Poverty does not modify the association between perceived diet healthiness and adherence to nutritional guidelines in the Constances cohort (France)

Suggested explanations for the (in)effectiveness of nutrition information interventions among adults with a low socioeconomic status: a scoping review

Unhealthy diets are a major threat to population health and are especially prevalent among those with a low socioeconomic status (SES). Health promotion initiatives often rely on nutrition information interventions (NIIs), but are usually less effective among adults with a low SES than in their high-SES counterparts. Explanations for this lower effectiveness are set out in extant studies. These have been conducted across a wide range of disciplines and subject fields and using a variety of methodological approaches. We have therefore conducted a scoping review to identify and synthesise the following: (1) explanations suggested in studies carried out in high-income countries for why NIIs are (in)effective among adults with a low SES and (2) whether these suggested explanations were studied empirically. Eight databases were searched for relevant studies published since 2009 across various disciplines. This identified 4951 papers, 27 of which were included in our review after screening. Only fifteen of these proposed an explanation for the (in)effectiveness of NIIs among adults with a low SES. The following four main themes were uncovered: health literacy, economic resources, social resources and convenience. Ten studies tested their explanations empirically, but the results were inconsistent. The reasons why NIIs are (in)effective among low-SES adults are therefore still largely unclear. Also, current literature predominantly relies on individualistic explanations, most notably focusing on psychological and economic attributes. Consequently, if the effectiveness of NIIs among low-SES populations is to be improved, future studies should examine a wider range of explanations and test them systematically and empirically.

An incongruous intervention: Exploring the role of anti-institutionalism in less-educated individual's limited uptake of nutrition information

Despite many efforts, nutritional health interventions have been largely unable to reduce health inequalities between less- and more-educated individuals, since their effectiveness among the former is often limited. Conventionally, adverse financial circumstances and poorer health literacy are argued to explain this. Drawing on recent sociological insights, we propose a complementing and novel sociocultural explanation based on how contemporary power relations in society breed anti-institutionalism among less-educated individuals. Using a survey of a representative sample of the Dutch population (n = 2398), we focus on the strategic case of the lower uptake of nutrition information among less-educated individuals. We find that two aspects of anti-institutionalism, i.e. institutional distrust and antipaternalism, substantially account for the educational gap in the uptake of nutrition information. This indicates that current nutrition information inspires opposition among less-educated individuals. More generally, it suggests that the development of nutritional health interventions should avoid invoking institutional connotations, to increase their acceptance by those who commonly need these most.

Health behaviours of teachers and other education professionals in France: can we do better?

Education professionals play a critical role in health education, both as knowledge providers and as role-models. Drawing on the CONSTANCES French cohort (baseline 2012-19) and adjusting for important confounders, we compared education professionals (n = 14 730) with a random sample of non-education sector employees (n = 34 244) on three indicators of high-risk behaviour (at-risk drinking, current smoking, past-year cannabis use) and three indicators of unhealthy lifestyle (low physical activity, poor adherence to nutritional guidelines, overweight/obesity). Among education professionals, we distinguished between teachers (n = 12 820), school principals (n = 372), senior education advisers (n = 189), school health professionals (n = 128) and school service staff (n = 1221). Compared with non-education sector employees with similar demographic and socioeconomic profiles, teachers were less likely to be at-risk drinkers, to smoke, to have used cannabis in the past year and to be overweight/obese. Other non-teaching education professionals were also less involved in high-risk behaviours than non-education employees, but results were more mixed concerning some lifestyle indicators, with certain non-teaching education professional groups showing a higher likelihood of being physically inactive or overweight/obese. In this nationwide French study, our results suggest a window of opportunity to promote school staff health but also indirectly, that of the youth with whom they interact daily. We suggest that school staff should be supported in health matters not only through the provision of health information but also most importantly, through the development of a favourable and supportive environment enabling them to put health knowledge into practice.

Linking socioeconomic disadvantage to healthiness of food practices: Can a practice-theoretical perspective sharpen everyday life analysis?

Food is one of the key themes in public health policy and debates over inequalities in health. In this article, we argue that more research is needed to understand how socioeconomic disadvantage is translated into low degrees of healthiness. We suggest that everyday life analysis may be sharpened by way of drawing upon a practice-theoretical perspective on the mundane processes involved in this translation. We base our suggestion on a small review of three strands in the literature on social inequality, food and health, namely public health research, lifestyle analysis and everyday life studies, and we take our analytical starting point in the latter. In the article, we argue that a practice-theoretical perspective may enable research in social disadvantage and healthiness of food that describes and interprets variants in the conditioned agency, which cuts cross the multiplicity of different practices that make-up people's daily lives. Finally, we suggest that a stronger focus on social interaction and social hierarchy would adapt a practice-theoretical perspective further to empirical analysis in the field of food, health and socioeconomic disadvantage.

Dietary Restrictions and Depressive Symptoms: Longitudinal Results from the Constances Cohort

Cross-sectional results have suggested a linear association between the number of dietary exclusions and depressive symptoms. This longitudinal study aimed to examine the direction of this association. Methods: In the population-based Constances cohort, depressive symptoms were defined by a score ≥19 on the Centre of Epidemiologic Studies-Depression (CES-D) scale. Diet was measured with a 24-item qualitative food frequency questionnaire (FFQ). Both variables were available at inclusion (from 2012 to 2014) and on follow-up (2015 for the CES-D and 2017 for diet). Food exclusion was categorized into five different groups: No exclusion, exclusion of one, two, three, or ≥4 food groups according to the self-reported number of food groups rarely or never consumed. Logistic regressions were conducted, either taking depressive symptoms as the outcome on follow-up with dietary exclusions at baseline as predictor or with the opposite, adjusting for age, sex, education, income, alcohol intake, smoking, physical activity, and anemia. The path analysis included outcomes and covariates in one model. Results: The median follow-up was three years. A total of 29,337 participants (53.4% women, 48.15 ± 12.9 y.o.) had complete CES-D data and 25,356 (53.56% women, 49.05 ± 12.8 y.o.) FFQ data. Dietary exclusion at inclusion predicted depressive symptoms at follow-up (odds ratio [95% confidence interval]: 2.35 [1.62–3.40] for ≥4 excluded items compared to no exclusions). Depressive symptoms at inclusion predicted dietary exclusions at follow-up (3.45 [1.93–6.16] for ≥4 excluded items). In the path analysis, the standardized estimate of the association between dietary exclusions at inclusion and depressive symptoms at follow-up was by far higher than the opposite (0.1863 and 0.00189, respectively, both p < 0.05). Conclusions: The association of dietary exclusion with subsequent depression is stronger than the opposite association.

Association between unemployment and the co-occurrence and clustering of common risky health behaviors: Findings from the Constances cohort

Background

Unemployment is associated with a high prevalence of risky health behaviors. Mortality increases with the number of co-occurring risky behaviors but whether these behaviors co-occur with a greater than expected frequency (clustering) among unemployed people is not known.

Methods

Differences according to unemployment status in co-occurrence and clustering of smoking, alcohol abuse, low leisure-time physical activity and unhealthy diet (marked by low fruit and vegetable intake) were assessed in 65,630 salaried workers, aged 18 to 65, who were participants in Constances, a French population-based cohort. Among them, 4573 (7.0%) were unemployed without (n = 3160, 4.8%) or with (n = 1413, 2.1%) past experience of unemployment.

Results

Compared to the employed, unemployed participants without or with past experience of unemployment were similarly overexposed to each risky behavior (sex and age adjusted odds-ratios ranging from 1.38 to 2.19) except for low physical activity, resulting in higher rates of co-occurrence of two, three and four behaviors (relative risk ratios, RRR 1.20 to 3.74). Association between behavior co-occurrence and unemployment did not vary across gender, partnership status or income category. Risky behavior clustering, i.e., higher than expected co-occurrence rates based on the prevalence of each behavior, was similar across unemployment status. The same observations can be made in employed participants with past experience of unemployment, although overexposure to risky behaviors (ORs 1.15 to 1.38) and increased rates of co-occurrence (ORs 1.19 to 1.58) were not as pronounced as in the unemployed.

Conclusions

Co-occurrence of risky behaviors in currently and/or formerly unemployed workers is not worsened by behavior clustering. Engagement in each of these behaviors should be considered an engagement in distinct social practices, with consequences for preventive policies.