Ritva Prättälä

A systematic review of socio-economic differences in food habits in Europe: consumption of fruit and vegetables

Objective: To evaluate the differences in the consumption of fruit and vegetables between groups with different socio-economic status (SES) in the adult population of European countries.Design: A systematic review of published and unpublished surveys of food habits conducted between 1985 and 1999 in 15 European countries. Educational level and occupational status were used as indicators of SES. A pooled estimate of the mean difference between the highest and the lowest level of education and occupation was calculated separately for men and women, using DerSimonian and Lairds random effects model.Setting: The inclusion criteria of studies were: use of a validated method for assessing intake at the individual level; selection of a nationwide sample or a representative sample of a region; and providing the mean and standard deviation of overall fruit and vegetable consumption for each level of education or occupation, and separately for men and women.Subjects: Participants in the individual surveys had to be adults (18–85 y).Results: Eleven studies from seven countries met the criteria for being included in the meta-analysis. A higher SES was associated with a greater consumption of both fruit and vegetables. The pooled estimate of the difference in the intake of fruit was 24.3 g/person/day (95% confidence interval (CI) 14.0–34.7) between men in the highest level of education and those in the lowest level of education. Similarly, this difference was 33.6 g/person/day for women (95% CI 22.5–44.8). The differences regarding vegetables were 17.0 g/person/day (95% CI 8.6–25.5) for men and 13.4 g/person/day (95% CI 7.1–19.7) for women. The results were in the same direction when occupation instead of education was used as an indicator of SES.Conclusions: Although we cannot exclude over-reporting of intake by those with highest SES, it is unlikely that this potential bias could fully explain the differences we have found. Our results suggest that an unhealthier nutrition pattern may exist among adults belonging to lower socio-economic levels in Europe.Sponsorship: The present study was supported by the European Unions FAIR programme (FAIR-97-3096).European Journal of Clinical Nutrition (2000) 54, 706–714

Trends in smoking behaviour between 1985 and 2000 in nine European countries by education

Objective: To examine whether trends in smoking behaviour in Western Europe between 1985 and 2000 differed by education group. Design: Data of smoking behaviour and education level were obtained from national cross sectional surveys conducted between 1985 and 2000 (a period characterised by intense tobacco control policies) and analysed for countries combined and each country separately. Annual trends in smoking prevalence and the quantity of cigarettes consumed by smokers were summarised for each education level. Education inequalities in smoking were examined at four time points. Setting: Data were obtained from nine European countries: Norway, Sweden, Denmark, Finland, the United Kingdom, the Netherlands, Germany, Italy, and Spain. Participants: 451 386 non-institutionalised men and women 25–79 years old. Main outcome measures: Smoking status, daily quantity of cigarettes consumed by smokers. Results: Combined country analyses showed greater declines in smoking and tobacco consumption among tertiary educated men and women compared with their less educated counterparts. In country specific analyses, elementary educated British men and women, and elementary educated Italian men showed greater declines in smoking than their more educated counterparts. Among Swedish, Finnish, Danish, German, Italian, and Spanish women, greater declines were seen among more educated groups. Conclusions: Widening education inequalities in smoking related diseases may be seen in several European countries in the future. More insight into effective strategies specifically targeting the smoking behaviour of low educated groups may be gained from examining the tobacco control policies of the UK and Italy over this period.

Gender, socioeconomic status and family status as determinants of food behaviour

This study examines social structural and family status factors as determinants of food behaviour. The data were derived from the FINMONICA Risk Factor Survey, collected in Finland in spring 1992. A multidimensional framework of the determinants of food behaviour was used, including social structural position, family status and gender. The associations between the determinants of food behaviour were estimated by multivariate logistic regression models, adjusted for age and regional differences. Food behaviour was measured by an index including six food items which were chosen based on Finnish dietary guidelines. In general, womens food behaviour was more in accordance with the dietary guidelines than that of men. The pattern of association between educational level and food behaviour was similar for both genders, but slightly stronger for men than women. Employment status was associated only with womens food behaviour, but the tendency was the same for men. Marital status was associated with mens as well as womens food behaviour. The food behaviour of married men and women was more in line with the dietary guidelines than the food behaviour of those who had been previously married. Parental status, however, was only associated with womens food behaviour, that is, the food behaviour of women with young children was more closely in line with the dietary guidelines than that of the rest of the women.

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.

Men, masculinity and food: interviews with Finnish carpenters and engineers

This study explores how Finnish men from two occupational groups describe food in their everyday life. The concept of masculinity is used in interpreting mens food-related behaviours and beliefs. Data are drawn from semi-structured interviews in the 1990s with twenty carpenters and twenty engineers involved in the building trade. The paper presents analyses of the similarities and differences in how the men talked about meat; vegetables; beer and wine as parts of meals; food as energy, health and pleasure; and cooking. The results show variation both between and within occupational groups. The men did not stress the role of meat, but rather emphasised the role of vegetables. The carpenters tended to favour meat whereas the engineers had a more positive attitude to vegetables. Eating was described as an everyday routine needed to refuel the body and stay healthy. In addition, the engineers talked about the pleasures of eating. The men described cooking as optional or exceptional. The carpenters seemed to more actively embrace hegemonic masculinity and reject what is feminine than the engineers, who have reformulated their definition of masculinity to encompass concerns with health. This study suggests that both masculinity and occupational class play a role in male food-related practices and preferences.

Income and health behaviours. Evidence from monitoring surveys among Finnish adults

Study objective: To examine the associations of individual and household income with various health behaviours, before and after adjusting for educational attainment and occupational social class. Design and Setting: Data from 19 982 respondents to nationwide health behaviour surveys from 1993 to 1999 (response rate 70%) were linked with socioeconomic information from population registers. Measurements: The income measures were total individual income liable to taxation and household’s monthly disposable income. Health behaviours included smoking, alcohol use, leisure time physical activity, use of vegetables, use of saturated fat on bread, and being overweight. Main results: In men, smoking and infrequent vegetable use were more common among those with lower individual and household income. However, adjusting for education and occupational class removed most of the differences. Use of saturated fat on bread increased with decreasing individual income, before and after the adjustments. In women, smoking, infrequent vegetable use and being overweight were more common among those with lower income, but the differences by both income measures were largely removed by the adjustments. Women with higher income more often also were high alcohol users and had less physical activity, in particular when income was measured by the respondents’ individual income. Conclusions: Adjusting for education and occupation largely removed income differences in health behaviours, but for some behaviours some independent effect remained. The results suggest that income does not only reflect the available material resources, but works as a general socioeconomic indicator that is associated with health behaviours in much the same way as other socioeconomic indicators.

Sociodemographic determinants of multiple unhealthy behaviours.

Background: Although behaviours regarded as unhealthy are widespread, behaving in an unhealthy manner in several respects is relatively uncommon. However, people with multiple unhealthy behaviours exist and their number is larger than expected if the behaviours were not related to each other. The aim of this study was to examine sociodemographic determinants of multiple unhealthy behaviours, with special reference to independent and combined effects of the determinants. Methods : Data on unhealthy behaviours were derived from nationwide surveys among Finnish adults. The mean number of unhealthy behaviours practised on a daily basis and the probability of reporting three or four of these behaviours was examined across sociodemographic groups. Results: Age, educational level and marital status predicted reporting of three or four unhealthy behaviours. Interactions were observed between education and age in both genders as well as between marital status and age in men and educational level and living area in women. Mean numbers of unhealthy behaviours showed similar patterns to having three or four unhealthy behaviours but few differences between the means were statistically significant and there were no interactions. Conclusion: The influence of each sociodemographic determinant on multiple unhealthy behaviours was relatively independent from the other sociodemographic determinants. As the effect of these determinants tends to be cumulative, engaging in multiple unhealthy behaviours is common in population subgroups with several unfavourable characteristics. In health promotion initiatives special attention should be paid to such population groups and their social circumstances.

The sociodemographic patterning of drinking and binge drinking in Estonia, Latvia, Lithuania and Finland, 1994–2002

BackgroundDespite the relatively low recorded alcohol consumption level, the Baltic countries (Estonia, Latvia and Lithuania) and neighbouring Finland suffer from similar harmful consequences related to the use of alcoholic beverages, including socio-economic inequalities in alcohol related mortality. Comparative evidence is needed to understand harmful drinking patterns and to implement preventive alcohol policies also in the Baltic countries. This study compared heavy and binge drinking by sex, age, education, urbanisation and marital status in the Baltic countries and Finland.MethodsThe data were nationally representative postal surveys conducted in Estonia (n = 6271), Latvia (n = 6106), Lithuania (n = 7966) and Finland (n = 15764) during 1994–2002. The criterion for heavy drinking was at least 15 portions weekly among men, and at least five among women, and for binge drinking at least six portions per one occasion.ResultsHeavy drinking was more common among younger participants in all countries, and in Latvia among the less-educated. Among Finnish men, and among women from all countries except Latvia, the better-educated were more often heavy drinkers. In Latvia and Finland, urban men, and in all countries, urban women, were more often heavy drinkers. Heavy drinking was more common among non-married Lithuanian and Finnish men, and Finnish women. Binge drinking was more common among less-educated Estonian and Latvian men, and among younger and less-educated women in all countries.ConclusionOur results support the continued power of traditional drinking habits in the North Eastern part of Europe. In the future the target groups for prevention of excessive drinking should also include young and less-educated women in all four countries studied.

Social capital, health behaviours and health: a population-based associational study

BackgroundSocial capital is associated with health behaviours and health. Our objective was to explore how different dimensions of social capital and health-related behaviours are associated, and whether health behaviours mediate this association between social capital and self-rated health and psychological well-being.MethodsWe used data from the Health 2000 Survey (n=8028) of the adult population in Finland. The response rate varied between 87% (interview) and 77% (the last self-administered questionnaire). Due to item non-response, missing values were replaced using multiple imputation. The associations between three dimensions of social capital (social support, social participation and networks, trust and reciprocity) and five health behaviours (smoking, alcohol use, physical activity, vegetable consumption, sleep) were examined by using logistic regression and controlling for age, gender, education, income and living arrangements. The possible mediating role of health behaviours in the association between social capital and self-rated health and psychological well-being was also analysed with a logistic regression model.ResultsSocial participation and networks were associated with all of the health behaviours. High levels of trust and reciprocity were associated with non-smoking and adequate duration of sleep, and high levels of social support with adequate duration of sleep and daily consumption of vegetables. Social support and trust and reciprocity were independently associated with self-rated health and psychological well-being. Part of the association between social participation and networks and health was explained by physical activity.ConclusionsIrrespective of their social status, people with higher levels of social capital – especially in terms of social participation and networks – engage in healthier behaviours and feel healthier both physically and psychologically.

Alcohol-related mortality, drinking behavior, and business cycles

This paper explores the connection between alcohol-related mortality, drinking behavior, and macroeconomic conditions in Finland using both aggregate and microlevel data from recent decades. The aggregate data reveal that an improvement in economic conditions produces a decrease in alcohol-related mortality. Microlevel data show that alcohol consumption increases during economic expansion while the probability of being a drinker remains unchanged. This demonstrates that alcohol-related mortality and self-reported alcohol consumption may be delinked in the short-run business cycle context. One explanation for this paradox is that most harmful forms of drinking are not captured in survey-based data used to study the effect of macroeconomic conditions on alcohol consumption. Our evidence does not overwhelmingly support the conclusions reported for the United States that temporary economic downturns are good for health.