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.     

Educational attainment and differences in fruit and vegetable consumption among middle-aged adults in the Korean National Health and Nutrition Examination Survey IV

We investigated whether socioeconomic differences affect fruit and vegetable (FV) consumption with respect to total intake and intake of various FV subgroups. Our study included 6667 adults aged 40-64 years who completed a dietary survey in the fourth Korean NHANES (2007-2009). FV intake was estimated from 24-hour recalls and food frequency questionnaires. Differences in FV consumption related to educational attainment were analyzed according to different nutritional categories of FV. Both men and women in the low-education group had the lowest intake of total FV and total fruits, and women also had the lowest intake of total vegetables. Also lowest in this group was consumption of mushrooms and vegetables (excluding kimchi) among men, and cruciferous and allium vegetables (excluding Chinese cabbage and radish) among women, while kimchi consumption was the highest in this group. Additionally, an association between educational level and intake of citrus fruits was evident among men. Adults in the low-education group consumed less carotene-rich FV, red fruit and/or vegetables, and dark-green leafy vegetables, fewer total vegetable dishes, and fewer types of fruit than in other groups. Men in this group had the lowest intake of yellow/orange fruit and/or vegetables, and women consumed the least folate-rich FV. There is a clear association between educational attainment and FV intake with regard to total intake, and to specific nutrients, bioactive compounds, colors, and variety.     

Health behaviours as explanations for educational level differences in cardiovascular and all-cause mortality: a follow-up of 60 000 men and women over 23 years

BACKGROUND: Health behaviours are potential explanatory factors for socioeconomic differences in mortality. We examined the extent to which seven health behaviours covering dietary habits, smoking and physical activity, can account for relative differences in cardiovascular and all-cause mortality by educational level. METHODS: Health behaviour data derived from nationwide Finnish health behaviour surveys from the years 1979 to 2001. These annually repeated cross-sectional surveys were linked to register-based information on educational level and subsequent mortality from the year of the survey until the end of 2001 (average follow-up time 11.9 years). The analyses included 29 065 men and 31 543 women of whom 4263 died. Cardiovascular disease (CVD), coronary heart disease (CHD), stroke and all-cause mortality was studied. RESULTS: Educational level showed a graded association with all mortality outcomes. Health behaviours explained 54% of the relative difference between primary and higher educational level in CVD mortality among in men and 22% among in women. For all-cause mortality the corresponding figures were 45 and 38%. Smoking, vegetable use and physical activity were the most important health behaviours explaining educational level differences in all mortality outcomes, while the effects of type of fat used on bread, coffee drinking, relative weight and alcohol use were small. CONCLUSIONS: Smoking, low vegetable use and physical inactivity explained a substantial part of educational level differences in cardiovascular and all-cause mortality among men and women. Socioeconomic trends in these behaviours are of crucial importance in determining whether socioeconomic mortality differences will widen or narrow in the future.     

Relative weight and income at different levels of socioeconomic status

OBJECTIVES: We examined the association of relative weight with individual income at different levels of socioeconomic status among gainfully employed Finnish women and men. METHODS: We used a population-based survey including 2068 women and 2314 men with linked income data from a taxation register. Regression analysis was used to calculate mean income levels within educational and occupational groups. RESULTS: Compared with their normal-weight counterparts, obese women with higher education or in upper white-collar positions had significantly lower income; a smaller income disadvantage was seen in overweight women with secondary education and in manual workers. Excess body weight was not associated with income disadvantages in men. CONCLUSIONS: Obesity is associated with a clear income disadvantage, particularly among women with higher socioeconomic status.     

Social inequalities in mortality: changes in the relative importance of income, education and household size over a 27-year period

BACKGROUND: The aim of this paper was to measure socio-economic inequalities in mortality over a 27-year period, and estimate the simultaneous effects of education and income adjusted for changing proportions and potential confounders. METHODS: Census data in 1970, 1980 and 1990 with information about income, educational level and household size were linked to mortality records at the individual level and analysed with absolute mortality rates, Poisson regression (univariate and multivariate) and Relative Index of Inequality (RII). RESULTS: Mortality differences increased between income quartiles and educational groups as well as between singles and non-singles. RII between income quartiles increased from 1.6 to 3.6 for men and 1.7 to 2.7 for women while RII between the educational groups increased from 1.6 to 2.8 for men and 1.5 to 2.1 for women. However, RII derived from the adjusted multivariate regression analysis was 1.8 (men) and 1.9 (women) between the income groups in 1990 and 2.2 (men) and 1.7 (women) between the educational groups. In the 1990s current income was more important than previous income, and the rate ratios (RR) increased for groups dropping into the lowest income quartile between two censuses. CONCLUSION: Low education and single status have become relatively more important risk factors for mortality over time. Confounder effects of education and household size could partly explain the seemingly large increase in inequalities between income groups. Results may also indicate a stronger reverse causation (poor health causing low income) over time.     

Assessment of fruit and vegetable intake among the 50-year-old population of Wroclaw

Intake of fruit and vegetable among 50-year-old population of Wroclaw and the impact of education level on the consumption of fruits and vegetables was assessed. The study group was 50-year-old, 1520 inhabitants of Wroclaw (879 women and 641 men), who participated in 2008 in the Cardiovascular Diseases Prevention Program organized by the Health Division of the Municipal Office in Wroclaw. To assess fruit and vegetable intake Food Frequency Questionnaire (FFQ) was used. The mean daily intake of vegetables and fruit was 289,4 g for women and 209,1 g for men. Women consumed significantly more vegetables, fruits, and the amounts of fruits and vegetables compared with men. The impact of educational level on fruit and vegetable consumption in the study group was found.     

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 self-reported insomnia and stress in Finland from 1979 to 2002: a population-based repeated cross-sectional survey

ABSTRACT: BACKGROUND: Over the decades, global public health efforts have sought to reduce socio-economic health differences, including differences in mental health. Only a few studies have examined changes in socio-economic differences in psychological symptoms over time. The aim of this study was to assess trends in socio-economic differences in self-reported insomnia and stress over a 24-year time period in Finland. METHODS: The data source is a repeated cross-sectional survey "Health Behaviour and Health among the Finnish Adult Population" (AVTK), from the years 1979 to 2002, divided into five study periods. Indicators for socio-economic status included employment status from the survey, and educational level and household income from the Statistics Finland register data. We studied the age group of 25--64 years (N = 70115; average annual response rate 75%). Outcome measures were single questions of self-reported insomnia and stress. RESULTS: The overall prevalence of insomnia was 18-19% and that of stress 16-19%. Compared to the first study period, 1979--1982, the prevalence of stress increased until study period 1993--1997. The prevalence of insomnia increased during the last study period, 1998--2002. Respondents who were unemployed or had retired early reported more insomnia and stress over time among both men and women. Lower education was associated with more insomnia especially among men; and conversely, with less stress among both sexes. Compared to the highest household income level, those in the intermediate levels of income had less stress whereas those in the lowest income levels had more stress among both sexes. Income level differences in insomnia were less consistent. In general, socio-economic differences in self-reported insomnia and stress fluctuated some, but did not change substantially over the study period 1979--2002. CONCLUSIONS: Self-reported insomnia and stress were more common during later study periods. The socio-economic differences in insomnia and stress have remained fairly stable over a 24-year time period. However, some of the associations in socio-economic differences were curvilinear and converse. Future studies are needed to explore the complex socio-economic gradients, especially in stress.     

Socioeconomic differences in the consumption of vegetables, fruit and fruit juices. The influence of psychosocial factors

BACKGROUND: The aim was to investigate whether social network and social support factors can explain socioeconomic differences in the risk of consuming low amounts of vegetables, fruit and fruit juices. METHODS: The Malm? Diet and Cancer Study was a prospective cohort study. The present cross-sectional study examined data from a subpopulation of 11,837 individuals that completed baseline examinations in 1992-1994. Dietary habits were assessed using a modified diet history method, and socioeconomic and social network factors were measured with a structured questionnaire. Low consumption was defined as the lowest consumption quartile for vegetables and fruit, while fruit juice consumption was dichotomized to separate users from non-users. RESULTS: Socioeconomic differences were most pronounced regarding the consumption of vegetables and fruit juices. For both sexes, unskilled manual workers had a twice as high risk of low vegetable and fruit juice consumption as higher non-manual employees. No socioeconomic differences in fruit consumption were observed for men, and only moderate differences for women with a higher consumption in higher socioeconomic groups. When the psychosocial variables were introduced in the multivariate model, social participation moderately reduced the socioeconomic differences in vegetable consumption, and the female socioeconomic differences in fruit consumption, but had no effect on the socioeconomic differences in fruit juice consumption. The other psychosocial variables had no effect on the socioeconomic differences. CONCLUSION: Considerable socioeconomic differences in vegetable, fruit and fruit juice consumption were observed. Social participation seemed to be a strong determinant for these food choices. However, this effect was largely independent of the socioeconomic differences.     

Diminishing or increasing contrasts? Social class variation in Finnish food consumption patterns, 1979-1990.

The study examines whether social-class-based food consumption patterns changed in Finland during 1979-1990. The data were compiled by the National Public Health Institute in connection with a programme entitled 'Monitoring Health Behaviour among the Finnish Adult Population'. A questionnaire was sent annually to a random sample of Finns (N = 3400-5100, response rate 68-86%). This study was restricted to respondents 25-54 years old. Social class was defined by level of education (low, middle, high). Trends and variations in consumption patterns were studied by cross-tabulations and by fitting logistic regression models. The results show that the proportions of users of butter, high-fat milk and coffee sugar decreased during the study eriod whereas that of regular users of vegetables increased. Since the mid-1980s the shift towards 'healthier' food choices has accelerated among men, yet women are consistently more health-oriented. Social class appears to be a significant determinant of food consumption patterns. Men and women of lower social class follow trends set by upper social classes with a time lag of about ten years. Along with an overall shift towards observance of dietary recommendations, social class differences in Finnish food consumption patterns have diminished, without, however, disappearing altogether.     

Body weight dissatisfaction by socioeconomic status among obese, preobese and normal weight women and men: results of the cross-sectional KORA Augsburg S4 population survey

ABSTRACT: BACKGROUND: Body weight dissatisfaction is an important factor in preventing weight gain and promoting weight loss or maintenance. This study focuses on differences in the rates of body weight dissatisfaction among obese, preobese and normal weight women and men by socioeconomic status within a general adult population in Germany. METHODS: Data were analyzed from 4186 adults aged 25 to 74 who participated in a cross-sectional, representative population-based health survey (KORA S4, 1999-2001, Augsburg region/Germany). Body mass was measured anthropometrically and indexed following international standards. Among the 2123 women participating in the survey, 40.3% had a normal weight, 34.9% were preobese, and 24.8% were obese (compared to 25.9%, 51.4% and 22.6% among men, respectively). Body weight dissatisfaction, educational level, household income and occupational status were assessed by computer-aided personal interviewing. An index for socioeconomic status was calculated and categorized into quintiles. Multiple logistic regressions were performed to test for differences in the odds of body weight dissatisfaction across socioeconomic strata in normal weight, preobese and obese groups. Body mass index, age, family status, place of residence and health behaviors were adjusted for. RESULTS: Overall, being dissatisfied with one's body weight was more prevalent in women (48.3%) than in men (33.2%). In the normal weight group, no significant differences in the odds of being dissatisfied were found across socioeconomic groups among women or men. Among preobese men, compared to the lowest socioeconomic stratum, increased odds of being dissatisfied with one's body weight were associated with the highest socioeconomic index group (OR=2.3, 95% CI: 1.4-3.8), middle and high educational level (OR=1.6, 95% CI: 1.1-2.3, and OR=1.9, 95% CI: 1.3-3.7), high income (OR=1.8, 95% CI: 1.2-2.7), and middle and high occupational status (both OR=1.8, 95% CI: 1.2-2.6). Among preobese women, the odds of being dissatisfied were only significantly elevated in those with a middle educational level (OR=1.6, 95% CI: 1.1-2.3). Among obese men, elevated odds were found in the highest socioeconomic index group (OR=3.7, 95% CI: 1.8-7.5) and in those with a high educational level (OR=2.3, 95% CI: 1.3-4.1), high income (OR=2.6, 95% CI: 1.4-4.7), and middle and high occupational status (both OR=2.2, 95% CI: 1.3-3.6). The odds of dissatisfaction among obese women were not associated with socioeconomic status as a whole, but were associated with a high educational level, albeit with a comparatively large confidence interval (OR=3.6, 95% CI: 1.0-12.8). CONCLUSIONS: In Germany, body weight dissatisfaction is more prevalent among obese and preobese men in high socioeconomic status groups, a pattern not found in women. The exception to this is a greater prevalence of dissatisfaction among obese and preobese women with a high educational level (albeit inconsistently). Moreover, there is a social gradient in body weight dissatisfaction, especially in obese men, which may partly explain why obesity is more prevalent in men with low socioeconomic status. It also suggests that they are a target group for obesity care in which body weight satisfaction is an important topic.     

Residential area deprivation predicts fruit and vegetable consumption independently of individual educational level and occupational social class: a cross sectional population study in the Norfolk cohort of the European Prospective Investigation into Cancer (EPIC-Norfolk)

STUDY OBJECTIVE: To investigate the independent association between individual and area based socioeconomic measures and fruit and vegetable consumption. DESIGN: Cross sectional population based study. SETTING AND PARTICIPANTS: 22,562 men and women aged 39-79 years living in the general community in Norfolk, United Kingdom, recruited using general practice age-sex registers. OUTCOME MEASURES: Fruit and vegetable intake assessed using a food frequency questionnaire. MAIN RESULTS: Being in a manual occupational social class, having no educational qualifications, and living in a deprived area all independently predicted significantly lower consumption of fruit and vegetables. The effect of residential area deprivation was predominantly in those in manual occupational social class and no educational qualifications. CONCLUSIONS: Understanding some of the community level barriers to changing health related behaviours may lead to more effective interventions to improving health in the whole community, particularly those who are most vulnerable.     

Socioeconomic position in childhood and adulthood and weight gain over 34 years: the Alameda County Study

PURPOSE: Socioeconomic position (SEP) has been shown to be related to obesity and weight gain, especially among women. It is unclear how different measures of socioeconomic position may impact weight gain over long periods of time, and whether the effect of different measures vary by gender and age group. We examined the effect of childhood socioeconomic position, education, occupation, and log household income on a measure of weight gain using individual growth mixed regression models and Alameda County Study data collected over thirty four years(1965-1999). METHODS: Analyses were performed in four groups stratified by gender and age at baseline: women, 17-30 years (n = 945) and 31-40 years (n = 712); men, 17-30 years (n = 766) and 31-40 years (n = 608). RESULTS: Low childhood SEP was associated with increased weight gain among women 17-30 (0.13 kg/year, p < 0.001). Low educational status was associated with increased weight gain among women 17-30 (0.14 kg/year, p = 0.030), 31-40 (0.14 kg/year, p = 0.014), and men 17-30 (0.20 kg/year, p = 0.001). CONCLUSION: Log household income was inversely associated with weight gain among men 31-40 (-0.10 kg/yr, p = 0.16). Long-term weight gain in adulthood is associated with childhood SEP and education in women and education and income in men.     

Household Income Disparities in Fruit and Vegetable Consumption by State and Territory: Results of the 2009 Behavioral Risk Factor Surveillance System

Few studies take into account the influence of family size on household resources when assessing income disparities in fruit and vegetable (F/V) consumption. Poverty income ratio (PIR) is a measure that utilizes both reported income and household size. We sought to examine state-specific disparities in meeting Healthy People 2010 objectives for F/V consumption by percent PIR. This analysis included 353,005 adults in 54 states and territories reporting data to the 2009 Behavioral Risk Factor Surveillance System in the United States. Percent PIR was calculated using the midpoint of self-reported income range and family size. The prevalences consuming at least two fruits and at least three vegetables per day were examined by percent PIR (<130% [greatest poverty], 130% to <200%, 200% to <400%, and ≥400% [least poverty]). The percent of adults consuming vegetables at least three times daily was significantly lower (21.3%) among those living at greatest poverty (<130% PIR) compared with 30.7% among those with least poverty (≥400% PIR). Daily consumption of vegetables at least three times was significantly lower among those with greatest poverty in a majority of states and territories surveyed (43 of 54). The overall percent of adults consuming fruits at least 2 times daily was also lower among those living at greatest vs least poverty, but the difference was smaller (32.0% vs 34.2%), with 14 states reporting a difference that was significantly lower among those with greatest poverty. Our study revealed that in 2009 a significantly lower proportion of US adults living at greatest poverty consumed fruits at least two times daily or vegetables at least three times daily compared with those with the least poverty, with greater disparity in vegetable intake. Policy and environmental strategies for increased affordability, access, availability, and point-of-decision information are approaches that may help disparate households purchase and consume F/V.     

The relationships among socioeconomic status, fruit and vegetable intake, and alcohol consumption

Abstract Purpose . We examined the relationships among fruit and vegetable intake, alcohol consumption, and socioeconomic status (SES). We hypothesized that fruit and vegetable consumption would be inversely associated with alcohol consumption and the relationship would differ by SES. Design . A cross-sectional analysis. Setting . Large, urban Midwestern county. Subjects . A unique, racially/ethnically diverse sample of 9959 adults (response rate: 66.3%). Measures . Fruit and vegetable intake was measured using two items that assessed servings per day. Alcohol consumption was measured in terms of volume of alcohol consumed and binge drinking. Individual measures of SES included education and household income. Analysis . Weighted multivariate linear and Poisson regression were used to estimate effects. Results . The relationship between fruit and vegetable intake and alcohol consumption varied by SES. Those with lower household incomes who consumed five or more servings of fruits and vegetables per day were less likely to engage in binge drinking relative to those consuming zero to one servings of fruits and vegetables per day (risk ratio = .66; 95% confidence interval: .46, .95). No association was observed for higher-household-income individuals. Conclusion . We observed an inverse relationship between fruit and vegetable consumption and alcohol intake in those with lower household incomes but not in those with higher household incomes. Results suggest that the relationship between diet and alcohol consumption may be more relevant in populations with more restricted economic choices. Results are, however, based on cross-sectional data.     

Who eats what? A comparison of dietary patterns among men and women in different occupational groups

Abstract: Dietary data were obtained during a community-based study of risk factors for heart disease in 1983. Results were compared for men and women in broadly defined socioeconomic groups based on occupation and education. People in higher status occupation groups and with more education, and women more than men, had food consumption patterns more consistent with current health promotion messages. For example, they reported eating more wholemeal or brown bread and more fresh fruit and vegetables, drinking more skim or low-fat milk, eating fewer eggs and having less sugar in hot drinks or on cereals. There was some evidence, however, of an interplay of influences of cost and health awareness. For example, retired men were less likely than employed men to eat butter, cream, fresh fruit and vegetables, while men in the upper socioeconomic groups reported relatively higher consumption of butter and cream. The results emphasise the need for a range of strategies aimed at specific subgroups in order to improve national dietary patterns in Australia.     

Does food group consumption vary by differences in socioeconomic, demographic, and lifestyle factors in young adults? The Bogalusa Heart Study

OBJECTIVE: To examine if food group consumption varies by differences in socioeconomic, demographic, and lifestyle factors in young adults from a semirural setting in Louisiana. DESIGN: Cross-sectional. SUBJECTS: Young adults (n=1,266, 74% European American, 26% African American; 39% men, 61% women) aged 20 to 38 years, enrolled in the Bogalusa Heart Study. MEASURES: Food group consumption was assessed by a food frequency questionnaire. Socioeconomic (eg, income and education), demographic (eg, age, sex, and ethnicity), and lifestyle (eg, marital status and physical activity) information was obtained by a self-administered questionnaire and the subjects were stratified according to these groups. STATISTICAL ANALYSES: Analysis of covariance (adjusted for covariates) was used to detect differences in the mean servings of food groups consumed per day between the various socioeconomic, demographic, and lifestyle groups. RESULTS: Compared to income$45,000 had lower consumption of burgers/sandwiches (P<0.05) and those with income levels from $30,001 to $45,000 had lower consumption of mixed dishes (P<0.05). Intake of cereals/breads (P<0.05), dairy products (P<0.01), fruits/100% fruit juices (P<0.001), and vegetables (P<0.001) was higher in subjects with >12 years of education. European-American men consumed more servings of dairy products (P<0.05) and sweetened beverages (P<0.05) than African-American men. European-American women consumed more servings of dairy products (P<0.05), vegetables (P<0.05), and fats (P<0.05) than African-American women. African Americans (men and women) consumed more servings of fruits/100% fruit juices (P<0.0001) than European Americans (men and women), respectively. Married individuals consumed more servings of snacks/desserts (P<0.05), but fewer servings of alcoholic beverages (P<0.0001) than those who were unmarried. Active individuals consumed more servings of fruits/100% fruit juices (P<0.05) and fewer servings of burgers/sandwiches (P<0.05) than inactive individuals. CONCLUSIONS: These findings suggest that food group consumption varies by socioeconomic, demographic, and lifestyle factors in young adults from a semirural setting. Food and nutrition professionals who encounter diverse populations need to consider the influence of income, education, sex, ethnicity, marital status, and physical activity on food consumption patterns when planning diets, nutrition education programs, and interventions for young adults.     

Knowledge, barriers, and stage of change as correlates of fruit and vegetable consumption among urban and mostly immigrant black men

BACKGROUND: Daily fruit and vegetable consumption in black men is low and has remained relatively unchanged during the past 20 years. OBJECTIVE: To examine awareness of fruit and vegetable recommendations promoted by federal agencies and correlates of fruit and vegetable consumption among an urban and mostly immigrant population of adult black men. DESIGN: A cross-sectional study analyzing baseline data (n=490) from a randomized controlled trial. SETTING: A large health care worker's union. MAIN OUTCOME MEASURES: Knowledge, perceived benefits, stage of readiness, perceived barriers, and daily servings of fruit and vegetable intake. STATISTICAL ANALYSES PERFORMED: One-way analysis of variance and t tests were used to compare fruit and vegetable intake across main study variables. Regression analysis was used to identify independent predictors of fruit and vegetable intake. RESULTS: Fruit and vegetable intake was low (mean was three servings/day). Ninety-four percent were not aware that men should consume at least nine servings of fruits and vegetables daily and 59.8% were not aware that eating a colorful variety is important. In contrast, over half (54.7%) were aware that a single serving is equal to about a handful; 94.1% correctly reported fruit and vegetables as an important source of fiber; 79.6% correctly reported vitamin pills were not a substitute for eating fruits and vegetables; and 94.5% recognized that there are health benefits to eating fruits and vegetables, although identification of specific benefits was minimal. In regression analysis, a greater level of fruit and vegetable consumption was significantly associated with greater knowledge of fruit and vegetable recommendations, lower perceived barriers, and a more advanced stage of change (action vs contemplation/preparation). Perceived health benefits were not associated with fruit and vegetable consumption. CONCLUSIONS: There is a lack of awareness of the current fruit and vegetable recommendations. In addition, men reported fruit and vegetable intakes that were far below national recommendations. Greater efforts are needed to help urban and primarily immigrant black men realize the importance of and recommendations for fruit and vegetable consumption.     

Income differences in mortality: a register-based follow-up study of three million men and women

OBJECTIVES: We analyse whether the relationship between net household income and mortality form a continuous linear gradient or is curvilinear, assess the attenuation of this association after adjusting for confounding and reverse causality, and assess the strength of the association by age and cause of death. DESIGN AND SETTING: Prospective study of mortality in Finland among all men and women over 30 years old. Information on household income and sociodemographic factors was from the records of the Finnish tax authorities and the 1990 census. Income data were available for more than 95% of the cohort. Follow-up was by record linkage to death certificates in 1991-1996; altogether about 261 000 deaths. RESULTS: The all-cause mortality ratio between the lowest and the highest household income decile is 2.37 (95% CI : 2.30-2.44) among men and 1.73 (95% CI : 1.67-1.80) among women. Adjusting for household structure, spouse's economic activity, social class, education and own economic activity attenuates the relationship by 61% among men and 52% among women. The association between income and mortality is mainly linear before and after adjusting for confounding, and the association is strong for all 5-year age groups below 60-64 years, after which it declines rapidly in strength. CONCLUSIONS: The mainly linear nature of the relationship and the strong attenuation after adjustment for other socioeconomic factors and economic activity status, and the age pattern of the relationship indicate that a large part of the relationship is unlikely to be due to direct causal effects of poverty and material hardship. Rather, income seems to be related to accumulation of factors that increase mortality over the whole range of incomes.     

The role of socioeconomic indicators on non-alcohol and alcohol-associated suicide mortality among women in Finland. A register-based follow-up study of 12 million person-years

This study was to analyse the effects and interrelationships of three socioeconomic indicators – education, occupation-based social class and income – on non-alcohol and alcohol-associated suicide mortality among women in Finland. The register data used comprised the 1990 census records linked to the death register for the years 1991–2001 for women who were 25–64 years old in 1990. Adjusted relative mortality rates and the relative index of inequality (RII) were estimated using Poisson regression. The study population experienced 1926 suicides, of which 563 (29%) had alcohol intoxication as a contributory cause. The age-adjusted effects of education on non-alcohol associated suicide were modest, while social class and income related inversely and strongly. The effect of social class was partly mediated by income, and social class explained income differences to some extent. The associations between these socioeconomic indicators and alcohol-associated suicide were stronger, and following adjustment for each other large effects were left for education, social class and income. Further adjustment for living arrangements had little effect on socioeconomic differences in both types of suicide, but practically all of the effects of income and some of education and social class were mediated by employment status. In conclusion, current material factors are hardly the main underlying drivers of socioeconomic differences in suicide among Finnish women. Low social class proved to be an important determinant of suicide risk, but the strong independent effect of education on alcohol-associated suicide indicates that the roots of these differences are probably established in early adulthood when educational qualifications are obtained and health-behavioural patterns set.