Changes in socio-economic differences in food habits over time

Multiple socioeconomic circumstances and trajectories of fruit and vegetable consumption: the Helsinki Health Study

AIMS

Fruit and vegetable consumption is essential in disease prevention. Socioeconomic differences in consumption have been observed but evidence from longitudinal studies incorporating multiple socioeconomic indicators is lacking. We examined long-term fruit and vegetable consumption trajectories and multiple socioeconomic circumstances as their determinants.

METHODS

We used survey data from the Helsinki Health Study (phase 1 in 2000-2002, N=8960, response rate 67%; phases 2-4 in 2007, 2012 and 2017) among initially 40- to 60-year-old employees of City of Helsinki, Finland. Fruit and vegetable consumption was measured by a food frequency questionnaire and consumption times per month were calculated. Childhood (parental education, economic difficulties), conventional (own education, occupational class, household income) and material (housing tenure, wealth, current economic difficulties) socioeconomic circumstances were included. We used group-based trajectory modelling for identifying fruit and vegetable consumption trajectories and multinomial logistic regression for examining associations between socioeconomic circumstances and the trajectories.

RESULTS

Four fruit and vegetable consumption trajectories were identified: increasing higher (12%), decreasing higher (10%), stable moderate (43%) and stable low (35% of participants). Childhood, conventional and material socioeconomic circumstances were all associated with the trajectories: belonging to a lower socioeconomic group was associated with belonging to the stable low and moderate trajectories. In multivariate models, the strongest associations were found for occupational class and household wealth.

CONCLUSIONS

Disadvantageous childhood and adulthood socioeconomic circumstances were associated with lower long-term fruit and vegetable consumption. Socioeconomic circumstances should be considered in attempts to promote fruit and vegetable consumption, and people with disadvantageous circumstances need to be targeted in future interventions.

Socioeconomic inequities in diet quality among a nationally representative sample of adults living in Canada: an analysis of trends between 2004 and 2015

BACKGROUND

Socioeconomic inequities in diet quality are stable or widening in the United States; however, these trends have not been well characterized in other nations. Moreover, purpose-developed indices of inequities that can provide a more comprehensive and precise perspective of trends in absolute and relative dietary gaps and gradients using multiple indicators of socioeconomic position (SEP) have not yet been used, and can inform strategies to narrow dietary inequities.

OBJECTIVES

We quantified nationally representative trends in absolute and relative gaps and gradients in diet quality between 2004 and 2015 according to 3 indicators of SEP among adults in Canada.

METHODS

Adults (≥18 y old) who participated in the nationally representative, cross-sectional Canadian Community Health Survey-Nutrition in 2004 (n = 20,880) or 2015 (n = 13,970) were included. SEP was classified using household income (quintiles), education (5 categories), and neighborhood deprivation (quintiles). Dietary intake data from 24-h recalls were used to derive Healthy Eating Index-2015 (HEI-2015) scores. Dietary inequities were quantified using absolute and relative gaps (between the most and least disadvantaged) and absolute [Slope Index of Inequality (SII)] and relative gradients (Relative Index of Inequality). Overall and sex-stratified multivariable linear regression and generalized linear models examined trends in HEI-2015 scores between 2004 and 2015.

RESULTS

Mean HEI-2015 scores improved from 55.3 to 59.0 (maximum: 100); however, these trends were not consistently equitable. Whereas inequities in HEI-2015 scores were stable in the total population and in females, the absolute gap [from 1.60 (95% CI: 0.09, 3.10) to 4.27 (95% CI: 2.20, 6.34)] and gradient [from SII = 2.09 (95% CI: 0.45, 3.73) to SII = 4.84 (95% CI: 2.49, 7.20)] in HEI-2015 scores for household income, and the absolute gradient for education [from SII = 8.06 (95% CI: 6.41, 9.71) to SII = 10.52 (95% CI: 8.73, 12.31)], increased in males.

CONCLUSIONS

Absolute and relative gaps and gradients in overall diet quality remained stable or widened between 2004 and 2015 among adults in Canada.

Dietary Changes among Adults in The Netherlands in the Period 2007-2010 and 2012-2016. Results from Two Cross-Sectional National Food Consumption Surveys

Insight into dietary trends is important for the development and evaluation of dietary policies. The aim of this study is to describe changes in dietary intakes of Dutch adults and to evaluate these changes by age, gender, and education. In 2007-2010 and 2012-2016, two national food consumption surveys were conducted including 2106 and 1540 adults, respectively. Data collection included two non-consecutive 24 h dietary recalls. Mean habitual intakes of foods and nutrients relevant for a healthy diet of both surveys were estimated. Between the two periods the mean consumption of red or processed meat, dairy, sodium and alcohol and the ratio of whole-grain to cereal products decreased by 4-30% and the consumption of fibre and unsaturated fatty acids increased by about 3% and 6%, respectively. For most food groups, changes in consumption were comparable for both sexes and in all age groups. A healthier consumption pattern and several favorable changes were observed among higher-educated people. Most, but not all, changes in food consumption are favorable from a public health point of view. However, there is still a large potential for further improvements. A healthier consumption pattern was observed in adults with a higher educational level which calls for attention to social disparities when developing dietary policies.

Diet Quality Compared to the Nutritional Knowledge of Polish, German, and Slovakian University Students-Preliminary Research

The eating habits of students differ significantly from those recommended by health practitioners. The aim of this study was to find differences related to diet quality and knowledge on nutrition among Polish, German, and Slovakian students as well as to examine which factors differentiate the diet quality of students from these three countries. The study was conducted on a group of 394 university students from Poland, Germany, and Slovakia. The assessment of diet quality and knowledge on food and nutrition was done with the use of the Dietary Habits and Nutrition Beliefs Questionnaire. The diet of German students was characterized by a significantly higher consumption of legume-based foods, vegetables, and fruit compared to Polish students and Slovakian participants (p < 0.001). The diet of the Poles was characterized by a high consumption of cured meat, smoked sausages, hot dogs, white bread and bakery products, butter, fried foods, and energy drinks. The most important factors significantly associated with diet quality involved the country, place of residence, Body Mass Index (BMI), physical activity, and time spent watching TV or using a computer. Polish students were characterized by the highest level of knowledge on food and nutrition (p < 0.001). However, it was not reflected in their diet. The authorities of universities should aim to provide students with access to canteens on campuses which would offer the possibility of consumption of both affordable and healthy meals.

A systematic review of the determinants of seafood consumption

Although seafood is considered to be an important part of a balanced diet, many national food consumption surveys suggest that seafood is not consumed in sufficient amounts. As consumers are moving to diversify their diet from animal-based protein, it is important to understand the factors influencing consumption of marine foods. This review aims to assess the characteristics of seafood consumers as well as the influences on seafood consumption in Europe, USA, Canada, Australia and New Zealand. Systematic search strategies were used to identify relevant journal articles from three electronic databases (PubMed, Web of Science and Embase). Three searches were carried out and identified 4405 unique publications from which 121 met the criteria for the review process. The reviewed studies revealed that seafood consumers were more likely to be older, more affluent and more physically active and were less likely to smoke compared with non-seafood consumers. Sex and BMI did not appear to have a directional association with seafood consumption. The most commonly reported barriers to seafood consumption were cost, followed by sensory or physical barriers, health and nutritional beliefs, habits, availability and cooking skills. The most commonly reported influences were beliefs about the contribution of seafood to health, environmental influences and personal preferences. Based on the findings of this review, future intervention strategies to increase seafood consumption may need to consider affordability and education in terms of health, nutrition and cooking skills. More research is needed to explore the effectiveness of specific interventions at increasing the consumption of seafood.

Relationships between psychological distress and health behaviors among Canadian adults: Differences based on gender, income, education, immigrant status, and ethnicity

Objective

Psychosocial health predicts physical health outcomes in both clinical samples and the general population. One mechanism is through relationships with health behaviors. Results might differ based on sociodemographic characteristics such as education, income, ethnicity, and immigrant status. Our objective was to analyze sociodemographic differences in relationships between psychosocial health measures and health behaviors in the general population of Canadian adults.

Methods

We analyzed relationships between non-specific psychological distress, assessed using the Kessler-10 scale, and five key health behaviors: fruit and vegetable intake, screen sedentary behavior, physical activity, alcohol consumption, and cigarette use. Data were collected by Statistics Canada for the Canadian Community Health Survey in 2011–2014. Our sample included 54,789 participants representative of 14,555,346 Canadian adults. We used univariate general linear models on the weighted sample to analyze relationships between distress (predictor) and each health behavior, controlling for age. We entered sex and one of four sociodemographic variable of interest (education, income, ethnicity, immigrant status) into each model to analyze gender and sociodemographic differences in relationships.

Results

Greater distress predicted less fruit and vegetable intake and physical activity, and greater screen sedentary behavior and cigarette use, in the full sample, with small effect sizes (partial η² up to 0.013). Differences by gender and sociodemographic characteristics were evident for all health behaviors.

Conclusions

Psychosocial health might contribute to persistent socioeconomic disparities in health in part through relationships with health behaviors, although relationships in the general population are modest. Health behavior interventions incorporating psychosocial health might need to be tailored based on socioeconomic characteristics, and future research on intersections between multiple sociodemographic risk factors remains necessary.

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Past studies show relationships between psychosocial health and health behaviors.

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Relationships might differ based on sociodemographic characteristics.

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We analyzed distress and five health behaviors in a nationally representative sample.

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Relationships differed based on gender, education, income, immigration status, and ethnicity.

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Modest relationships observed might be important given persistent health disparities.

The joint contribution of physical activity, insomnia symptoms, and smoking to the cost of short-term sickness absence

Physical inactivity has been associated with both insomnia symptoms and smoking. Further, they are all independently associated with increased sickness absence (SA) from work. However, joint contribution of either physical activity (PA) with insomnia symptoms or with smoking to SA and, especially, their direct cost for the employer is poorly understood. Therefore, we aimed to examine these joint associations with short-term (<15 days) SA cost. The Helsinki Health Study is a cohort of midlife employees of the City of Helsinki, Finland (baseline n = 8960, response rate 67%). During 2000-2002, the participants were mailed a survey questionnaire that gathered information on health behavior and sociodemographic characteristics. SA, salary, and time of employment were followed up through the employer's personnel register between 2002 and 2016 for those with a written consent to the use of their register data (78% of the participants). Individual salary data were used to calculate the direct cost of short-term SA. Data were analyzed with a two-part model. Inactive participants with frequent insomnia symptoms had 2526€ (95% CI 1736€-3915€) higher cost of short-term SA than vigorously active participants without insomnia symptoms. Furthermore, inactive smokers had 4166€ (95% CI 2737€-5595€) higher cost for the employer over the follow-up than vigorously active non-smokers. In conclusion, this study showed that PA and insomnia symptoms as well as PA and smoking are jointly associated with short-term SA cost. The results emphasize encouraging employers to improve work environments so that they promote active lifestyle, good sleep, and non-smoking in order to reduce the cost of SA.

Socio-economic indicators are independently associated with intake of animal foods in French adults

OBJECTIVE

The specific role of major socio-economic indicators (education, occupation, income) in influencing consumer choice of animal foods (AF) intake could reveal distinct socio-economic facets, thus enabling elucidation of mechanisms leading to social inequalities in health. We investigated the independent association of each indicator with intake of different AF and their effect modification.

DESIGN

Cross-sectional study. AF intake was estimated using three 24 h dietary records. Associations between socio-economic factors and AF intake and interactions between socio-economic indicators were assessed using ANCOVA adjusted for age and energy intake. Analyses were performed separately for men and women, since gender interactions were found.

SETTING

France.

SUBJECTS

Adults (n 92 036) participating in the NutriNet-Santé Study.

RESULTS

Low educated persons had higher intake of red meat (+9-12 g/d), processed meat (+6-9 g/d) and poultry (for men, +7 g/d) than those with a higher education level. Percentage of fish consumers was lower in individuals of the lowest income class compared with those in higher classes. Manual workers had a higher intake of cream desserts (for men, +14 g/d) than managerial staff. Few significant interactions were found. In stratified analyses, persons with the highest income consumed more yoghurt than those who had lower income, only in low educated individuals.

CONCLUSIONS

Socio-economic disparities in AF intake varied according to the socio-economic indicator, suggesting the specific influence of each indicator on AF intake. In particular, lower education was associated with higher intake of red and processed meats and cream desserts, and had an effect modification on the relationship between income and AF intake.

Everyday distinction and omnivorous orientation: An analysis of food choice, attitudinal dispositions and social background

In recent years studies on cultural consumption have experienced a Bourdieusian renaissance. This is indicated by a growing body of research analysing distinctions in different areas of culture, and numerous studies on the homology thesis applying the concepts of distinction, field and capital. Concurrently, however, it has been argued that instead of distinctive tastes, distinction and class status are increasingly manifested by cultural omnivorousness. For a good part studies focussing on distinction in food have analysed eating out and stylization through restaurant preferences, rather than everyday food choices. In this article we investigate everyday food choices from the perspective of distinction and omnivorousness. Our analysis draws on cross-sectional quantitative data collected in 2012 among 15-64-year-old Finns (N = 2601). The article maps out the relationship between food choice frequencies, dispositions and social background with Multiple Correspondence Analysis (MCA). The results show that the consumption of fruit and vegetables, ready-meals and convenience foods were among the most divisive food choices. The first structuring dimension juxtaposed processed, fatty and sugared foods with unprocessed foods and fresh ingredients. This dimension was associated with healthiness and weight control as dispositions. On the second structuring dimension there were differences in the valuation of taste, pleasure and sociability, and a contrast between moderate and restrictive choices. Particularly the first dimension was associated with educational, occupational, and gender differences. Distinction within everyday food choices was manifested in the use of healthy and unprocessed foods and 'moderate hedonism' in contrast to more restrictive tastes.

Confirmatory Factor Analysis Compared with Principal Component Analysis to Derive Dietary Patterns: A Longitudinal Study in Adult Women

BACKGROUND

Principal component analysis (PCA) has been used extensively to derive dietary patterns. We proposed to use confirmatory factor analysis (CFA) in the same context as PCA--as a one-step approach--to derive dietary patterns.

OBJECTIVES

The first aim of this study was methodologic and was to compare dietary patterns derived with the use of PCA and CFA, used as equivalent one-step approaches. The second aim of this study was to study these patterns in association with individual characteristics and new adult-onset asthma.

METHODS

We included 30,589 French women from the E3N (epidemiologic prospective cohort study of women from the MGEN national insurance plan) with 1177 reported cases of adult-onset asthma between 1993 and 2005. PCA and CFA were used in the same context, on 27 food groups, to derive dietary patterns. Associations between dietary patterns and adult-onset asthma were assessed by Cox proportional hazards models.

RESULTS

Whether we used PCA or CFA, 3 similar factors were found and labeled "Prudent," "Western," and "Aperitif." Correlations between patterns derived with the use of PCA and CFA were high. For the "Prudent" and "Aperitif" patterns, we observed comparable patterns in terms of associations with food groups, individual characteristics, and the onset of asthma. For the "Western" patterns, the one derived with the use of CFA was more related to an unhealthy diet than the one derived with the use of PCA, with higher correlations with the food groups "processed meat" (0.73 vs. 0.51) and "dough and pastry" (0.63 vs. 0.40), and negative associations with physical activity and with having parents who were farmers. Regarding associations with adult-onset asthma, a significant positive association was observed for the "Western" pattern derived with the use of CFA [multivariate RR for highest vs. lowest quintile: 1.30 (1.02, 1.67), P-trend: 0.03], whereas no association was reported when using PCA [RR: 1.14 (0.89, 1.47), P-trend: 0.40].

CONCLUSION

Although quite similar dietary patterns were derived with the use of PCA and CFA, this study supports the alternative use of CFA to PCA for the identification of dietary patterns in epidemiologic studies.

Bread consumption patterns in a Swedish national dietary survey focusing particularly on whole-grain and rye bread

Background

Bread types with high contents of whole grains and rye are associated with beneficial health effects. Consumer characteristics of different bread consumption patterns are however not well known.

Objective

To compare bread consumption patterns among Swedish adults in relation to selected socio-demographic, geographic, and lifestyle-related factors. For selected consumer groups, the further aim is to investigate the intake of whole grains and the context of bread consumption, that is, where and when it is consumed.

Design

Secondary analysis was performed on bread consumption data from a national dietary survey (n=1,435). Respondents were segmented into consumer groups according to the type and amount of bread consumed. Multiple logistic regressions were performed to study how selected socio-demographic, geographic, and lifestyle-related factors were associated with the consumer groups. Selected consumption groups were compared in terms of whole-grain intake and consumption context. Consumption in different age groups was analysed more in detail.

Results

One-third of the respondents consumed mainly white bread. Socio-demographic, geographic, and healthy-lifestyle-related factors were associated with the bread type consumed. White bread consumption was associated with younger age groups, less education, children in the family, eating less fruit and vegetables, and more candy and snacks; the opposite was seen for mainly whole-grain bread consumers. Older age groups more often reported eating dry crisp bread, whole-grain bread, and whole-grain rye bread with sourdough whereas younger respondents reported eating bread outside the home, something that also mainly white bread eaters did. Low consumers of bread also consumed less whole grain in total.

Conclusions

Traditional bread consumption structures were observed, as was a transition among young consumers who more often consumed fast food bread and bread outside the home, as well as less rye and whole-grain bread. Target groups for communication strategies and product development of more sensorily attractive rye or whole-grain-rich bread should be younger age groups (18–30 years), families with children, and groups with lower educational levels.

Multiple socioeconomic determinants of weight gain: the Helsinki Health Study

BACKGROUND

Socioeconomic differences in weight gain have been found, but several socioeconomic determinants have not been simultaneously studied using a longitudinal design. The aim of this study was to examine multiple socioeconomic determinants of weight gain.

METHODS

Mail surveys were conducted in 2000-2002 among 40 to 60-year old employees of the City of Helsinki, Finland (n = 8,960, response rate 67%). A follow-up survey was conducted among the baseline respondents in 2007 with a mean follow-up of 5 to 7 years (n = 7,332, response rate 83%). The outcome measure was weight gain of 5 kg or more over the follow-up. Socioeconomic position was measured by parental education, childhood economic difficulties, own education, occupational class, household income, home ownership and current economic difficulties. Multivariable logistic regression models were fitted adjusting simultaneously for all covariates in the final model.

RESULTS

Of women 27% and of men 24% gained 5 kg or more in weight over the follow-up. Among women, after adjusting for age, baseline weight and all socioeconomic determinants, those with basic (OR 1.40 95% CI 1.11-1.76) or intermediate education (OR 1.43 95% CI 1.08-1.90), renters (OR 1.18 95% CI 1.03-1.36) and those with occasional (OR 1.19 95% CI 1.03-1.38) or frequent (OR 1.50 95% CI 1.26-1.79) economic difficulties had increased risk of weight gain. Among men, after full adjustment, having current frequent economic difficulties (OR 1.70 95% CI 1.15-2.49) remained associated with weight gain.

CONCLUSIONS

Current economic difficulties among both women and men, and among women low education and renting, were associated with weight gain. Prevention of weight gain among ageing people would benefit from focusing in particular on those with economic difficulties.

Bidirectional associations between insomnia symptoms and unhealthy behaviours

It has been suggested that there are associations among insomnia symptoms and unhealthy behaviours. However, previous studies are sparse and mainly cross-sectional, and have not been focused on several key unhealthy behaviours. The aim of this study was to examine whether the associations are bidirectional, i.e. whether insomnia symptoms are associated with subsequent unhealthy behaviours, and whether unhealthy behaviours are associated with subsequent insomnia symptoms. The data were derived from the Helsinki Health Study prospective cohort study. The baseline data were collected in 2000-02 (n = 8960, response rate 67%) among 40-60-year-old employees of the City Helsinki, Finland. The follow-up data were collected in 2007 (n = 7332, response rate 83%). Logistic regression analysis was used to examine the associations among insomnia symptoms and unhealthy behaviours, including smoking, heavy and binge drinking, physical inactivity and unhealthy food habits. Frequent insomnia symptoms at baseline were associated with subsequent heavy drinking [odds ratio (OR): 1.34; 95% confidence interval (CI): 1.07-1.68] and physical inactivity (OR: 1.27; 95% CI: 1.08-1.48) after full adjustment for gender, age, corresponding unhealthy behaviour at baseline, marital status, occupational class, sleep duration and common mental disorders. Additionally, heavy drinking (OR: 1.48; 95% CI: 1.22-1.80) and binge drinking (OR: 1.26; 95% CI: 1.08-1.46) at baseline were associated with subsequent insomnia symptoms at follow-up after full adjustment. In conclusion, insomnia symptoms were associated with subsequent heavy drinking and physical inactivity, and heavy and binge drinking were also associated with subsequent insomnia symptoms.

Changes in occupational class differences in leisure-time physical activity: a follow-up study

Background

Physical activity is known to have health benefits across population groups. However, less is known about changes over time in socioeconomic differences in leisure-time physical activity and the reasons for the changes. We hypothesised that class differences in leisure-time physical activity would widen over time due to declining physical activity among the lower occupational classes. We examined whether occupational class differences in leisure-time physical activity change over time in a cohort of Finnish middle-aged women and men. We also examined whether a set of selected covariates could account for the observed changes.

Methods

The data were derived from the Helsinki Health Study cohort mail surveys; the respondents were 40-60-year-old employees of the City of Helsinki at baseline in 2000-2002 (n = 8960, response rate 67%). Follow-up questionnaires were sent to the baseline respondents in 2007 (n = 7332, response rate 83%). The outcome measure was leisure-time physical activity, including commuting, converted to metabolic equivalent tasks (MET). Socioeconomic position was measured by occupational class (professionals, semi-professionals, routine non-manual employees and manual workers). The covariates included baseline age, marital status, limiting long-lasting illness, common mental disorders, job strain, physical and mental health functioning, smoking, body mass index, and employment status at follow-up. Firstly the analyses focused on changes over time in age adjusted prevalence of leisure-time physical activity. Secondly, logistic regression analysis was used to adjust for covariates of changes in occupational class differences in leisure-time physical activity.

Results

At baseline there were no occupational class differences in leisure-time physical activity. Over the follow-up leisure-time physical activity increased among those in the higher classes and decreased among manual workers, suggesting the emergence of occupational class differences at follow-up. Women in routine non-manual and manual classes and men in the manual class tended to be more often physically inactive in their leisure-time (<14 MET hours/week) and to be less often active (>30 MET hours/week) than those in the top two classes. Adjustment for the covariates did not substantially affect the observed occupational class differences in leisure-time physical activity at follow-up.

Conclusions

Occupational class differences in leisure-time physical activity emerged over the follow-up period among both women and men. Leisure-time physical activity needs to be promoted among ageing employees, especially among manual workers.