Sobel tests were performed on each mediation interaction to test for statistical significance (Table S4), and all interactions' z-scores indicated P-values < 0.05.
However, respondents who are aware of grapefruit-mediation interactions for their prescribed medication are less likely to increase grapefruit consumption as age increases.
Unfortunately, more advanced methods that could address both mediation and interaction concurrently (i.e., exposure-mediator interactions) in a complex sampling design such as NHANES are not readily available.
In reality, for many diseases, mediated interaction and pure mediation will co-occur.
Nevertheless, we feel that these examples, though a simplification of actual disease processes, may serve as clinical illustrations of mediated interaction and pure mediation.
We then explore the theoretical difference between mediated interaction and pure mediation, since these effects seem very similar to each other but in fact are distinct entities.
The first example will illustrate the clinical difference between mediated interaction and pure mediation and involves the concepts of reversible and irreversible damage [ 4].
We therefore suggest researchers using causal mediation analysis to realize that mediated interaction might actually indicate relevant processes in the pathways under study.
The principal investigator used clarifying and probing questions when elements of the discussion were unclear, particularly when the discussion touched on mediation of interactions by the future teleconsultation technology.
In this paper, we focus on mediated interaction and contrast it against pure mediation.
Alternatively, at low levels of exposure the effect might be mediated interaction (reversible damage), whilst at high exposure level the effect may become pure mediation (irreversible damage).
