Mediterranean diet and associations with the gut microbiota and pediatric-onset multiple sclerosis using trivariate analysis.

BACKGROUND: The interplay between diet and the gut microbiota in multiple sclerosis (MS) is poorly understood. We aimed to assess the interrelationship between diet, the gut microbiota, and MS. METHODS: We conducted a case-control study including 95 participants (44 pediatric-onset MS cases, 51 unaffected controls) enrolled from the Canadian Pediatric Demyelinating Disease Network study. All had completed a food frequency questionnaire ≤21-years of age, and 59 also provided a stool sample. RESULTS: Here we show that a 1-point increase in a Mediterranean diet score is associated with 37% reduced MS odds (95%CI: 10%-53%). Higher fiber and iron intakes are also associated with reduced MS odds. Diet, not MS, explains inter-individual gut microbiota variation. Several gut microbes abundances are associated with both the Mediterranean diet score and having MS, and these microbes are potential mediators of the protective associations of a healthier diet. CONCLUSIONS: Our findings suggest that the potential interaction between diet and the gut microbiota is relevant in MS.

Multiple sclerosis (MS) is a disease where the immune system attacks the protective covering of nerve cells in the brain. There may be a relationship between diet and bacteria within the gut and MS, however this is not well understood. We investigated how diet and gut bacteria are linked to MS in young people. We examined the diet and types of bacteria in stool samples from those with and without MS. We found that a diet richer in fiber and Mediterranean foods were less common in those with MS. This dietary pattern was linked to certain differences in the gut bacteria. These findings raise the possibility, but cannot prove, that what we eat may help prevent MS by influencing our gut bacteria. This research opens the door to further studies on how diet can impact MS through our gut bacteria.

A collaborative approach to designing an online nutrition education program for people with multiple sclerosis.

PURPOSE: People with multiple sclerosis (pwMS) want disease-specific dietary advice to reduce the confusion around diet. This study used co-design principles to develop an online nutrition education program for pwMS. METHODS: Mixed-methods (multiphase sequential design). Phase 1: online survey (n = 114 pwMS) to explore preferred content and characteristics of a nutrition program and develop a draft program. Phase 2: feedback on the draft program from stakeholders (two meetings; n = 10 pwMS and multiple sclerosis (MS) health professionals) and pwMS (two workshops; n = 6) to produce a full program prototype. Phase 3: cognitive interviews (n = 8 pwMS plus 1 spouse) to explore acceptability and ease of comprehension of one module of the program, analysed using deductive content analysis. RESULTS: Preferred topics were included in the program, which were further developed with consumer feedback. Cognitive interviews produced four themes: (1) positive and targeted messaging to motivate behaviour change; (2) "not enough evidence" is not good enough; (3) expert advice builds in credibility; and (4) engaging and appropriate online design elements are crucial. CONCLUSIONS: Positive language appears to improve motivation to make healthy dietary changes and engagement with evidence-based nutrition resources. To ensure acceptability, health professionals can use co-design to engage consumers when developing resources for pwMS.IMPLICATIONS FOR REHABILITATIONCo-designed nutrition education programs can help people achieve high-quality diets in line with recommendations, but very few programs exist for people with multiple sclerosis (MS), and none were co-designedThe participatory research in this study was instrumental in ensuring that important information regarding program acceptability was identifiedCo-design can ensure that the language is appropriate for the target audience, and positive language appeared to improve motivation in people with MS to engage with the online nutrition education programWhere practical and feasible, health professionals should collaborate with MS consumers when developing resources, and use positive, empowering language.

Effect of household cooking on the retention of vitamin D2 and 25-hydroxyvitamin D2 in pulse UV-irradiated, air-dried button mushrooms (Agaricus bisporus).

Vitamin D deficiency has widespread global prevalence. Fresh mushrooms exposed to ultraviolet (UV) radiation generate vitamin D2 which remains after drying. It is not clear if vitamin D2 is retained after rehydration and cooking of dried mushrooms. The aim of this study was to determine the true retention of both vitamin D2 and 25-hydroxyvitamin D2 (25(OH)D2) after cooking UV-irradiated, air-dried, then rehydrated button mushrooms (Agaricus bisporus). Mushrooms were exposed to pulsed UV radiation, then air-dried in a convection oven, followed by rehydration in warm water. Samples were cooked in three different ways: frying (5 min), baking (10 min, 200 °C) and boiling (20 min, 90 °C). Compared to rehydrated, uncooked controls, there was a high retention of D vitamers (≥95%) after cooking. Frying and baking resulted in significantly higher vitamin D2 retention compared to boiling (p < 0.0001). UV-irradiated, dried mushrooms are a valuable source of vitamin D2 after rehydration and cooking.

The Retention of Vitamin D2 and 25-Hydroxyvitamin D2 in Pulse UV-Irradiated Dried Button Mushrooms (Agaricus bisporus) after 12 Months of Storage.

Fresh mushrooms exposed to ultraviolet (UV) radiation prior to drying generate high concentrations of vitamin D2. The aim of this study was to determine the retention of D vitamers in mushrooms that were pulse UV irradiated, then air dried, and stored for up to 12 months. Fresh button mushrooms (A. bisporus) were exposed to pulsed UV radiation (dose 200 mJ/cm2, peak of 17.5 W/cm2), air dried and vacuum sealed before being stored in the dark at room temperature. After storage, samples were freeze dried and quantified for D vitamers using triple quadrupole mass spectrometry. After 3, 6 and 12 months of storage, there was 100% (11.0 ± 0.8 µg/g dry weight (DW), 93% (10.1 ± 0.6 µg/g DW) and 58% (5.5 ± 0.6 µg/g DW) retention of vitamin D2 and 88% (0.14 ± 0.01 µg/g DW), 71% (0.11 ± 0.01 µg/g DW) and 68% (0.1 ± 0.01 µg/g DW) retention of 25-hydroxyvitamin D2 (25(OH)D2), respectively. Compared to the irradiated dried mushrooms that were not stored, the D vitamer concentration was statistically significantly lower (p < 0.05) at 6 and 12 months for 25(OH)D2 and at 12 months for vitamin D2. Sufficient vitamin D2 (99 µg) remained after 12 months storage to provide at least 100% of daily dietary vitamin D requirements in a 20 g serving.

Higher consumption of ultra-processed foods and increased likelihood of central nervous system demyelination in a case-control study of Australian adults.

BACKGROUND: Consumption of ultra-processed foods (UPFs) has been linked to risk of chronic diseases, with scant evidence in relation to multiple sclerosis (MS). METHODS: We tested associations between UPF consumption and likelihood of a first clinical diagnosis of central nervous system demyelination (FCD) (267 cases, 508 controls), a common precursor to MS. We used data from the 2003-2006 Ausimmune Study and logistic regression with full propensity score matching for age, sex, region of residence, education, smoking history, body mass index, physical activity, history of infectious mononucleosis, dietary misreporting, and total energy intake. RESULTS: Higher UPF consumption was statistically significantly associated with an increased likelihood of FCD (adjusted odds ratio = 1.08; 95% confidence interval = 1.0,1.15; p = 0.039), representing an 8% increase in likelihood of FCD per one energy-adjusted serving/day of UPFs. CONCLUSION: Higher intakes of UPF were associated with increased likelihood of FCD in this Australian cohort. Nutrition education and awareness of healthy eating patterns may benefit those at high risk of FCD.

Total Dairy Consumption Is Not Associated With Likelihood of a First Clinical Diagnosis of Central Nervous System Demyelination.

Background: The evidence associating consumption of dairy products and risk of MS is contradictory and inconclusive. Objective: To test associations between dairy consumption and the likelihood of a first clinical diagnosis of central nervous system demyelination (FCD), a common precursor to MS. Methods: We used data from the 2003-2006 Ausimmune Study, a population-based Australian, multicentre, matched case-control study (272 cases, 519 controls). Total dairy consumption (servings/day) was calculated by summing consumption of milk, cheese and yogurt. Covariate-adjusted treatment effects using augmented inverse probability weighting was used to test for associations with FCD. We conducted sensitivity analyses in the subset of participants who had had a classic first demyelinating event (FDE), defined as a single, first episode of symptoms suggestive of CNS demyelination. Results: There were no statistically significant associations between total dairy consumption (per one serving/day) and FCD (adjusted OR 1.00; 95% CI 0.93, 1.07; p = 0.979). However, yogurt consumption (vs. no yogurt consumption) was associated with an 11% decreased likelihood of FDE (adjusted OR 0.89; 95% CI 0.89, 0.79; p = 0.046). Conclusion: While total dairy consumption was not associated with FCD in this Australian case-control study, yogurt consumption was associated with reduced likelihood of FDE.

Vitamin D Fortification of Milk Would Increase Vitamin D Intakes in the Australian Population, but a More Comprehensive Strategy Is Required.

Low vitamin D status (serum 25-hydroxyvitamin D (25(OH)D) concentration < 50 nmol/L) is prevalent in Australia, ranging between 15% and 32% in the adolescent and adult populations. Vitamin D intakes are also low across the population and were recently estimated at 1.8−3.2 µg/day on average, assuming equal bioactivity of the D vitamers. In combination, these findings strongly suggest that data-driven nutrition policy is needed to increase vitamin D intake and improve status in the Australian population. Food fortification is a potential strategy. We used up-to-date vitamin D food composition data for vitamin D3, 25(OH)D3, vitamin D2, and 25(OH)D2, and nationally representative food and supplement consumption data from the 2011−2013 Australian Health Survey, to model a fortification scenario of 0.8 µg/100 mL vitamin D for fluid dairy milks and alternatives. Under the modelled fortification scenario, the mean vitamin D intake increased by ~2 µg/day from baseline to 4.9 µg/day from food only (7.2 µg/day including supplements). Almost all individual intakes remained substantially below 10 µg/day, which is the Estimated Average Requirement in North America. In conclusion, this modelling showed that fortification of fluid milks/alternatives with vitamin D at the current permitted level would produce a meaningful increase in vitamin D intake, which could be of potential benefit to those with a low vitamin D status. However, this initial step would be insufficient to ensure that most of the population achieves the North American EAR for vitamin D intake. This approach could be included as an effective component of a more comprehensive strategy that includes vitamin D fortification of a range of foods.

Outcomes of Breast Cancer Patients Treated with Chemotherapy, Biologic Therapy, Endocrine Therapy, or Active Surveillance During the COVID-19 Pandemic.

PURPOSE: Provide real-world data regarding the risk for SARS-CoV-2 infection and mortality in breast cancer (BC) patients on active cancer treatment. METHODS: Clinical data were abstracted from the 3778 BC patients seen at a multisite cancer center in New York between February 1, 2020 and May 1, 2020, including patient demographics, tumor histology, cancer treatment, and SARS-CoV-2 testing results. Incidence of SARS-CoV-2 infection by treatment type (chemotherapy [CT] vs endocrine and/or HER2 directed therapy [E/H]) was compared by Inverse Probability of Treatment Weighting. In those diagnosed with SARS-CoV-2 infection, Mann-Whitney test was used to a assess risk factors for severe disease and mortality. RESULTS: Three thousand sixty-two patients met study inclusion criteria with 641 patients tested for SARS-COV-2 by RT-PCR or serology. Overall, 64 patients (2.1%) were diagnosed with SARS-CoV-2 infection by either serology, RT-PCR, or documented clinical diagnosis. Comparing matched patients who received chemotherapy (n = 379) with those who received non-cytotoxic therapies (n = 2343) the incidence of SARS-CoV-2 did not differ between treatment groups (weighted risk; 3.5% CT vs 2.7% E/H, P = .523). Twenty-seven patients (0.9%) expired over follow-up, with 10 deaths attributed to SARS-CoV-2 infection. Chemotherapy was not associated with increased risk for death following SARS-CoV-2 infection (weighted risk; 0.7% CT vs 0.1% E/H, P = .246). Advanced disease (stage IV), age, BMI, and Charlson's Comorbidity Index score were associated with increased mortality following SARS-CoV-2 infection (P ≤ .05). CONCLUSION: BC treatment, including chemotherapy, can be safely administered in the context of enhanced infectious precautions, and should not be withheld particularly when given for curative intent.

A proinflammatory diet is associated with an increased likelihood of first clinical diagnosis of central nervous system demyelination in women.

BACKGROUND: While a number of studies have examined associations between dietary factors and risk of multiple sclerosis (MS), little is known about intakes of inflammation-modulating foods and nutrients and risk of MS. OBJECTIVES: To test associations between the Dietary Inflammatory Index (DII®) and risk of a first clinical diagnosis of central nervous system (CNS) demyelination (FCD) (267 cases, 507 controls) using data from the Ausimmune Study. METHODS: The 2003-2006 Ausimmune Study was a multicentre, matched, case-control study examining environmental risk factors for an FCD, a common precursor to MS. The DII is a well-recognised tool that categorises individuals' diets on a continuum from maximally anti-inflammatory to maximally pro-inflammatory. The DII score was calculated from dietary intake data collected using a food frequency questionnaire. Conditional logistic regression models were used to estimate the association between DII and FCD separately for men and women. RESULTS: In women, a higher DII score was associated with increased likelihood of FCD, with a 17% increase in likelihood of FCD per one-unit increase in DII score (adjusted odds ratio 1.17, 95% confidence interval 1.04-1.33). There was no association between DII and FCD in men (adjusted odds ratio 0.88, 95% confidence interval 0.73-1.07). CONCLUSIONS: These findings suggest that a pro-inflammatory diet is associated with an increased likelihood of FCD in women.

Omega-3 Index, fish consumption, use of fish oil supplements and first clinical diagnosis of central nervous system demyelination.

Higher intakes of omega-3 polyunsaturated fatty acids (n3PUFAs) have been associated with lower MS risk. We aimed to test associations between the Omega-3 Index, blood levels of n3PUFAs, fish oil supplement use, and fish consumption with a first clinical diagnosis of CNS demyelination (FCD). Cases (n = 250) had a higher Omega-3 Index compared with a matched group of controls (n = 471) (average treatment effect (ATE)=0.31, p = 0.047, based on augmented inverse probability weighting). A higher percentage of cases than controls used fish oil supplements (cases=17% vs. controls=10%). We found that Omega-3 Index increased as time between FCD and study interview increased (e.g., at or below median (112 days), based on ATE, mean=5.30, 95% CI 5.08, 5.53; above median, mean=5.90, 95% CI 5.51, 6.30). Fish oil supplement use increased in a similar manner (at or below median (112 days), based on ATE, proportion=0.12, 95% CI 0.06, 0.18; above the median, proportion=0.21, 95% CI 0.14, 0.28). Our results suggest a behaviour change post FCD with increased use of fish oil supplements.

Are There Ethnic Disparities in Exposure to Workplace Hazards Among New Zealand Migrants to Australia?

Disparities in exposure to workplace hazards exist between Maori and non-Maori workers in New Zealand, with Maori workers generally incurring poorer conditions. This study aimed to determine if these ethnic disparities are similar after migration to Australia. A national cross-sectional telephone survey asked participants what tasks they undertook in their job to assess exposure to carcinogens as well as whether they experienced ethnic discrimination, bullying, job precariousness, or job strain. A total of 389 New Zealand Caucasians and 152 Maori/Pasifika workers were recruited. After adjustment, 79% of Maori/Pasifika compared with 67% of New Zealand Caucasian workers were assessed as being exposed to at least one carcinogen at work. Maori/Pasifika workers were also more likely to report ethnic discrimination and fair or poor current health than New Zealand Caucasians. Some ethnic disparities in exposure to workplace hazards in New Zealand are apparent after migration to Australia.

How Refugees Experience the Australian Workplace: A Comparative Mixed Methods Study.

There is a growing body of evidence indicating poorer working conditions for migrant workers, particularly refugees, compared with native-born workers. Our objectives were to compare exposure to workplace psychosocial stressors in working refugees with other migrant groups and Australian-born workers of Caucasian ancestry and to describe the working experience of refugees. Cross-sectional surveys collected information on the workplace stressors of job complexity, control, security, bullying, and racial discrimination from six migrant groups (n = 1062) and Caucasian Australians (n = 1051); semi-structured face-to-face interviews were used with currently employed refugees (n = 30). Content analysis examined the qualitative data. Compared to all other groups, working refugees were more likely to report experiencing racial discrimination in the workplace and to report exposure to more than three hazards. Content analysis indicated that working refugees are working below their capacity, in terms of hours and qualifications, and in jobs that were low status and lacked security. Despite challenging work conditions, participants reported adequate health and safety training and feeling a sense of pride in their work. These findings highlight the need for better support for refugees in negotiating the workplace once they find employment and the importance of employers providing an inclusive and equitable workplace.

A randomised controlled trial to test the feasibility of online mindfulness programs for people with multiple sclerosis.

BACKGROUND: Practicing mindfulness may improve mental health and reduce pain in people with multiple sclerosis (MS). Since participating in face-to-face mindfulness programs can be challenging for people with MS, exploring alternative ways of delivering these programs is necessary. The objective of this trial was to assess feasibility of two different eight-week online mindfulness programs across five domains: recruitment, practicality, acceptability, integration of mindfulness practice, and limited efficacy testing on mental health, quality of life and pain. METHODS: In a three-arm randomised controlled mixed-method trial, participants were assigned to: 1) Mindfulness for Multiple Sclerosis (M4MS) (n=18); 2) Chair Yoga (n=18); or 3) wait-list control group (n=19) for eight weeks. Daily home practice diaries and weekly reflective journals were collected along with online questionnaires at baseline and post-intervention. Feasibility was assessed using descriptive statistics, multilevel mixed-effects regression, and content analysis. RESULTS: Online recruitment, online program delivery and online data collection were all found to be feasible. The sign up rate was 65% and overall, 87% of the participant completed the eight-week online programs. The programs were perceived as practical and acceptable by the participants. Integration of mindfulness practice into daily life varied, with time and fatigue reported as common barriers to practice. No statistically significant differences in efficacy measures were found among groups (p>0.05). CONCLUSION: Online mindfulness programs are feasible and acceptable for people with MS. This study provides useful insights for future trials when designing online mindfulness programs for people with MS.

An exploratory study of diet in childhood and young adulthood and adult-onset multiple sclerosis.

There is little evidence on the role of diet in childhood/adolescence and multiple sclerosis (MS) in adulthood. The MS Sunshine Study recruited adults with recent-onset MS (n = 602) and matched controls (n = 653). Of these, 84% provided dietary recall for specific ages between childhood and young adulthood (6-10, 11-15 and 16-20 years). We used logistic regression to test associations between age-specific diet and case-control status. Consumption of fruit (all ages), yoghurt (all ages) and legumes (11-15 years) was associated with lower probability of adult-onset MS (all p < 0.05). These results suggest that healthy dietary habits between childhood and young adulthood may reduce MS risk.

Recruiting migrant workers in Australia for Public Health surveys: how sampling strategy make a difference in estimates of workplace hazards.

OBJECTIVES: One third of the Australian work force are immigrants. Relatively little is known about working conditions for specific migrant groups. The objectives of this paper are to describe and compare the sampling strategies used to recruit migrant workers from specific migrant groups working in Australia into a cross-sectional study designed to produce population estimates of workplace hazards and self-reported health. RESULTS: Two cross sectional telephone surveys were conducted with immigrants currently working in Australia. Survey 1 used quota sampling from lists provided by a sample broker. Survey 2 used a combination of probability and non-probability sampling, including random sampling from telephone lists. Data from the surveys were weighted and comparisons made with unweighted data. While weighting adjusted for most differences across the sample sources, the likelihood of exposure to workplace hazards depended on exposure types and sampling strategies. We concluded that by using a combination of sampling strategies it is possible to recruit immigrants from specific migrant groups and provide a balanced view of working conditions, although no one strategy was best for all types of measures. Access to a robust sample source for migrants would enable a better perspective to migrant populations' working conditions.

Examining the Impact of Two Dimensions of Precarious Employment, Vulnerability and Insecurity on the Self-Reported Health of Men, Women and Migrants in Australia.

Precarious employment is increasing and adversely affects health. We aimed to investigate how perception of precariousness in current employment impacts gender and migrant workers in Australia. Using cross-sectional interviews of 1292 workers born in Australia, New Zealand, India and the Philippines, data were collected on self-reported health, employment conditions and sociodemographics. Factor analysis of nine questions about perceptions of current employment revealed two dimensions, vulnerability and insecurity. Women had higher vulnerability scores (µ = 6.5 vs. µ = 5.5, t = 5.40, p-value (p) < 0.000) but lower insecurity scores (µ = 8.6 vs. µ = 9.3 t = -4.160 p < 0.0003) than men. Filipino-born workers had higher vulnerability compared with other migrant workers (µ = 6.5 vs. µ = 5.8 t = -3.47 p < 0.0003), and workers born in India had higher insecurity compared with other migrant workers (µ = 9.8 vs. µ = 8.9, t = -6.1 p < 0.0001). While the prevalence of insecurity varied by migrant status, the negative effect on health was higher for Australian-born workers than migrants. Increasing levels of vulnerability and insecurity impacted self-reported health negatively (Coefficient (Coef).0.34 p < 0.0001; Coef.0.25 p < 0.0001, respectively). The combination of high vulnerability and high insecurity had the greatest impact on health (Coef. 2.37 p = 0.002), followed by high vulnerability and moderate insecurity (Coef. 2.0 p = 0.007). Our study suggests that understanding both changes in employment conditions over time as well as knowledge of cultural patterns may offer the best chance of understanding the impact of precarious employment experiences.

Descriptive study of workplace demand, control and bullying among migrant and Australian-born workers by gender: does workplace support make a difference?

OBJECTIVE: The objective of this study is to examine the relationship between bullying in migrants and Australians and types of workplace Iso-strain, by gender. DESIGN AND SETTING: Two descriptive cross-sectional surveys of the Australian working population. PARTICIPANTS: Australian-born workers of Caucasian ancestry (n=1051, participant response rate=87.3%) and workers born in New Zealand (n=566), India (n=633) and the Philippines (n=431) (participant response rate=79.5%). PRIMARY AND SECONDARY OUTCOMES MEASURES: Using logistic regression, we examined whether self-reported assessment of various forms of bullying in the workplace was associated with Iso-strain (job with high demands and low control and without social support), gender and migrant status. RESULTS: The prevalence of workplace bullying within the previous year was 14.5%. Sexual harassment, though rare (n=47, 1.8%), was reported by more women than men (83% vs 17%, χ2=19.3, p<0.0001) and more Australia or New Zealand born workers compared to India or the Philippines workers (75.5% vs 25.5%, χ2=4.6, p=0.032). Indian-born women had lower adjusted OR for being bullied and for being intimidated compared to other women. Independent of migrant status, Iso-strain (1), (low support from boss) and Iso-strain (2), (low support from colleagues) predicted being bullied. Women were more likely to be in an Iso-strain (1) job than men (18.7% vs 13.6%, p=0.013) and had twice the risk of being both verbally abused and intimidated compared to men (OR 9 vs OR 5.5, p<0.0001). CONCLUSION: Workplace bullying was more likely for women than men. There were few differences between workers from different migrant groups. Iso-strain was the strongest predictor of workplace bullying. Workplaces should encourage supportive and collegiate work environments.

Does exposure to workplace hazards cluster by occupational or sociodemographic characteristics? An analysis of foreign-born workers in Australia.

BACKGROUND: Disparities in exposure to occupational hazards may be linked to social position as well as the type of job a person holds. This study aimed to describe the prevalence of exposure to workplace hazards among three migrant worker groups and to assess whether social disparities in exposure for these groups remain after adjusting for occupational characteristics. METHODS: Data were collected in 2017/2018 from 1630 Australian workers born in New Zealand, India, and the Philippines. Weighted estimated prevalence of exposure to 10 carcinogens and four psychosocial hazards (discrimination, job strain, vulnerability, and insecurity) was calculated for sociodemographics and occupation. Regression estimated the likelihood of exposure by sociodemographics after adjustment for occupational characteristics. RESULTS: Exposure to workplace hazards ranged from 11.7% (discrimination) to 61.2% (exposed to at least one carcinogen). Compared with workers born in India, New Zealand born workers were over twice as likely to be exposed to diesel engine exhaust (adjusted odds ratio [aOR] = 2.60) and 60% more likely to be exposed to at least one carcinogen (aOR = 1.60) but less likely to be exposed to any psychosocial hazard. Social disparities by country of birth, sex, age, education, and number of years in Australia, as well as company size, employment type, and hours, worked remained associated with greater likelihood of reporting one or more workplace hazards after adjusting for occupational characteristics. CONCLUSION: Examining sociodemographic as well as occupational characteristics helps to clarify groups most likely to be exposed to workplace hazards who can be hidden when examining occupational characteristics alone.

Using Three Cross-Sectional Surveys to Compare Workplace Psychosocial Stressors and Associated Mental Health Status in Six Migrant Groups Working in Australia Compared with Australian-Born Workers.

Migrant workers may be more likely to be exposed to workplace psychosocial stressors (WPS) which have an affect on physical and mental health. Given the relative lack of research on this topic, the study objectives were to estimate and compare the prevalence of WPS in migrant and Australian workers and investigate associated mental health problems. Three cross-sectional surveys, two with migrant workers and one with Australian workers, were pooled to provide estimates of prevalence. Regressions were conducted to investigate associations between workers and WPS. All WPS, except unfair pay, were associated with higher probability of mental health problems. The association between WPS and mental health did differ between some migrant groups. Compared with Australian-born workers, all other migrant groups tended to have a lower risk of mental health outcomes. Interactions between WPS and migrants showed variable levels in the risk of having a mental health problem, some attenuated and some increased. The study showed that country of birth does play a part in how treatment in the workplace is perceived and responded to. Any interventions to improve workplace conditions for migrant workers need to be aware of the different experiences related to migrant ethnicity.

Using Cross-Sectional Data to Identify and Quantify the Relative Importance of Factors Associated with and Leading to Food Insecurity.

Australian governments routinely monitor population household food insecurity (FI) using a single measure-'running out of food at least once in the previous year'. To better inform public health planning, a synthesis of the determinants and how they influence and modify each other in relation to FI was conducted. The analysis used data from the Health & Wellbeing Surveillance System cross-sectional dataset. Weighted means and multivariable weighted logistic regression described and modelled factors involved in FI. The analysis showed the direction and strength of the factors and a path diagram was constructed to illustrate these. The results showed that perceived income, independent of actual income was a strong mediator on the path to FI as were obesity, smoking and other indicators of health status. Eating out three or more times a week and eating no vegetables more strongly followed FI than preceded it. The analysis identified a range of factors and demonstrated the complex and interactive nature of them. Further analysis using propensity score weighted methods to control for covariates identified hypothetical causal links for investigation. These results can be used as a proof of concept to assist public health planning.