in public health and education policy, leading to the identification of many policy and program gaps in our food and education systems. Research shows young adults finishing secondary school without consistent food education lack knowledge of basic nutrition, food skills, food systems, everyday food practices, and food production. School farms as food literacy interventions can positively impact food literacy and food security. Links have been established between food literacy and food system knowledge and healthier food practices to decrease diet-related diseases like obesity and diabetes amongst individuals and improve overall community health and well-being. However, little research exists on self-identifying school farms as unique and specific programs or their connection to food literacy in secondary schools. This community-based research study aimed to develop a working definition of ‘school farm’ and understand school farms’ capacity to build adolescent food literacy. I used semi-structured interviews with multiple stakeholders (n=18) across 6 school farms in British Columbia, Canada, and applied Framework Analysis using food literacy and community-determined frameworks as well as inductive coding to analyse qualitative data. My analysis showed that school farms are defined by 1) food production capacity and scale; 2) community integration, and 3) experiential educational opportunities to teach food systems and core curricula. School farms offer comprehensive food literacy education, including individual and collective food system skills, behaviours, and knowledges, to improve personal, community, and environmental health. My data also revealed school farms’ positive impacts on students’ mental health and well-being, and the academic success of neurodivergent and culturally diverse students who often struggle in traditional formal education settings. Additionally, the data indicated school farms face major barriers like funding, sustainability, and management obstacles. This study helps to clarify the concept of school farms and explain how they contribute to student food literacy, especially within the context of British Columbia.
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Background: Sleep deficits, which include social jetlag, poor sleep quality, and short sleep duration, have been commonly observed in adolescents due to development-specific late chronotype, early school start time, and other physiological and environmental factors. Recent findings indicate that sleep is potentially associated with unhealthy eating habits, such as frequent consumption of sugar-sweetened beverages (SSB). The associations may also differ by gender. This thesis examined the gender-specific associations between three different types of sleep deficits and SSB consumption among adolescents. Methods: This thesis used a cross-sectional study design and included 1031 adolescents from Wave 6 (Spring 2012) of the British Columbia Adolescent Substance Use Survey (BASUS) (mean age: 15±0.7 years). Descriptive statistics analyzed the prevalences of self-reported sleep deficits and SSB consumption by gender. Multivariable logistic regression models using interaction terms examined the associations between each sleep deficit variable and three measures of SSB consumption, by gender. Additional confounders were included in the sensitivity analyses to test the robustness of results. Results: Compared to no social jetlag (≤ 1h), consistent positive associations of higher social jetlag levels were observed with above-median (OR 1.63 (95% CI: 1.01, 2.65)) and any weekly SSB intake (1.97 (1.06, 3.66)) in girls; boys showed a similar positive but non- statistically significant OR trend with any SSB intake. Non-significant positive associations were seen between more frequent restless sleep and daily SSB intake in girls, but only boys with occasional restless sleep (1-2 days/week) had significantly higher odds of any SSB intake (3.21 (1.31, 7.88)), compared to no restless sleep (
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Publications
- A systematic review of evidence on employment transitions and weight change by gender in ageing populations (2022)
PLOS ONE, - Letter to Editor: a cautionary note about “Dietary diversity score and cardio-metabolic risk factors: an updated systematic review and meta-analysis” (2022)
Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity, - Therapeutic carbohydrate restriction pre-COVID pandemic: assessing registered dietitians’ knowledge, use and perceived barriers in Canada (2022)
European Journal of Clinical Nutrition, - Adiposity and the role of diverse social supports: an observational, gender-sensitive study using the baseline Canadian Longitudinal Study on Aging (2021)
Public Health Nutrition, 24 (18), 6103--6112 - Gender Differences in the Role of Social Support for Hypertension Prevention in Canada: A Population-Based Cross-Sectional Study of the Canadian Longitudinal Study on Aging Cohort (2021)
CJC Open, 3 (12), S62--S70 - Is eating a mixed diet better for health and survival?: A systematic review and meta-analysis of longitudinal observational studies (2021)
Critical Reviews in Food Science and Nutrition, , 1--17 - Pharmacist-led cardiovascular risk prevention in Western Canada: a qualitative study (2021)
International Journal of Pharmacy Practice, 29 (1), 45--54 - Plant-based dietary practices in Canada: examining definitions, prevalence and correlates of animal source food exclusions using nationally representative data from the 2015 Canadian Community Health Survey–Nutrition (2021)
Public Health Nutrition, 24 (5), 777--786 - Socioeconomic inequalities in pediatric obstructive sleep apnea (2021)
Journal of Clinical Sleep Medicine, - The role of dietary diversity in preventing metabolic‐related outcomes: Findings from a systematic review (2021)
Obesity Reviews, - Associations between social connections, their interactions, and obesity differ by gender: A population-based, cross-sectional analysis of the Canadian Longitudinal Study on Aging (2020)
PLOS ONE, - Social connections and hypertension in women and men (2020)
Journal of Hypertension, Publi - Chronic sleep deprivation and adolescent health: Two longitudinal studies of youth in Western Canada (2019)
European Journal of Public Health, 29 (Array) - Chronic sleep disturbance, not chronic sleep deprivation, is associated with self-rated health in adolescents (2019)
Preventive Medicine, - Does Ethnic Identification Moderate the Impact of Depression on Obesity in Young People? Results of a Systematic Scoping Review (2019)
Adolescent Research Review, - Factors associated with noncommunicable disease among adults in Mecha district, Ethiopia: A case control study (2019)
PLOS ONE, 14 (5), e0216446 - Obesity prevention in corticosteroid‐treated patients: Use and effectiveness of strategies for weight management (2019)
Clinical Obesity, 9 (4) - Prevalence of overweight and obesity in Western countries: discrepancies in published estimates (2019)
European Journal of Epidemiology, - Stressful life events, gender and obesity: A prospective, population-based study of adolescents in British Columbia (2019)
International Journal of Pediatrics and Adolescent Medicine, - The gender-specific role of prolonged sleep deficits on adolescent health: two longitudinal studies of youth depression and health in Western Canada (2019)
Sleep Medicine, 64, S78--S79 - The impact of rising food prices on obesity in women: a longitudinal analysis of 31 low-income and middle-income countries from 2000 to 2014 (2019)
International Journal of Obesity, 43 (4), 774--781 - UK government’s sugar reduction programme on test (2019)
BMJ, - Chronic sleep deprivation and gender-specific risk of depression in adolescents: a prospective population-based study (2018)
BMC Public Health, 18 (1) - Economic policy and the double burden of malnutrition: Cross-national longitudinal analysis of minimum wage and women's underweight and obesity (2018)
Public Health Nutrition, 21 (5), 940-947 - Gender, stressful life events and interactions with sleep: a systematic review of determinants of adiposity in young people (2018)
BMJ Open, - P28 Cumulative sleep problems and overall health: a longitudinal analysis of 3104 young women and men in the BASUS cohort study (2018)
Poster presentations, - P29 Does chronic sleep deprivation influence the risk of depression in young people? a longitudinal and gender-based analysis of the BASUS cohort study (2018)
Poster presentations, - The impact of rising food prices on obesity in women: a longitudinal analysis of 31 low-income and middle-income countries from 2000 to 2014 (2018)
International Journal of Obesity, 43 (4), 774--781 - Economic Determinants of Diet in Older Adults (2017)
Food for the Aging Population: Second Edition, , 145-167 - Economic policy and the double burden of malnutrition (2017)
Public Health Nutrition, - Dietary diversity, diet cost, and incidence of type 2 diabetes in the United Kingdom (2016)
PLOS Medicine, - Dietary Diversity, Diet Cost, and Incidence of Type 2 Diabetes in the United Kingdom: A Prospective Cohort Study (2016)
PLoS Medicine, 13 (7) - Marital transitions and associated changes in fruit and vegetable intake (2016)
Social Science & Medicine, - Marital transitions and associated changes in fruit and vegetable intake: Findings from the population-based prospective EPIC-Norfolk cohort, UK (2016)
Social Science and Medicine, 157, 120-126 - Minimum wage and overweight and obesity in adult women (2016)
PLoS One, - Minimum wage and overweight and obesity in adult women: A multilevel analysis of low and middle income countries (2016)
PLoS ONE, 11 (3) - Gender and the double burden of economic and social disadvantages on healthy eating (2015)
BMC Public Health, - Gender and the double burden of economic and social disadvantages on healthy eating: Cross-sectional study of older adults in the EPIC-Norfolk cohort (2015)
BMC Public Health, 15 (1) - Evaluating chronic disease management in real-world settings in six European countries (2014)
International Journal of Care Coordination, - Evaluating chronic disease management in real-world settings in six European countries: Lessons from the collaborative DISMEVAL project (2014)
International Journal of Care Coordination, 17 (1-2), 25-37 - Gender, diet quality and obesity (2014)
University of Cambridge, - Persistent financial hardship, 11-year weight gain, and health behaviors in the Whitehall II study (2014)
Obesity, 22 (12), 2606-2612 - Persistent financial hardship, 11‐year weight gain, and health behaviors in the Whitehall II study (2014)
Obesity, - Social relationships and healthful dietary behaviour (2014)
Social Science & Medicine, - Social relationships and healthful dietary behaviour: Evidence from over-50s in the EPIC cohort, UK (2014)
Social Science and Medicine, 100, 167-175 - The growing price gap between more and less healthy foods (2014)
PLoS One, - The growing price gap between more and less healthy foods: Analysis of a novel longitudinal UK dataset (2014)
PLoS ONE, 9 (10) - The underlying challenges of coordination of chronic care across Europe (2014)
International Journal of Care Coordination, 17 (3-4), 83-92 - Variety more than quantity of fruit and vegetable intake varies by socioeconomic status and financial hardship (2014)
Appetite, - Variety more than quantity of fruit and vegetable intake varies by socioeconomic status and financial hardship. Findings from older adults in the EPIC cohort (2014)
Appetite, 83, 248-255 - Approaches to chronic disease management evaluation in use in europe: A review of current methods and performance measures – corrigendum (2013)
International Journal of Technology Assessment in Health Care, 29 (1), 113 - Economic determinants of diet in older adults (2013)
Journal of Epidemiology and Community Health, - Economic determinants of diet in older adults: Systematic review (2013)
Journal of Epidemiology and Community Health, 67 (9), 721-727 - Is Europe putting theory into practice? (2013)
International Journal of Integrated Care, - Is Europe putting theory into practice? A qualitative study of the level of self-management support in chronic care management approaches (2013)
BMC Health Services Research, 13 (1) - Reported barriers to evaluation in chronic care (2013)
Health Policy, - Reported barriers to evaluation in chronic care: Experiences in six European countries (2013)
Health Policy, 110 (2-3), 220-228 - Socioeconomic status, financial hardship and measured obesity in older adults (2013)
BMC Public Health, - Socioeconomic status, financial hardship and measured obesity in older adults: A cross-sectional study of the EPIC-Norfolk cohort (2013)
BMC Public Health, 13 (1) - Approaches to chronic disease management evaluation in use in Europe: a review of current methods and performance measures. (2012)
International journal of technology assessment in health care, - Barriers and facilitators to integrating care: experiences from the English Integrated Care Pilots. (2012)
International journal of integrated care, 12 (JULY-) - Case management for at-risk elderly patients in the English integrated care pilots: observational study of staff and patient experience and secondary care utilisation. (2012)
International journal of integrated care, 12 (JULY-) - Overcoming fragmentation in health care: chronic care in Austria, Germany and The Netherlands. (2012)
Health economics, policy, and law, - What is the evidence base for public involvement in health-care policy?: results of a systematic scoping review. (2012)
Health expectations : an international journal of public participation in health care and health policy, - A ‘vector of rights’ approach for public health: towards an intersectional human rights framework for considering the prevention and treatment of harms to girl child soldiers (2008)
Australian Journal of Human Rights, - Loss of translation elongation factor (eEF1A2) expression in vivo differentiates between Wallerian degeneration and dying-back neuronal pathology. (2008)
Journal of anatomy,
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