Socioeconomic determinants of health. The contribution of nutrition to inequalities in health

Sociodemographic differences in dietary habits described by food frequency questions — results from Denmark

OBJECTIVES

To investigate whether a modest number of food frequency questions are sufficient to describe sociodemographic differences in dietary habits, and to identify sociodemographic characteristics of subjects adhering to food-based dietary guidelines operationalised in a "healthy-diet index".

DESIGN

Cross-sectional population survey.

SUBJECTS

A total of 480 men, 515 women, aged 15-90 y. Random sample of private telephone numbers drawn from regional telephone records, geographically stratified. Participation rate 62%.

METHODS

Computer-assisted telephone interviews, including six food frequency questions, a question on type of fat spreads used on bread, questions on seven sociodemographic variables.

RESULTS

The summary of the healthy-diet index showed that the subjects who adhered to food-based dietary guidelines (top quintile) compared to those who did not (bottom quintile) were most often women (odds ratio (OR)=6.07; confidence interval (CI): 3.91-9.43, women vs men), of older age (OR=9.72; CI: 3.02-31.31, old age vs young), highly educated (OR=3.69; CI: 1.53-8.92, high education vs low) and living in multiperson households including children (OR=4.66; CI: 2.47-8.80, multiperson household vs single household). The results also showed that gender difference in dietary habits is associated with other sociodemographic variables.

CONCLUSIONS

The selected food frequency questions proved sufficient to describe sociodemographic differences in dietary habits, and this method may be a valuable supplement to traditional quantitative dietary surveys in monitoring sociodemographic changes in eating patterns. The results also underline the influence of sociodemographic status on dietary habits.

SPONSORSHIP

The Danish Nutrition Council funded the study.

Overnight deep body temperature and urinary cortisol excretion in infants from economically deprived areas

OBJECTIVES

To assess the pattern of postnatal physiological maturation in economically deprived infants by measuring the age-related changes in deep body temperature during night-time sleep.

SETTING

Inner city Leicester, UK.

PARTICIPANTS

Forty-eight infants aged 6-21 weeks from economically deprived areas and 87 control infants from more affluent areas.

OUTCOME MEASURES

Average deep body temperature between 2 and 4 h after bedtime, overnight and early morning urinary cortisol excretion.

RESULTS

Both groups showed a decline in overnight deep body temperature with age that averaged 0.030 degrees C per week (SE = 0.003). Over the age range studied, the average age-adjusted overnight temperature in the infants from deprived homes was 0.090 degrees C (SE = 0.028) higher than that for the affluent group (P = 0.001). Deprived infants had on average 51% higher overnight urinary cortisol and 80% higher morning cortisol. The differences remained when the effects of room temperature, clothing, smoking, birthweight and gestational age were taken into account.

CONCLUSION

These indicators of postnatal physiological maturation suggest that infants from economically deprived homes mature less quickly. This might increase their vulnerability to illness.

An examination of at-home food preparation activity among low-income, food-insecure women

A secondary analysis of data from a study of nutritional vulnerability among 153 women in families seeking charitable food assistance was undertaken to estimate the extent and nutritional significance of at-home food preparation activity for these women. At-home food preparation was estimated from women's reported food intakes from three 24-hour recalls. The relationships between food preparation and energy and nutrient intake, food intake, and 30-day household food security status were characterized. Almost all participants (97%) consumed foods prepared from scratch at least once during the three days of observation; 57% did so each day. Both the frequency and complexity of at-home food preparation were positively related to women's energy and nutrient intakes and their consumption of fruits and vegetables, grain products, and meat and alternates. The intakes by women in households with food insecurity with hunger reflected less complex food preparation but no less preparation from scratch than women in households where hunger was not evident, raising questions about the extent to which food skills can protect very poor families from food insecurity and hunger. Our findings indicate the need for nutrition professionals to become effective advocates for policy reforms to lessen economic constraints on poor households.

Association of education with dietary intake among young adults in the bi-ethnic Coronary Artery Risk Development in Young Adults (CARDIA) cohort

OBJECTIVE

To examine associations of changes in dietary intake with education in young black and white men and women.

DESIGN

The Coronary Artery Risk Development in Young Adults (CARDIA) study, a multi-centre population-based prospective study. Dietary intake data at baseline and year 7 were obtained from an extensive nutritionist-administered diet history questionnaire with 700 items developed for CARDIA.

SETTING

Participants were recruited in 1985-1986 from four sites: Birmingham, Alabama; Chicago, Illinois; Minneapolis, Minnesota; and Oakland, California.

SUBJECTS

Participants were from a general community sample of 703 black men (BM), 1006 black women (BW), 963 white men (WM) and 1054 white women (WW) who were aged 18-30 years at baseline. Analyses here include data for baseline (1985-1986) and year 7 (1992-1993).

RESULTS

Most changes in dietary intake were observed among those with high education (>or=12 years) at both examinations. There was a significant decrease in intake of energy from saturated fat and cholesterol and a significant increase in energy from starch for each race-gender group (P<0.001). Regardless of education, taste was considered an important influence on food choice.

CONCLUSION

The inverse relationship of education with changes in saturated fat and cholesterol intakes suggests that national public health campaigns may have a greater impact among those with more education.

A systematic review of socioeconomic differences in food habits in Europe: consumption of cheese and milk

OBJECTIVE

To assess differences in cheese and milk consumption across socioeconomic groups in representative samples from several European countries.

DESIGN

A meta-analysis of published and unpublished surveys of food habits performed in nine European countries between 1985 and 1999. Educational and occupational levels were used as indicators of socio-economic status.

RESULTS

A higher socioeconomic status was associated with a greater consumption of cheese. The pooled estimate of the difference in cheese consumption between women in the highest vs the lowest educational level was 9.0 g/day (95% CI: 7.1 to 11.0). The parallel observation in men was 6.8 g/day (95% CI: 3.4 to 10.1). Similar results were obtained using occupation as an indicator of socioeconomic status. The pooled estimates of the higher cheese consumption among subjects belonging to the highest (vs the lowest) occupational level were 5.1 g/day (95% CI: 3.7 to 6.5) in women and 4.6 g/day (95% CI: 2.1 to 7.0) in men. No statistically significant associations were found for milk consumption concerning educational or occupational level.

CONCLUSIONS

Our findings suggest that consumption of cheese is likely to be higher among subjects belonging to higher socioeconomic levels. We did not find enough evidence to support that milk intake is different according to educational or social levels.

Heat or eat? Cold-weather shocks and nutrition in poor American families

OBJECTIVES

The authors sought to determine the effects of cold-weather periods on budgets and nutritional outcomes among poor American families.

METHODS

The Consumer Expenditure Survey was used to track expenditures on food and home fuels, and the Third National Health and Nutrition Examination Survey was used to track calorie consumption, dietary quality, vitamin deficiencies, and anemia.

RESULTS

Both poor and richer families increased fuel expenditures in response to unusually cold weather. Poor families reduced food expenditures by roughly the same amount as their increase in fuel expenditures, whereas richer families increased food expenditures.

CONCLUSIONS

Poor parents and their children spend less on and eat less food during cold-weather budgetary shocks. Existing social programs fail to buffer against these shocks.

Social diversity of Irish adults nutritional intake

OBJECTIVE

The first health and lifestyle survey of Irish adults was carried out in 1998 and aimed to describe the health-related lifestyle behaviours of a cross-section of various population strata residing in the Republic of Ireland. This paper reports on the social variation in nutrient intake.

DESIGN

A self-administered postal questionnaire, including a 149 food item semiquantitative food frequency section, from which nutrient intakes were estimated based on McCance and Widdowson food composition tables.

SETTING

Community-based adults aged 18 years and over residing in the Republic of Ireland on the Register of Electors.

SUBJECTS

A stratified sample of adults on the Register of Electors received the questionnaire, of which 6539 (62%) were returned.

RESULTS

The contribution of fat to total energy intake increased with decreasing socioeconomic grouping, a finding reflective of the higher consumption levels of foods high in fat by respondents from socially disadvantaged groups. Energy from carbohydrates was greatest among those from socially advantaged groups, and was close to the recommended 50% of the total energy intake. Conversely, energy from protein decreased with increasing social status group. The mean intake of vitamins and minerals was generally close to or above the recommended values. Significant variation was observed among females across the different levels of education, whereas living with someone appeared to influence the micronutrient intake of males. The reported diets of males and females over the age of 65 years were lacking in vitamin D. Mean calcium levels among males were borderline and females over the age of 65 years had mean dietary iron levels below the recommended intake.

CONCLUSIONS

For the first time, quantification of nutrient intake in the different social groups in Ireland has been undertaken. A healthy balance of energy derived from fat, protein and carbohydrate is best achieved among respondents from higher social positions. The positive relation observed with healthy food intake and increasing education level was also present in macronutrient intake and a clear gender and social support interplay was seen in the nutrient intake levels.

Selection of reference foods for a scale of standards for use in assessing the transitional process from milk to solid food in infants and pre-school children

OBJECTIVE

This paper describes the development of a reliable scale of standards for use in evaluating the progress of the transition from milk to solid food in infants and preschool children. The maturation of chewing and swallowing behavior in infants and young children, which enables processing of solid food, varies, and a scale would assist not only in the instruction of mothers and nurses but also in preventing delay in the introduction of solid food.

DESIGN

A range of 159 reference foods were selected on the basis of intake during the period of transition from liquid to solid food. These foods were listed in our previous study, Validity and reliability were tested to create a scale.

METHODOLOGY

Foods were selected on the basis of 50% of the subjects studied being able to eat them, and on the food groups classified by cluster analyses using the Varclus procedure of SAS. Validity, of the scale was tested by using Pearson's correlation coefficient between the scale score of selected food items and the total score of all 159 food items. The total score of 159 food items was calculated using the general linear models (GLM) procedure of SAS. Reliability was tested using Cronbach's coefficient alpha.

SETTING

Public health centers in Aomori, Tokyo, Saitama, Nagano, and Okinawa (Japan).

SUBJECT

Five hundred and eighty healthy mothers and children from 2 to 46 months were randomly selected and 470 (81.0%) completed the study. To avoid regional bias, subjects were drawn from northern to southern prefectures in Japan, namely Aomori, Tokyo, Saitama, Nagano, and Okinawa.

RESULTS

Twenty food items were selected. By analyzing the score correlation using Pearson's correlation coefficient (R =0.97, P <0.001) and GLM (R2 =0.95, P <0.001), it was confirmed that these 20 food items adequately represented the original 159. The reliability was also found to be sufficient (Cronbach's coefficient alpha=0.96).

CONCLUSIONS

The findings demonstrate that a scale of standards for measuring progress in chewing ability can be created using 20 food items. Such a standard will provide a useful basis against which to assess delay of solid food introduction in childhood.

SPONSORSHIP

Grant-in-Aid for Scientific Research, provided by the Japanese Ministry of Education, Science and Culture, Project No. 07838030.

Heat or eat? Cold-weather shocks and nutrition in poor American families

OBJECTIVES

The authors sought to determine the effects of cold-weather periods on budgets and nutritional outcomes among poor American families.

METHODS

The Consumer Expenditure Survey was used to track expenditures on food and home fuels, and the Third National Health and Nutrition Examination Survey was used to track calorie consumption, dietary quality, vitamin deficiencies, and anemia.

RESULTS

Both poor and richer families increased fuel expenditures in response to unusually cold weather. Poor families reduced food expenditures by roughly the same amount as their increase in fuel expenditures, whereas richer families increased food expenditures.

CONCLUSIONS

Poor parents and their children spend less on and eat less food during cold-weather budgetary shocks. Existing social programs fail to buffer against these shocks.

Nutrition before birth, programming and the perpetuation of social inequalities in health

The need to explain social inequalities in health has led to the theory that chronic disease is due, in part, to a legacy of adverse experiences in early life. Epidemiological studies show consistently that individuals who are small at birth have an increased risk of cardiovascular disease in adulthood. There is growing consensus that this association reflects a causal relationship and is not simply the product of bias or confounding. The concept of programming is invoked as the biological mechanism; birth size is thus a proxy for fetal programming. Recent findings suggest that fetal programming interacts with the post-birth environment. The adverse exposures that are thought to underlie and potentiate programming cluster in socially patterned ways, thus creating substantial inequalities in health. Experiments in animals demonstrate that nutritional interventions before or during pregnancy can produce programming phenomena in the offspring, sometimes without an impact on birth size. However, the extent to which maternal nutrition contributes to programming in contemporary developed countries is uncertain.

Effects of low income on infant health

BACKGROUND

Few population-based studies have analyzed the link between poverty and infant morbidity. In this study, we wanted to determine whether inadequate income itself has an impact on infant health.

METHODS

We interviewed 2223 mothers of 5-month-old children participating in the 1998 phase of the Quebec Longitudinal Study of Child Development to determine their infant's health and the sociodemographic characteristics of the household (including household income, breast-feeding and the smoking habits of the mother). Data on the health of the infants at birth were taken from medical records. We examined the effects of household income using Statistics Canada definitions of sufficient (above the low-income threshold), moderately inadequate (between 60% and 99% of the low-income threshold) and inadequate (below 60% of the low-income threshold) income on the mother's assessment of her child's overall health, her report of her infant's chronic health problems and her report of the number of times, if any, her child had been admitted to hospital since birth. In the analysis, we controlled for factors known to affect infant health: infant characteristics and neonatal health problems, the mother's level of education, the presence or absence of a partner, the duration of breast-feeding and the mother's smoking status.

RESULTS

Compared with infants in households with sufficient incomes, those in households with lower incomes were more likely to be judged by their mothers to be in less than excellent health (moderately inadequate incomes: adjusted odds ratio [OR] 1.5, 95% confidence interval [CI] 1.1-2.1; very inadequate incomes: adjusted OR 1.8, 95% CI 1.3-2.6). Infants in households with moderately inadequate incomes were more likely to have been admitted to hospital (adjusted OR 1.8, 95% CI 1.2-2.6) than those in households with sufficient incomes, but the same was not true of infants in households with very inadequate incomes (adjusted OR 0.7, 95% CI 0.4-1.2). Household income did not significantly affect the likelihood of an infant having chronic health problems.

INTERPRETATION

Less than sufficient household incomes are associated with poorer overall health and higher hospital admission rates among infants in the first 5 months of life, even after adjustment for factors known to affect infant health, including the mother's level of education.

Socioeconomic disparities in cancer-risk behaviors in adolescence: baseline results from the Health and Behaviour in Teenagers Study (HABITS)

BACKGROUND

This study explores the association between socioeconomic deprivation and five factors associated with long-term risk of cancer, in adolescents.

METHODS

BMI, fat intake, fruit and vegetable intake, smoking, and exercise were assessed in 4320 students ages 11 to 12, from 36 schools, in the first year of a 5-year longitudinal study of the development of health behaviors (HABITS study). Neighborhood socioeconomic deprivation for each student's area of residence was matched to their postcode (zip code). We used multiple logistic regression analyses to investigate the relationship between risky behaviors and socioeconomic circumstances.

RESULTS

Univariate analyses showed boys and girls from more deprived neighborhoods were more likely to have tried smoking, to eat a high fat diet, and to be overweight. Girls living in more deprived areas were also less likely to eat five servings of fruit and vegetables or to exercise at the weekend. Most differences persisted after controlling for ethnicity. A clear deprivation gradient emerged for each risk factor, indicating the linear nature of the relationship.

CONCLUSIONS

This study demonstrates the influence of deprivation on engaging in cancer-risk health behaviors. These patterns may set young people from more socioeconomically deprived social environments on a trajectory leading to increased cancer mortality in adult life.

Toothbrushing as part of the adolescent lifestyle predicts education level

Socio-economic differences in health and health behavior are well-known. Our hypothesis was that toothbrushing frequency in adolescents predicts their education level in adulthood. The aim was also to study the role of toothbrushing in adolescents' health-related lifestyle. Data from nationally representative samples of 12- to 16-year-olds (N = 11,149) were linked with register data on the highest level of education attained at age 27-33 years. Adolescents with a low toothbrushing frequency reached only the lowest education levels. School achievement or sociodemographic background only partly accounted for the association. Exploratory factor analysis found four dimensions of health behaviors. At age 12, a low toothbrushing frequency was loaded highly with "street-oriented" behaviors, concentrated around smoking and alcohol use. At ages 14 and 16, it was associated with a "traditional" lifestyle of the less-well-educated. Altogether, a low toothbrushing frequency indicated selection into the less-well-educated stratum of society. This is likely to be reflected in socio-economic health differences in adulthood.

Economy, community and mortality in British Columbia, Canada

Stimulated by the growing body of literature relating economic inequalities to inequalities in health, this article explores relationships between various economic attributes of communities and mortality rates among 24 coastal communities in British Columbia, Canada. Average household income, a measure of community wealth, was negatively related and the incidence of low incomes, a measure of poverty, was positively related to age-standardized mortality. Both were more strongly related to female than male mortality. Mean and median household income, the incidence of low incomes and a lack of disposable income, and the proportion of total income dollars derived from government sources were significantly related to mortality rates for younger and middle-aged men but not for elderly men. Mortality rates for younger and middle-aged women were not explicated by these economic attributes of communities: among elderly women only, mortality rates were higher in communities with a lower average household income and in those with a higher incidence of low incomes. Finally, a higher concentration in white-collar industries was related to higher mortality rates for females, even after controlling for other economic attributes of communities. These results do not obviously support a psychosocial argument for an individual-level relationship between income and health that assumes residents perceive their status primarily in relation to other members of the same community, but do provide moderate support for the materialist argument and moderate support for the psychosocial argument that assumes community residents perceive their status in relation to an encompassing reference group. Other viable interpretations of these relationships pertain to ecological characteristics of communities that are related to both economic well-being and population health status; in this instance, concentration in specific economic industries may help to understand the ecological relationships presented here.

Socioeconomic differences in dietary patterns among middle-aged men and women

The aim of the study is to (i) identify common dietary patterns, (ii) study socioeconomic differences in these dietary patterns, and (iii) assess whether they contribute to socioeconomic differences in biological risk factors. The data come from the Whitehall II study of London civil servants, who participated in the third phase (1991-1993) and were 39-63-years old (N=8004). Food frequency questionnaire and socioeconomic background information was from a questionnaire, and biological risk factors from a medical screening. Six dietary patterns were identified. In reference to high employment grade men, the odds ratios of low grade men consuming the 'unhealthy' or the 'very unhealthy' diet were 1.26 and 3.34, respectively, while the odds for the 'French' diet was 0.13. Among women the corresponding odds were 2.98, 6.19 and 0.25. Adjusting for spouse's socioeconomic status and to a lesser extent smoking and exercise as well as job control attenuate these grade differences somewhat. Among men and women adjusting for dietary patterns accounted for about 25-50 per cent of grade differences in HDL and serum triglyceride levels.

Obesity and underweight among Brazilian elderly: the Bambuí Health and Aging Study

The coexistence of obesity (body mass index, BMI > or = 30kg/m²) and underweight (BMI <= 20kg/m²) and related factors were investigated among all residents aged 60+ years in Bambuí, Minas Gerais State, using multinomial logistic regression. 1,451 (85.5%) of the town's elderly participated. Mean BMI was 25.0 (SD = 4.9kg/m²) and was higher for women and decreased with age. Prevalence of obesity was 12.5% and was positively associated with female gender, family income, hypertension, and diabetes and inversely related to physical activity. Underweight affected 14.8% of participants, increased with age, and was higher among men and low-income families. It was negatively associated with hypertension and diabetes and directly associated with Trypanosoma cruzi infection and > or = 2 hospitalizations in the previous 12 months. Both obesity and underweight were associated with increased morbidity. The association of underweight with T. cruzi infection, increased hospitalization, and low family income may reflect illness-related weight loss and social deprivation of elderly in this community. Aging in poverty may lead to an increase in nutritional deficiencies and health-related problems among the elderly.

Fat and sugar: an economic analysis

As incomes rise, the share of income spent on food decreases. To Engel's law should be added the observation that the diet structure changes as well. Incomes and the macronutrient composition of the diet are linked at the aggregate and-most likely-the individual level. People in higher income nations consume more added sugars and fats than do people in lower income nations. Lower income consumers within rich nations consume lower-quality diets than do higher income consumers. The lowering of energy costs ($/MJ) through technological innovation has been most marked for foods containing added sugars and fat. Although wealthier persons in poor nations are more likely to be overweight, obesity in the United States is associated with lower incomes. Obesity in the United States and similar societies may be a socioeconomic, as opposed to a medical, problem and one that is related to diet structure and diet costs.

The role of energy density

Dietary energy density (ED) appears to have a major influence on the regulation of food intake and body weight. If people consume a fixed weight of food each day, then high-ED diets should be associated with high energy intakes and with overweight. In contrast, low-ED diets should result in lower daily energy intakes and therefore weight loss. For this approach to work, low-ED foods must be as palatable as high-ED foods and, calorie for calorie, have a greater satiating power. Each of those assumptions is debatable. Dietary ED depends chiefly on the water content of foods. As a rule, high-ED foods are more palatable but less satiating, whereas low-ED foods are more satiating but less palatable. Consumer preferences for high-ED foods can be explained in terms of good taste, low cost, and convenience. Low-ED foods, such as fresh produce, provide less energy per unit cost than do high-ED foods, which often contain added sugars and fats. Poverty and obesity may well be linked through the habitual consumption of a low-cost, high-ED diet.

Socio-economic status, dietary intake and 10 y trends: the Dutch National Food Consumption Survey

OBJECTIVE

To study differences in dietary intake between adults with different socioeconomic status (SES) and trends over time.

DESIGN

Cross-sectional study based on data of three Dutch National Food Consumption Surveys (DNFCS-1 1987/88; DNFCS-2 1992; DNFCS-3 1997/98), obtained from a panel by a stratified probability sample of the non-institutionalized Dutch population.

SUBJECTS

A total of 6008 men and 6957 women aged 19 y and over.

METHODS

Dietary intake was assessed with a 2 day dietary record. Background information was obtained by structured questionnaire. Sociodemographic variables were available from panel information. SES, based on educational level, occupation and occupational position was categorized into (very) low, middle and high. Analysis of variance with age as covariable was used to explore the effects of SES on dietary intake and anthropometry. Statistical tests for trend were carried out with models in which week-weekend-day effects and an interaction term of time with SES were also included.

RESULTS

The prevalence of obesity and skipping of breakfast was higher among people with a low SES. In all three surveys, subjects in the (very) low SES group reported having a higher consumption of potatoes, meat and meat products, visible fats, coffee and soft drinks (men only). Subjects with a high SES reported consuming more vegetables, cheese and alcohol. As regards nutrients, in all surveys a higher SES was associated with higher intake of vegetable protein, dietary fibre and most micronutrients. A higher SES was also associated with a lower fat intake but the differences between social classes were rather small and not consistent when the contribution of alcohol to energy intake was taken into account.

CONCLUSION

In general, dietary intake among subjects in higher SES groups tended to be closer to the recommendations of the Netherlands Food and Nutrition Council and this phenomenon was quite stable over a period of 10 y.

A cost constraint alone has adverse effects on food selection and nutrient density: an analysis of human diets by linear programming

Economic constraints may contribute to the unhealthy food choices observed among low socioeconomic groups in industrialized countries. The objective of the present study was to predict the food choices a rational individual would make to reduce his or her food budget, while retaining a diet as close as possible to the average population diet. Isoenergetic diets were modeled by linear programming. To ensure these diets were consistent with habitual food consumption patterns, departure from the average French diet was minimized and constraints that limited portion size and the amount of energy from food groups were introduced into the models. A cost constraint was introduced and progressively strengthened to assess the effect of cost on the selection of foods by the program. Strengthening the cost constraint reduced the proportion of energy contributed by fruits and vegetables, meat and dairy products and increased the proportion from cereals, sweets and added fats, a pattern similar to that observed among low socioeconomic groups. This decreased the nutritional quality of modeled diets, notably the lowest cost linear programming diets had lower vitamin C and beta-carotene densities than the mean French adult diet (i.e., <25% and 10% of the mean density, respectively). These results indicate that a simple cost constraint can decrease the nutrient densities of diets and influence food selection in ways that reproduce the food intake patterns observed among low socioeconomic groups. They suggest that economic measures will be needed to effectively improve the nutritional quality of diets consumed by these populations.

Socioeconomic differences in food purchasing behaviour and suggested implications for diet-related health promotion

BACKGROUND

The relationship between socioeconomic position (SEP) and diet has been examined mainly on the basis of food and nutrient intake. As a complement to this work, we focused on the socioeconomic patterning of food purchasing, as many educational dietary messages emphasize behaviours such as food choice when shopping. Also, the type of food people buy influences the quality of their nutrient intake.

METHODS

A probability sample of households in Brisbane City, Australia (n = 1003, 66.4% response rate). Data were collected using face-to-face interviews. SEP was measured using education, occupation and household income. Food purchasing was examined on the basis of grocery items (including meat and chicken) and fruit and vegetables.

RESULTS

Significant associations were found between each socioeconomic indicator and food purchasing. Persons from socioeconomically disadvantaged backgrounds were less likely to purchase grocery foods that were comparatively high in fibre and low in fat, salt and sugar. The least educated, those employed in blue-collar (manual) occupations and residents of low income households purchased fewer types of fruit and vegetables, and less regularly, than their higher status counterparts.

CONCLUSIONS

Health promotion efforts aimed at narrowing socioeconomic differences in food purchasing need to be designed and implemented with an understanding of, and a sensitivity to, the barriers to nutritional improvement that difficult life circumstances can impose.

Disparities in food habits across Europe

Socially-and culturally-patterned differences in food habits exist both between and within European populations. Daily individual food availability data, collected through the national household budget surveys (HBS) and harmonized in the context of the Data Food Networking (DAFNE) project, were used to assess disparities in food habits of seven European populations and to evaluate dietary changes within a 10-year interval. The availability of selected food items was further estimated according to the educational level of the household head and, based only on the Greek HBS data, according to quintiles of the household's food purchasing capacity. Results for overall food availability support the north-south differentiation in food habits. Generally, the availability of most food items, including foods such as vegetable fats, animal lipids and sugar products, has decreased over the 10 years. Households in which the head was in the higher education categories reported lower availability for most food items, with the exception of low-fat milk, fresh fruit, animal lipids and soft drinks; the latter showing a sharp increase even within southern European households. The household's food purchasing capacity can be used as an indicator of socio-economic status, with higher values being associated with lower status. Greek households of lower social class follow a healthier diet in terms of greater availability of vegetable oils, fresh vegetables, legumes, fish and seafood. Data from the DAFNE databank may serve as a tool for identifying and quantifying variation in food habits in Europe, as well as for providing information on the socio-economic determinants of food preferences.

Position of the American Dietetic Association: the role of dietetics professionals in health promotion and disease prevention

In the United States, the leading determinants of morbidity and mortality are rooted in behavioral choices related to eating habits, exercise, tobacco, alcohol consumption, and stress reduction. Scientific data consistently provide evidence that diet plays an important role in health promotion and disease prevention. Healthy eating habits--coupled with other healthful lifestyle behaviors--have the potential to reduce the risk of chronic disease. Health care typically assumes a curative or treatment role in the United States. However, dietetics professionals are shaping an alternate view of health, which includes developing healthy public policies, creating safe and supportive environments, building communities and coalitions, and reorienting health services to include health promotion as a primary approach to delivering health care. Individual-level approaches, such as counseling and group education, have been employed most often in modifying health behaviors. However, population-level approaches that affect availability of or access to healthy foods, opportunities for physical activity, and other healthy lifestyle determinants also are important. Dietetics professionals have pivotal roles in both individual- and population-level approaches.

Income inequality and health. Coastal communities in British Columbia, Canada

OBJECTIVE

An imbalance in the distribution of economic resources, i.e., income inequality, is a characteristic of a community that may influence the aggregate health of the population. In North America, income inequality seems to be strongly related to mortality rates among American communities such as states and metropolitan areas but largely irrelevant for health at similar levels of geopolitical aggregation in Canada. This article summarizes relevant international and North American evidence and then explores relationships between income inequality and mortality rates among coastal communities in the province of British Columbia, Canada.

METHODS

Cross-sectional analysis was conducted among twenty-four coastal communities in British Columbia, utilizing four measures based on the 1996 Census to measure income inequality and crude, age-standardized and age- and gender-specific mortality rates averaged over the five-year period 1994-98 to measure health.

RESULTS

The three valid measures of income inequality were positively and significantly related to the crude mortality rate but were not significantly related to the age-standardized mortality rate. Two of the inequality measures were related to mortality rates for males aged 0-44 and for males aged 45-64 before but not after controlling for mean household income.

DISCUSSION

Health researchers have yet to report a meaningful relationship between income inequality and population health within Canada. At the risk of committing the ecological fallacy, these findings provisionally support a psycho-social interpretation of the individual-level relationship between income and health wherein members of these communities compare themselves to an encompassing community, e.g., all Canadians.

Socioeconomic differences among Australian adults in consumption of fruit and vegetables and intakes of vitamins A, C and folate

OBJECTIVE

To determine whether socioeconomic groups differ in their food intakes for fruit and vegetables, their consumption of fruit and vegetables dense in vitamin A, folate and vitamin C, and their nutrient intakes of vitamin C, folate and vitamin A.

METHODS

The 1995 Australian National Nutrition Survey collected food intake data from 8883 adults aged 18-64 years using a 24-h dietary recall. Fruit and vegetables were measured as amount (g) consumed. Intakes of nutrients were estimated from the 24-h dietary recall data. Participants were categorized by whether or not they consumed fruit or vegetables high in vitamin A, folate and vitamin C. Gross annual household income was used to measure socioeconomic position.

RESULTS

Participants from low-income households consumed a smaller quantity of fruit and vegetables. They were also less likely to consume fruit and vegetables high in vitamin C, folate and vitamin A. Consistent with these findings, men and women from disadvantaged socioeconomic groups had lower intakes of vitamin C and folate compared with their more affluent counterparts. These differences were small to moderate in magnitude. Vitamin A intakes were not significantly related to income.

CONCLUSION

As well as promoting healthy dietary practices, nutrition-promotion strategies should target the nutrient intakes of lower socioeconomic groups. These programmes should focus on improving the quantity and choice of fruit and vegetables consumed by people from low-income households.

Socio-economic differences in fruit and vegetable consumption among Australian adolescents and adults

OBJECTIVES

To determine whether socio-economic groups differ in their fruit and vegetable consumption, and the variety eaten, and whether socio-economic differences are similar for adolescents and adults. The study also examined whether socio-economic groups vary in their reported desire to increase the amount of fruit and vegetables consumed, and the perceived barriers to achieving this.

DESIGN, SETTING AND SUBJECTS

The 1995 Australian National Nutrition Survey collected fruit and vegetable intake data from adolescents aged 13-17 years and adults 18-64 years using a 24-hour dietary recall. Gross annual household income was used to measure socio-economic position.

RESULTS

Approximately 44% of males and 34% of females did not consume fruit in the 24 hours preceding the survey, and 20% of males and 17% of females did not consume vegetables. Among adolescents and adults, fruit and vegetable consumption was positively related to income. The only exception was vegetable consumption among adolescent males, which did not vary by income. Lower-income adults consumed a smaller variety of fruits and vegetables than their higher-income counterparts. Fruit and vegetable variety did not vary by income among adolescents. Lower-income adults expressed less desire to increase their fruit and vegetable consumption, and were more likely to report that price and storage were barriers to doing so. Socio-economic differences in consumption and variety were more apparent for adults than for adolescents.

CONCLUSIONS

In addition to increasing the consumption of fruits and vegetables among the general population, nutrition interventions, programmes and policy aiming to improve diet should target adolescents and adults from low socio-economic groups. Strategies should address price and storage barriers.

Income inequality and health. Coastal communities in British Columbia, Canada

OBJECTIVE

An imbalance in the distribution of economic resources, i.e., income inequality, is a characteristic of a community that may influence the aggregate health of the population. In North America, income inequality seems to be strongly related to mortality rates among American communities such as states and metropolitan areas but largely irrelevant for health at similar levels of geopolitical aggregation in Canada. This article summarizes relevant international and North American evidence and then explores relationships between income inequality and mortality rates among coastal communities in the province of British Columbia, Canada.

METHODS

Cross-sectional analysis was conducted among twenty-four coastal communities in British Columbia, utilizing four measures based on the 1996 Census to measure income inequality and crude, age-standardized and age- and gender-specific mortality rates averaged over the five-year period 1994-98 to measure health.

RESULTS

The three valid measures of income inequality were positively and significantly related to the crude mortality rate but were not significantly related to the age-standardized mortality rate. Two of the inequality measures were related to mortality rates for males aged 0-44 and for males aged 45-64 before but not after controlling for mean household income.

DISCUSSION

Health researchers have yet to report a meaningful relationship between income inequality and population health within Canada. At the risk of committing the ecological fallacy, these findings provisionally support a psycho-social interpretation of the individual-level relationship between income and health wherein members of these communities compare themselves to an encompassing community, e.g., all Canadians.

Childhood obesity: public-health crisis, common sense cure

During the past two decades, the prevalence of obesity in children has risen greatly worldwide. Obesity in childhood causes a wide range of serious complications, and increases the risk of premature illness and death later in life, raising public-health concerns. Results of research have provided new insights into the physiological basis of bodyweight regulation. However, treatment for childhood obesity remains largely ineffective. In view of its rapid development in genetically stable populations, the childhood obesity epidemic can be primarily attributed to adverse environmental factors for which straightforward, if politically difficult, solutions exist.

Is there a relationship between the food intakes of Scottish 5(1/2)-8(1/2)-year-olds and those of their mothers?

BACKGROUND

Recent reports have highlighted certain aspects of the diets of children and adults in Scotland today that are a cause for concern. If there are significant associations between family members in food choice and thus in nutrient intakes, this may be important in the aetiology and prevention of diseases relating to dietary risk factors.

AIM

To compare the food intake of Scottish children aged 5(1/2)-8(1/2) years with that of their mothers.

METHODS

As part of a larger study, data on food intakes were obtained from 4-day weighed food records for 36 Scottish children (12 boys and 24 girls), aged 5(1/2)-8(1/2) years, who had participated in the 1992/1993 National Diet and Nutrition Survey (NDNS), and their mothers.

RESULTS

Compared with their mothers, children had higher median densities [weight (g) of foods per 4.2 MJ (1000 kcal)] of snack foods including fruit, bread and confectionery and lower median densities of meat and meat products, fish, potatoes and vegetables. Positive, significant correlations between children and mothers were found for median densities of bread (r = 0.360, P < 0.05), fruit (r = 0.735, P < 0.001) and potatoes (r = 0.572, P < 0.001) and also for chips (r = 0.651, P < 0.001) and chocolate confectionery (r = 0.368, P < 0.05), the latter two being foods that should be reduced in the average Scottish diet.

CONCLUSIONS

Children's intakes of snack foods were correlated with that of their mothers emphasizing the need for change at a family level if current guidelines on diet are to be implemented.

Stakeholder interactions and the development of functional foods

OBJECTIVE

This paper investigates the roles of the individual stakeholders involved in the development of functional foods and the implications of their actions for public perception of this new food concept.

RESULTS

At a time when consumer awareness of the link between diet and health is strong, a new food concept incorporating of a wide spectrum of foods has captured the imagination of the food industry and consumers alike. Functional foods provide a new category of foods that appear to be offering the public the opportunity to achieve a healthy lifestyle with minimal effort. Public perception may determine whether this new food concept is to become the next successful breakthrough in nutritional science or just another marketing gimmick devised by food manufacturers. The paper also addresses issues that arise directly as a result of the emergence of functional foods, such as appropriate legislation in connection to health claims in order to ensure consumer protection and also the lack of clarity in relation to definitions of what constitutes a functional food.

CONCLUSION

The paper concludes that functional foods can only reach their maximum potential if the food industry, government and health professionals work together to improve communication between themselves and consumers and also to educate consumers, thereby allowing them to make informed decisions about dietary choices.

Sociodemographic diversity and behavioral medicine

The broad array of economic and cultural diversity in the U.S. population correlates with and impacts on the study of behavioral aspects of health. The purpose of this article was to provide a selective overview of behavioral medicine research on sociodemographically diverse populations, with a focus on ethnicity, gender, and socioeconomic status. Suggestions are provided with regard to methodological refinement of research and insights into possible future directions in behavioral medicine research on ethnically and economically diverse populations.

Impact of socioeconomic deprivation on outcome after surgery for colorectal cancer

BACKGROUND

Previous studies have demonstrated that socioeconomic deprivation is associated with poorer survival in patients with colorectal cancer. These differences have been attributed to more advanced disease at presentation.

METHODS

A total of 2269 patients undergoing resection for colorectal cancer in hospitals in central Scotland between 1991 and 1994 were studied. Socioeconomic status was defined using the Carstairs deprivation index. The impact of deprivation on case mix, treatment and outcome was analysed.

RESULTS

There were no significant differences in mode of presentation, extent of disease at presentation, type of resection and postoperative mortality rate among the socioeconomic groups. Following curative resection, the overall survival rate at 5 years was 47.0 per cent in deprived patients, compared with 55.4 per cent in affluent patients (P = 0.05); the cancer-specific survival rate was 62.6 per cent in the deprived and 68.1 per cent in the affluent (P = 0.05). Compared with the affluent, the adjusted hazard ratios for the deprived were 1.36 (95 per cent confidence interval (c.i.) 1.09 to 1.69) for overall mortality and 1.26 (95 per cent c.i. 0.95 to 1.67) for cancer-specific mortality. Following palliative resection, there was no difference in survival between the affluent and deprived for either overall (P = 0.27) or cancer-specific (P = 0.89) mortality.

CONCLUSION

These findings confirm that the cancer-specific survival rate following surgery for colorectal cancer is lower in deprived patients. Stage of disease at presentation and type of operation did not account for this difference. The excess mortality was confined to patients undergoing apparently curative resection.

[Sociodemographic differences in adherence to the Mediterranean dietary pattern in Spanish populations]

OBJECTIVES

Lower social classes tend to eat a less healthy diet. The aim of this study was to compare adherence to the Mediterranean dietary pattern among different demographic and social groups in the adult population.

METHODS

A cross-sectional study was performed in southern and northern regions of Spain in healthy volunteers (15,634 men and 25,812 women), aged 29-69 years, who were members of the European Prospective Investigation on Cancer cohort in Spain. Nine groups of food were included in the definition of the Mediterranean diet: vegetables and garden products, fruits, pulses, cereals, red meat, fish, olive oil, milk and milk products, and wine. Two techniques were used in the analysis: comparison of the mean daily intake of each group and calculation of an overall score for all the foods according to educational level and original social class.

RESULTS

Groups with the lowest educational levels consumed more cereals and pulses and lower quantities of vegetables, olive oil (women), milk and milk products (men). Wine consumption was positively associated with education in women and was negatively associated in men. Calculation of a score to measure overall adherence to the Mediterranean dietary pattern eliminated differences according to each food category. No variations were found according to educational level, but small differences were found in original social class. The adherence score was lowest in young adults and women and was slightly higher in the south than in the north of Spain.

CONCLUSIONS

The results suggest that the Mediterranean dietary pattern is fairly uniform, at least in the adult population of the regions included in this study.

Obesity, diabetes and associated cardiovascular risk factors among Torres Strait Islander people

OBJECTIVE

To describe the lifestyle-related chronic disease and risk factor prevalence among Torres Strait Islander people of the Torres Strait and Northern Peninsula Area Health Service District and to compare this information with that available for the general Australian population.

METHODS

Voluntary community-based screening for persons aged 15 years and older, including oral glucose tolerance test, anthropometry, health questionnaire, measurement of lipids and lipoprotein levels, blood pressure and urinary albumin to creatinine ratio.

RESULTS

Nine communities participated in screening between 1993 and 1997. Five hundred and ninety-two participants (286 male and 306 female) identified as Torres Strait Islander. There were high prevalences of overweight (30%), obesity (51%), abdominal obesity (70%), diabetes (26%), hypercholesterolaemia (33%), albuminuria (28%), hypertension (32%) and tobacco smoking (45%). Only 8.5% of men and 6.5% of women were free of any cardiovascular risk factors (abdominal obesity, hypercholesterolaemia, hypertension, dyslipidaemia, smoking, diabetes, albuminuria). Comparisons of this information for Torres Strait Islander people with results from the AusDiab survey show rates of obesity three times higher and diabetes six times higher than for other Australians.

CONCLUSIONS

There is a very high prevalence of preventable chronic disease and associated risk factors among Torres Strait Islander people of the Torres Strait and Northern Peninsula Area.

IMPLICATIONS

Effective interventions to prevent and manage obesity, diabetes and associated cardiovascular risk factors are essential if the health of the Torres Strait Islander people is to improve. Such interventions could inform initiatives to stem the burgeoning epidemic of obesity and diabetes among all Australians.

An investigation into school children's knowledge and awareness of food and nutrition

With the diet and exercise behaviours of UK school children showing little improvement over recent years, the need for dietary change is clearly indicated. This study aimed to assess the nutritional knowledge and understanding of primary school children in order to identify the most effective format for future nutrition messages. A qualitative methodology was employed and 114 children, aged 7-11 years, took part in 23 focus groups separated by age, gender and socio-economic status (SES). Issues discussed included parental food rules, children's perceptions of 'good' and 'bad' foods, diet-disease links and food groupings. Across the groups restrictive food rules were most frequently reported whilst between groups gender and SES differences were apparent in relation to parental control over food and children's nutritional knowledge. The limitations of the children's cognitive development could be seen in their conceptualization of food groups, where concrete grouping schemes were frequently used, and in the lack of understanding inherent in their food-health or food-nutrient associations. Taste and preference were confirmed as consistent influences in children's food classification. Primary school children may be receptive to food based dietary guidelines based on familiar, concrete food classifications. These should be cognitively appropriate and possibly need to be gender specific.

Characterization of household food insecurity in Québec: food and feelings

This study was undertaken to understand food insecurity from the perspective of households who experienced it. The results of group interviews and personal interviews with 98 low-income households from urban and rural areas in and around Québec City, Canada, elicited the meaning of "enough food" for the households and the range of manifestations of food insecurity. Two classes of manifestations characterized the experience of food insecurity: (1) its core characteristics: a lack of food encompassing the shortage of food, the unsuitability of both food and diet and a preoccupation with continuity in access to enough food; and a lack of control of households over their food situation; and (2) a related set of potential reactions: socio-familial perturbations, hunger and physical impairment, and psychological suffering. The results substantiate the existence of food insecurity among Québecers and confirm that the nature of this experience is consistent with many of the core components identified in upstate New York. This study underlines the monotony of the diet, describes the feeling of alienation, differentiates between a lack of food and the reactions that it engenders, and emphasizes the dynamic nature of the experience.

Socio-economic determinants of selected dietary indicators in British pre-school children

OBJECTIVES

To assess the proportion of pre-school children meeting reference nutrient intakes (RNIs) and recommendations for daily intakes of iron, zinc, vitamins C and A, and energy from non-milk extrinsic sugars. To assess whether meeting these five dietary requirements was related to a series of socio-economic variables.

DESIGN

Secondary analysis of data on daily consumption of foods and drinks from the National Diet and Nutrition Survey (NDNS) of children aged 1.5-4.5 years based on 4-day weighed intakes.

SUBJECTS

One thousand six hundred and seventy-five British pre-school children aged 1.5-4.5 years in 1993.

RESULTS

Only 1% of children met all five RNIs/recommendations examined; 76% met only two or fewer. Very few children met the recommendations for intakes of zinc (aged over four years) and non-milk extrinsic sugars (all ages). The number of RNIs/recommendations met was related to measures of socio-economic class. Children from families in Scotland and the North of England, who had a manual head of household and whose mothers had fewest qualifications, met the least number of RNIs/recommendations.

CONCLUSIONS

Very few pre-school children have diets that meet all the RNIs and recommendations for iron, zinc, vitamins C and A, and energy from non-milk extrinsic sugars. Dietary adequacy with respect to these five parameters is related to socio-economic factors. The findings emphasise the need for a range of public health policies that focus upon the social and economic determinants of food choice within families.

Social determinants of dietary habits in Denmark

OBJECTIVE

To investigate whether there is an association between socioeconomic status and a healthy diet, taking the possible influence of other social variables such as age, gender, income and household composition into consideration.

DESIGN

Cross-sectional study.

SETTING

Nationwide study in Denmark, 1995.

SUBJECTS

Random sample from the civil registration system. A total of 852 men and 870 women aged 18-80 y participated, a response rate of 58%.

INTERVENTIONS

A 7 day estimated dietary record was used to obtain information about the diet. Information about social background was gained through face-to-face interview.

RESULTS

The intake of fruit and vegetables and the percentage energy (E%) from fat in the diet were significantly associated with the educational level of both men and women. For men with only basic schooling, the mean intake of vegetables and fat was 84 g/10 MJ and 41 E% respectively. Men with long higher education had a mean intake of 119 g/10 MJ of vegetables and 37 E% of fat. For women, the corresponding figures for the intake of vegetables and fat were 131 g/10 MJ and 38 E% and 175 g/10 MJ and 37 E%, respectively. For women, age, income and household composition were also significantly associated with the intake of fruit and vegetables.

CONCLUSIONS

Education seems to be the most important social variable to explain social differences in dietary habits. Additional variables are needed to explain dietary habits of women. Differences are seen for both foods and nutrients.

SPONSORSHIP

The data analysis was financially supported by the Health Insurance Fund.

Food insecurity is associated with past and present economic disadvantage and body mass index

Fears and experiences of food restriction influence eating behavior but the association between past and present economic disadvantage, food insecurity and body size is poorly understood. Therefore, we examined these associations in a nationwide, representative sample of 25- to 64-y-old Finnish men and women (n = 6506). The respondents were classified by their body mass index (BMI) into four groups: thin, normal, overweight and obese. Economic disadvantage was assessed by three indicators including low household income, unemployment during past 5 y and long-term economic problems in childhood. Food insecurity was assessed by five separate items concerning economic fears and experiences related to sufficient supply of food during the past 12 mo, and a combined scale in which those with affirmative responses to four to five items were classified as hungry. Multivariable logistic regression analyses were conducted using both the BMI grouping and indicators of economic disadvantage as independent variables to predict food insecurity, controlling simultaneously for age, educational attainment and sex. The results showed that low household income, recent unemployment and economic problems in childhood were all predictors of food insecurity. Thin people were most likely to be hungry and showed most food insecurity in five separate items. In addition, obese people reported more buying cheaper food due to economic problems and fears or experiences of running out of money to buy food than did normal weight subjects. In conclusion, both past and present economic disadvantage is associated with various aspects of food insecurity. The association between food insecurity and BMI is curvilinear.

Independent predictors of breastfeeding intention in a disadvantaged population of pregnant women

BACKGROUND

Breastfeeding rates in Scotland are very low, particularly in the more disadvantaged areas. Despite a number of interventions to promote breastfeeding very few women actually intend to breastfeed their baby. The aim of this study was to identify personal and social factors independently associated with intention to breastfeed.

METHODS

Nine hundred and ninety seven women from two socio-economically disadvantaged housing estates located on the outskirts of Glasgow participated in a study that aimed to increase the prevalence of breastfeeding. Self-administered questionnaires completed by each participant collected information in early pregnancy, prior to exposure to the study intervention, on feeding intention, previous feeding experience and socio-demographic data.

RESULTS

Five factors were independently predictive of breastfeeding intention. These were previous breastfeeding experience, living with a partner, smoking, parity and maternal age. After adjusting for these five factors, neither deprivation nor receipt of milk tokens provided useful additional predictive information.

CONCLUSION

In this population of socially disadvantaged pregnant women we identified five variables that were independently predictive of breastfeeding intention. These variables could be useful in identifying women at greatest risk of choosing not to breastfeed. Appropriate promotional efforts could then be designed to give due consideration to individual circumstances.

Socioeconomic status, overweight and obesity in prepuberal children: a study in an area of Northern Italy

The aim of this study was to determine whether socio-economical status (SES) is associated with overweight and obesity in prepuberal children. In an area of North-Western Italy a sample of 1420 children, aged 10-11 years, had his/her height and weight recorded, (overweight and obesity were defined, respectively, as relative body weight > or = 120% and > or = 140%), and parents were requested to compile a questionnaire exploring some demographic and social conditions. 23% of the sample resulted overweight or obese. Prevalence rate ratios (PRR) of overweight and obesity (together) were calculated, adjusting for parents' age, parents' area of birth, and school district. PRR for mother's lowest educational level compared to the highest was 1.59 (95% CI: 1.19-2.13), while for father's education was 1.21 (0.90-1.63). PRRs for 'unemployed' or 'manual' mother compared to 'upper non manual' were respectively 1.83 (1.20-2.79) and 2.20 (1.31-3.68), while for 'unemployed' or 'manual' father were 2.63 (1.97-2.63), and 1.63 (1.27-2.09). The cultural resources of the mother, and the economical resources of the family seem to influence the prevalence of weight gain in prepuberal children. This should be taken into account when planning programs for the prevention or reduction of obesity in children.

Dietary trends among Scottish schoolchildren in the 1990s

BACKGROUND

In recent years, healthy eating messages have sought to highlight the advantages of a healthy balanced diet, but there is little evidence that the recommendations have been translated into sustained behavioural change. In Scotland, the national diet has become a major focus in key policy documents, and the diet of children and young people has been consistently highlighted as an area of particular concern. This paper reports on dietary trends among Scottish schoolchildren during the 1990s.

METHODS

Data were collected from a representative sample of Scottish schoolchildren as part of the WHO Cross-national Health Behaviour of School-aged Children (HBSC) study. Three consecutive national surveys were undertaken in Scotland, in 1990, 1994 and 1998, using self-completion food frequency questionnaires with 11-, 13- and 15-year-old school pupils.

RESULTS

Between 1990 and 1998, fruit and vegetable consumption increased among Scottish schoolchildren, especially among girls, but levels of consumption fell below current dietary recommendations. There has been a concomitant increase in consumption of high-fat and high-sugar foods, and consumption of these foods is higher among boys and children from lower socio-economic groups.

CONCLUSION

The findings emphasize the need for continued health promotion efforts to improve the diet of schoolchildren in Scotland especially among lower socio-economic groups.

Inequalities in diet and physical activity in Europe

The contribution of food, nutrition and physical activity to inequalities in health across Europe is largely unexplored. This paper summarizes cross sectional survey data on food patterns and nutrient intakes, and briefer data on physical activity, by various indicators of socio-economic status for countries across Europe. Factors are examined which underlie the outcome data seen. These include structural and material conditions and circumstances which contribute to excluding socio-demographic groups from participating in mainstream patterns of living. Trends in social and economic conditions, and their implications for nutritional and physical wellbeing are briefly outlined.

Disparities in vegetable and fruit consumption: European cases from the north to the south

OBJECTIVE

To present disparities in consumption of vegetables and fruits in Europe and to discuss how educational level, region and level of consumption influence the variation.

DESIGN

A review of selected studies from 1985 to 1997.

SETTING/SUBJECTS

33 studies (13 dietary surveys, nine household budget surveys and 11 health behaviour surveys) representing 15 European countries were selected based on criteria developed as part of the study. Association between educational level and consumption of vegetables and fruits was registered for each study and common conclusions were identified.

RESULTS

In the majority of the studies, with the exception of a few in southern and eastern Europe, consumption of vegetables and fruits was more common among those with higher education. The results suggest that in regions where consumption of vegetables and fruits is more common, the lower social classes tend to consume more of these than the higher social classes.

CONCLUSIONS

The differences in the patterns of disparities in vegetable and fruit consumption between regions, as well as within populations, need to be considered when efforts to improve nutrition and health are planned.