Hostname: page-component-76c49bb84f-l6pkv Total loading time: 0 Render date: 2025-07-04T15:37:18.969Z Has data issue: false hasContentIssue false

Socio-economic inequalities in women's fruit and vegetable intakes: a multilevel study of individual, social and environmental mediators

Published online by Cambridge University Press:  02 January 2007

Kylie Ball*
Affiliation:
Centre for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, Burwood, Victoria 3125, Australia
David Crawford
Affiliation:
Centre for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, Burwood, Victoria 3125, Australia
Gita Mishra
Affiliation:
School of Population Health, University of Queensland, Herston, Queensland, Australia
*
*Corresponding author: Email kball@deakin.edu.au
Rights & Permissions [Opens in a new window]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
Objective

This study employed a multilevel design to test the contribution of individual, social and environmental factors to mediating socio-economic status (SES) inequalities in fruit and vegetable consumption among women.

Design

A cross-sectional survey was linked with objective environmental data.

Setting

A community sample involving 45 neighbourhoods.

Subjects

In total, 1347 women from 45 neighbourhoods provided survey data on their SES (highest education level), nutrition knowledge, health considerations related to food purchasing, and social support for healthy eating. These data were linked with objective environmental data on the density of supermarkets and fruit and vegetable outlets in local neighbourhoods.

Results

Multilevel modelling showed that individual and social factors partly mediated, but did not completely explain, SES variations in fruit and vegetable consumption. Store density did not mediate the relationship of SES with fruit or vegetable consumption.

Conclusions

Nutrition promotion interventions should focus on enhancing nutrition knowledge and health considerations underlying food purchasing in order to promote healthy eating, particularly among those who are socio-economically disadvantaged. Further investigation is required to identify additional potential mediators of SES–diet relationships, particularly at the environmental level.

Information

Type
Research Article
Copyright
Copyright © The Authors 2006

References

1 US Department of Health and Human Services (DHSS) and US Department of Agriculture (USDA). Dietary Guidelines for Americans 2005. Washington, DC: DHSS and USDA, 2005.Google Scholar
2 National Health and Medical Research Council. Dietary Guidelines for Australian Adults. Canberra: Australian Government Printing Service, 2003.Google Scholar
3Subar, AF, Heimendinger, J, Patterson, BH, Krebs-Smith, SM, Pivonka, E, Kessler, R. Fruit and vegetable intake in the United States: the baseline survey of the Five A Day for Better Health Program. American Journal of Health Promotion 1995; 9: 352–60.Google Scholar
4Ball, K, Mishra, GD, Thane, CW, Hodge, A. How well do Australian women comply with dietary guidelines? Public Health Nutrition 2004; 7: 443–52.Google Scholar
5De Irala-Estevez, J, Groth, M. A systematic review of socioeconomic differences in food habits in Europe: consumption of fruit and vegetables. European Journal of Clinical Nutrition 2000; 54: 706–14.Google Scholar
6Johansson, L, Thelle, DS, Solvoll, K, Bjorneboe, GEA, Drevon, CA. Healthy dietary habits in relation to social determinants and lifestyle factors. British Journal of Nutrition 1999; 81: 211–20.Google Scholar
7Baranowski, T, Weber, K, Cullen, W, Baranowski, J. Psychosocial correlates of dietary intake: advancing dietary intervention. Annual Review of Nutrition 1999; 19: 1740.Google Scholar
8Parmenter, K, Waller, J, Wardle, J. Demographic variation in nutrition knowledge in England. Health Education Research 2000; 15: 163–74.Google Scholar
9Hupkens, C, Knibbe, R, Drop, M. Social class differences in food consumption: the explanatory value of permissiveness and health and cost considerations. European Journal of Public Health 2000; 10: 108–13.Google Scholar
10Stokols, D. Establishing and maintaining healthy environments: toward a social ecology of health promotion. American Psychologist 1992; 47: 622.Google Scholar
11Van Duyn, MA, Kristal, AR, Dodd, K, Campbell, MK, Subar, AF, Stables, G, Association of awareness, intrapersonal and interpersonal factors, and stage of dietary change with fruit and vegetable consumption: a national survey. American Journal of Health Promotion 2001; 16: 6978.Google Scholar
12Inglis, V, Ball, K, Crawford, D. Why do women of low socioeconomic status have poorer dietary behaviours than women of higher socioeconomic status? A qualitative exploration. Appetite 2005; 45: 334–43.Google Scholar
13Morland, K, Wing, S, Diez Roux, A. The contextual effect of the local food environment on residents' diets: the Atherosclerosis Risk in Communities study. American Journal of Public Health 2002; 92: 1761–7.Google Scholar
14Rose, D, Richards, R. Food store access and household fruit and vegetable use among participants in the US Food Stamp Program. Public Health Nutrition 2004; 7: 1081–8.Google Scholar
15Cheadle, A, Psaty, B, Curry, S, Wagner, E, Diehr, P, Koepsell, T, Community-level comparisons between the grocery store environment and individual dietary practices. Preventive Medicine 1991; 20: 250–61.Google Scholar
16Sooman, A, Macintyre, S, Anderson, A. Scotland's health – a more difficult challenge for some? The price and availability of healthy foods in socially contrasting localities in the west of Scotland. Health Bulletin 1993; 51: 276–84.Google Scholar
17Morland, K, Wing, S, Diez Roux, A, Poole, C. Neighbourhood characteristics associated with the location of food stores and food service places. American Journal of Preventive Medicine 2002; 22: 23–9.Google Scholar
18Bartley, M, Fitzpatrick, R, Firth, D, Marmot, M. Social distribution of cardiovascular disease risk factors: change among men in England 1984–1993. Journal of Epidemiology and Community Health 2000; 54: 806–14.Google Scholar
19Fehily, AM, Phillips, KM, Yarnell, JW. Diet, smoking, social class, and body mass index in the Caerphilly Heart Disease Study. American Journal of Clinical Nutrition 1984; 40: 827–33.Google Scholar
20Prattala, R, Karisto, A, Berg, MA. Consistency and variation in unhealthy behavior among Finnish men, 1982–1990. Social Science & Medicine 1994; 39: 115–22.Google Scholar
21Bittman, M. Recent Changes in Unpaid Work. Catalogue No. 4154.0. Canberra: Australian Bureau of Statistics, 1995.Google Scholar
22 Australian Bureau of Statistics (ABS). Census of Population and Housing: Socio-Economic Indexes for Areas (SEIFA). Catalogue No. 2033.0.55.001, Australia. Canberra: ABS, 2003.Google Scholar
23Brown, WJ, Dobson, AJ, Bryson, L, Byles, J. Women's Health Australia: on the progress of the main cohort studies. Journal of Women's Health & Gender-Based Medicine 1999; 8: 681–8.Google Scholar
24 Australian Bureau of Statistics (ABS). National Nutrition Survey User's Guide 1995. Catalogue No. 4801.1. Canberra: ABS, 1998.Google Scholar
25Turrell, G. Educational differences in dietary guideline food practices: are they associated with educational differences in food and nutrition knowledge? Australian Journal of Nutrition and Dietetics 1997; 54: 2533.Google Scholar
26Sallis, JF, Grossman, RM, Pinski, RB, Patterson, TL, Nader, PR. The development of scales to measure social support for diet and exercise behaviors. Preventive Medicine 1987; 16: 825–36.Google Scholar
27Dillman, DA. Mail and Telephone Surveys: The Total Design Method. New York: Wiley, 1978.Google Scholar
28Goldstein, H. Multilevel Statistical Models. 3rd ed. London: Edward Arnold, 2003.Google Scholar
29Baron, RM, Kenny, DA. The moderator–mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology 1986; 51: 1173–82.Google Scholar
30Rasbash, J, Steele, F, Browne, W, Prosser, B. A User's Guide to MLwiN, Version 2.0. London: Institute of Education, University of London, 2004.Google Scholar
31Turrell, G, Blakely, T, Patterson, C, Oldenburg, B. A multilevel analysis of socioeconomic (small area) differences in household food purchasing behaviour. Journal of Epidemiology and Community Health 2004; 58: 208–15.Google Scholar
32Krosnick, JA. Survey research. Annual Review of Psychology 1999; 50: 537–67.Google Scholar
33Dowler, E. Food poverty and food policy. IDS Bulletin. Poverty and Social Exclusion in North and South 1998; 29: 5865.Google Scholar