Structural, material and economic influences on the food-purchasing choices of socioeconomic groups

Abstract: Australian and overseas studies have found that respondents in low socioeconomic groups are least likely to purchase food that accords with recommendations in dietary guidelines. British and United States researchers have proposed that this consistently observed association is partly due to structural, material and economic factors that differentially affect socioeconomic groups. This study tested that proposition. Specifically, this study examined the notion that socioeconomic variability in food-purchasing choices are in part a function of the availability, accessibility and affordability of food recommended by dietary guidelines. Data collected from socioeconomic groups in the general community, and information provided by welfare recipients living in low-income areas of Brisbane and Logan city provided little support for this notion. Although significant differences were found between socioeconomic groups in terms of their food-purchasing choices, most respondents from all socioeconomic groups shopped at large supermarkets where recommended food was readily available, few reported difficulties obtaining access to these facilities, and the price difference between recommended and regular foods was, in most cases, small or nonexistent. This evidence leaves largely unanswered the question of why socioeconomic groups differ in their food-purchasing behaviours.     

Socioeconomic differences in food preference and their influence on healthy food purchasing choices

Background: Studies have shown that socioeconomic groups differ in their dietary behaviours, and it has been suggested that these differences partly account for health inequalities between social groups. To-date, however, we have a limited understanding of why socioeconomic groups differ in their dietary behaviours. This paper addresses this issue by examining the relationship between socioeconomic status, food preference (likes and dislikes) and the purchase of 'healthy' food (i.e. food consistent with dietary guideline recommendations). Methods: This study was based on a dual-sample, dual-method research design. One sample was systematically selected from the Australian Commonwealth electoral roll and the data collected using a mail-survey methodology (81% response rate, n =403). The second consisted of a convenience sample of economically disadvantaged people recruited via welfare agencies (response rate unknown, n =70). A mail survey methodology was deemed inappropriate for this sample, so the data were collected by personally delivering the questionnaire to each respondent. Results: Socioeconomic groups differed significantly in their food purchasing choices and preferences. The food choices of respondents in the welfare sample were the least consistent with dietary guideline recommendations, and they reported liking fewer healthy foods (all results were independent of age and sex). Notably, socioeconomic differences in preference explained approximately 10% of the socioeconomic variability in healthy food purchasing behaviour. Conclusion: Whilst it is not clear why socioeconomic groups differ in their food preferences, possible reasons include: reporting bias, differential exposure to healthy food as a consequence of the variable impact of health promotion campaigns, structural and economic barriers to the procurement of these foods, and subculturally specific beliefs, values, meanings, etc.     

Does living in a disadvantaged area entail limited opportunities to purchase fresh fruit and vegetables in terms of price, availability, and variety? Findings from the Brisbane Food Study

Understanding the role environmental factors may play in the dietary behaviours of socioeconomic groups is relevant for efforts to reduce health inequalities. In contrast with international research, earlier findings from the Brisbane Food Study (BFS), Australia, found no relationship between area socioeconomic characteristics and dietary behaviours or location of food shops. This paper examines whether the price and availability of fruits and vegetables are socioeconomically patterned using data from the BFS. Fifty census collection districts were randomly sampled and all local (i.e. within 2.5 km) supermarkets, greengrocers and convenience stores were observed. Little or no differences in price and availability were found on the basis of area socioeconomic characteristics.     

Socioeconomic disadvantage and the purchase of takeaway food: a multilevel analysis

This study examined relationships between individual-level socioeconomic position, area-level disadvantage, characteristics of the takeaway food environment, and the purchase of takeaway food. 'Takeaway' is conceptualised as foods or meals that are prepared and purchased outside of the home, and ready for immediate consumption either at the place of purchase or elsewhere. The analytic sample comprised 1001 households and 50 small areas in Brisbane, Australia. Takeaway food was purchased more regularly by high-income householders and those with higher levels of education. Residents of advantaged areas purchased takeaway food more regularly, although area differences attenuated to the null after adjustment for individual-level compositional factors. Number of takeaway shops in the local food environment, and road distance to the closest takeaway shop, were largely unrelated to the purchase of takeaway food. We conclude that there is little evidence that takeaway food purchasing in Brisbane is influenced by area-level socioeconomic disadvantage or features of the takeaway food environment. Rather, it seems that what matters most in terms of influencing the decision or capacity of Brisbane residents to purchase takeaway food are the socioeconomic characteristics of individuals and their households. The findings of this and previous analyses of the Brisbane Food Study data suggest that policy and health promotion aimed at improving the diets of residents and reducing dietary inequalities between socioeconomic groups should focus on people more so than places.     

The irony of a rich country: issues of financial access to and availability of healthy food in the Republic of Ireland

OBJECTIVE: To determine the weekly financial cost of a diet as recommended by national policy in two parents with two children, single parents with one child and single old people with low income, and begin to identify, in a rich country context, variation in food item availability, price and household purchasing capacity. DESIGN: Food baskets were developed based on national dietary recommendations and purchasing patterns of these household groups. National-level prices of each food were identified, as well as pricing across a representative selection of Irish retail outlet types. Basket costs were assessed relative to the financial capacity of household type. RESULTS: The types of retail outlets in which low-income groups tend to shop do not carry many own brand items and is less likely to stock healthy options, but when they do, they are more expensive than in other outlets. Single parents with one child, two adults with two children and single older people would have to spend 80%, 69% and 38%, respectively, of their weekly household income to purchase the food basket based on economy-line products. CONCLUSIONS: Financial access to and availability of healthy food options must be considered through a national policy cognisant of basic human needs for healthy living. This research provides evidence on the direct costs of healthy eating for policy and planning to ensure not only financial capacity but also to guarantee that affordable healthy food choices are physically available to all groups in society.     

Neighbourhood socioeconomic inequalities in food access and affordability

This study investigated whether the availability and accessibility of supermarkets and fruit and vegetable stores, and the availability, variety and price of foods within these stores, varied across areas of different levels of socioeconomic disadvantage in Melbourne, Australia. Data on food store locations, and food variety and price within stores were obtained through objective audits of 45 neighbourhoods of varying socioeconomic disadvantage. Geographical accessibility of healthy food stores was mostly better amongst those living in more advantaged neighbourhoods. Availability of healthy foods within stores only slightly favoured those in advantaged neighbourhoods. However food prices favoured those living in disadvantaged areas.     

Relationship of mother and child food purchases as a function of price: a pilot study

To our knowledge, there are no data on parental influences on child purchasing behavior of healthy or unhealthy foods. Mothers and children in ten families were given 5.00 US dollars to purchase portions of preferred fruits/vegetables and high energy-dense snack foods for each of ten trials of price manipulations. For five of the trials the price of the fruit/vegetable increased in price from 0.50 US dollars to 2.50 US dollars (in 0.50 US dollar increments), while the price of the energy-dense snack food remained constant at 1.00 US dollar. For the remaining five trials, the commodity that previously rose in price remained constant at 1.00 US dollars and the other commodity varied from 0.50 US dollars to 2.50 US dollars. Same-price elasticity was shown for both the child and parent purchases, and parent purchases were significantly related to child purchases of both healthy (regression estimate = 0.46, p < 0.001) and unhealthy (regression estimate = 0.12, p = 0.036) foods. Children's purchases of unhealthy snack food items were positively related to family socioeconomic status, and negatively related to child age. These results indicate that parental food choice and purchasing behaviors may play a role in the development of children's purchasing of both healthy and unhealthy foods.     

Increasing access to healthful foods: a qualitative study with residents of low-income communities

Background

Inadequate access to healthful foods has been identified as a significant barrier to healthful dietary behaviors among individuals who live in low-income communities. The purpose of this study was to gather low-income community members’ opinions about their food purchasing choices and their perceptions of the most effective ways to increase access to healthful foods in their communities.

Methods

Spanish and English focus groups were conducted in low-income, ethnically-diverse communities. Participants were asked about their knowledge, factors influencing their food purchasing decisions, and their perceptions regarding solutions to increase access to healthful foods.

Results

A total of 148 people participated in 13 focus groups. The majority of participants were female and ethnically diverse (63% Hispanic, 17% African American, 16% Caucasian, and 4% “other”). More than 75% of the participants reported making less than $1999 USD per month. Participants reported high levels of knowledge and preference for healthful foods. The most important barriers influencing healthful shopping behaviors included high price of healthful food, inadequate geographical access to healthful food, poor quality of available healthful food, and lack of overall quality of the proximate retail stores. Suggested solutions to inadequate access included placement of new chain supermarkets in their communities. Strategies implemented in convenience stores were not seen as effective. Farmers’ markets, with specific stipulations, and community gardens were regarded as beneficial supplementary solutions.

Conclusion

The results from the focus groups provide important input from a needs assessment perspective from the community, identify gaps in access, and offer potential effective solutions to provide direction for the future.

     

A multilevel analysis of socioeconomic (small area) differences in household food purchasing behaviour

STUDY OBJECTIVE: To examine the association between area and individual level socioeconomic status (SES) and food purchasing behaviour. DESIGN: The sample comprised 1000 households and 50 small areas. Data were collected by face to face interview (66.4% response rate). SES was measured using a composite area index of disadvantage (mean 1026.8, SD = 95.2) and household income. Purchasing behaviour was scored as continuous indices ranging from 0 to 100 for three food types: fruits (mean 50.5, SD = 17.8), vegetables (61.8, 15.2), and grocery items (51.4, 17.6), with higher scores indicating purchasing patterns more consistent with dietary guideline recommendations. SETTING: Brisbane, Australia, 2000. PARTICIPANTS: Persons responsible for their household's food purchasing. MAIN RESULTS: Controlling for age, gender, and household income, a two standard deviation increase on the area SES measure was associated with a 2.01 unit increase on the fruit purchasing index (95% CI -0.49 to 4.50). The corresponding associations for vegetables and grocery foods were 0.60 (-1.36 to 2.56) and 0.94 (-1.35 to 3.23). Before controlling for household income, significant area level differences were found for each food, suggesting that clustering of household income within areas (a composition effect) accounted for the purchasing variability between them. CONCLUSIONS: Living in a socioeconomically advantaged area was associated with a tendency to purchase healthier food, however, the association was small in magnitude and the 95% CI for area SES included the null. Although urban areas in Brisbane are differentiated on the basis of their socioeconomic characteristics, it seems unlikely that where you live shapes your procurement of food over and above your personal characteristics.     

Relation between breakfast food choices and knowledge of dietary fat and fiber among Swedish schoolchildren.

PURPOSE: To investigate dietary knowledge and beliefs of schoolchildren, in relationship to breakfast choices, with specific attention to fat and fiber content. METHODS: Food choice and perceptions were studied by interviews using the "stacking box methodology". Youth (n = 181) aged 11-15 years were instructed to select food items among photographs of breakfast foods. In addition to choosing their own typical breakfasts, they were asked to exchange foods in hypothetical breakfasts to create meals with less fat and more fiber. The interview also dealt with recent changes in breakfast habits, and perceptions of healthy breakfasts, dietary fat, and foods rich in fiber. Data were analyzed by logistic regression. RESULTS: Knowledge concerning sources and health attributes of dietary fiber was associated with usual consumption of bread and breakfast cereals rich in fiber. In a similar way, a positive attitude toward limited fat intake predicted consumption of reduced-fat milk products. However, no association was observed between food choices and knowledge of a food-packaging symbol indicating low-fat and fiber-enriched foods. CONCLUSION: Lack of awareness of, and knowledge about, healthy eating may be important barriers to the development of health promoting food habits by schoolchildren.     

Variety and quality of healthy foods differ according to neighbourhood deprivation

This study addresses a gap in the food environment literature by investigating spatial differences in the inter relationship of price, variety and quality of food in southern England. We conducted a survey of all grocery stores (n=195) in the city of Southampton, UK, and ranked neighbourhoods according to national quintiles of deprivation. We found no difference in availability or cheapest price across neighbourhoods. However, the poorest neighbourhoods had less variety of healthy products and poorer quality fruit and vegetables than more affluent neighbourhoods. Dietary inequalities may be exacerbated by differences in the variety and quality of healthy foods sold locally; these factors may influence whether or not consumers purchase healthy foods.     

Socioeconomic differences in food purchasing behaviour and suggested implications for diet-related health promotion

Background The relationship between socioeconomic position (SEP) and diet has been examined mainly on the basis of food and nutrient intake. As a complement to this work, we focused on the socioeconomic patterning of food purchasing, as many educational dietary messages emphasize behaviours such as food choice when shopping. Also, the type of food people buy influences the quality of their nutrient intake. Methods A probability sample of households in Brisbane City, Australia (n = 1003, 66.4% response rate). Data were collected using face‐to‐face interviews. SEP was measured using education, occupation and household income. Food purchasing was examined on the basis of grocery items (including meat and chicken) and fruit and vegetables. Results Significant associations were found between each socioeconomic indicator and food purchasing. Persons from socioeconomically disadvantaged backgrounds were less likely to purchase grocery foods that were comparatively high in fibre and low in fat, salt and sugar. The least educated, those employed in blue‐collar (manual) occupations and residents of low income households purchased fewer types of fruit and vegetables, and less regularly, than their higher status counterparts. Conclusions Health promotion efforts aimed at narrowing socioeconomic differences in food purchasing need to be designed and implemented with an understanding of, and a sensitivity to, the barriers to nutritional improvement that difficult life circumstances can impose.     

Socioeconomic differences in purchases of more vs. less healthy foods and beverages: Analysis of over 25,000 British households in 2010

Socioeconomic inequalities in diet-related health outcomes are well-recognised, but are not fully explained by observational studies of consumption. We provide a novel analysis to identify purchasing patterns more precisely, based on data for take-home food and beverage purchases from 25,674 British households in 2010. To examine socioeconomic differences (measured by occupation), we conducted regression analyses on the proportion of energy purchased from (a) each of 43 food or beverage categories and (b) major nutrients. Results showed numerous small category-level socioeconomic differences. Aggregation of the categories showed lower SES groups generally purchased a greater proportion of energy from less healthy foods and beverages than those in higher SES groups (65% and 60%, respectively), while higher SES groups purchased a greater proportion of energy from healthier food and beverages (28% vs. 24%). At the nutrient-level, socioeconomic differences were less marked, although higher SES was associated with purchasing greater proportions of fibre, protein and total sugars, and smaller proportions of sodium. The observed pattern of purchasing across SES groups contributes to the explanation of observed health differences between groups and highlights targets for interventions to reduce health inequalities.     

Food store types, availability, and cost of foods in a rural environment

OBJECTIVE: To characterize the built nutritional environment in terms of types and number of food stores, availability, and cost of selected food items in a rural area. DESIGN: A cross-sectional survey of food stores conducted in 2004. SUBJECTS/SETTING: We selected a rural county (population 91,582; 1,106 square miles). Food stores identified from a database were mapped and presence, location, and store type verified by ground-truthing. Stores were surveyed for availability and cost of selected foods. MAIN OUTCOME MEASURES: Price and availability of a limited number of staple foods representing the main food groups. STATISTICAL ANALYSES PERFORMED: Availability comparisons used least square means models and price comparisons used t tests. RESULTS: Of 77 stores identified, 16% were supermarkets, 10% grocery stores, and 74% convenience stores. There were seven stores per 100 square miles and eight stores per 10,000 residents. Availability of more healthful foods was substantially higher at supermarkets and grocery stores. For instance, low-fat/nonfat milk, apples, high-fiber bread, eggs, and smoked turkey were available in 75% to 100% of supermarkets and groceries and at 4% to 29% of convenience stores. Foods that were available at both supermarkets and convenience stores tended to be substantially more expensive at convenience stores. The healthful version of a food was typically more expensive than the less healthful version. CONCLUSIONS: In this rural environment, stores offering more healthful and lower-cost food selections were outnumbered by convenience stores offering lower availability of more healthful foods. Our findings underscore the challenges of shopping for healthful and inexpensive foods in rural areas.     

Socioeconomic differences in the cost,availability and quality of healthy food in Sydney

Objective: To compare the cost of a basket of staple foods, together with the availability and quality of fresh fruit and vegetables, by supermarket store type in high and low socioeconomic suburbs of Sydney. Methods: A food basket survey was undertaken in 100 supermarkets in the 20 highest and 20 lowest socioeconomic suburbs of Sydney. We assessed the cost of 46 foods, the range of 30 fresh fruit and vegetables and the quality of ten fresh fruit and vegetables. Two major supermarket retailers, a discount supermarket chain and independent grocery stores were surveyed. Results: The food basket was significantly cheaper in low compared to high socioeconomic suburbs ($177 vs $189, p<0.01). Discount supermarkets were at least 30% cheaper than other supermarket stores. There were fewer varieties and poorer quality fruit and vegetables in stores in low socioeconomic suburbs. Conclusions: Food basket prices and the availability and quality of fruit and vegetables varied significantly by store type and socioeconomic status of suburb. Implications for public health: A nationwide food and nutrition surveillance system is required to inform public health policy and practice initiatives. In addition to the food retail environment, these initiatives must address the underlying contributors to inequity and food insecurity for disadvantaged groups.     

Neighborhood characteristics associated with the location of food stores and food service places.

BACKGROUND: Although the relationship between diet and disease is well established, sustainable dietary changes that would affect risk for disease have been difficult to achieve. Whereas individual factors are traditional explanations for the inability of some people to change dietary habits, little research has investigated how the physical availability of healthy foods affects individuals' diets. This study examines the distribution of food stores and food service places by neighborhood wealth and racial segregation. METHODS: Names and addresses of places to buy food in Mississippi, North Carolina, Maryland, and Minnesota were obtained from respective departments of health and agriculture. Addresses were geocoded to census tracts. Median house values were used to estimate neighborhood wealth, while the proportion of black residents was used to measure neighborhood racial segregation. RESULTS: Compared to the poorest neighborhoods, large numbers of supermarkets and gas stations with convenience stores are located in wealthier neighborhoods. There are 3 times fewer places to consume alcoholic beverages in the wealthiest compared to the poorest neighborhoods (prevalence ratio [PR]=0.3, 95% confidence interval [CI]=0.1-0.6). Regarding neighborhood segregation, there are 4 times more supermarkets located in white neighborhoods compared to black neighborhoods (PR=4.3, 95% CI=1.5-12.5). CONCLUSIONS: Without access to supermarkets, which offer a wide variety of foods at lower prices, poor and minority communities may not have equal access to the variety of healthy food choices available to nonminority and wealthy communities.     

Perceptions of the Community Food Environment and Related Influences on Food Choice Among Midlife Women Residing in Rural and Urban Areas: A Qualitative Analysis

Introduction: Qualitative research on food choice has rarely focused on individuals' perceptions of the community food environment. Women remain gatekeepers of the family diet and food purchasing. Therefore we assessed midlife, Southern women's perceptions of the food environment. Related influences on food choices at work and at home were also examined.

Methods: We recruited 28 low- and moderate-income, midlife (37–67 years) women from rural and urban areas of southeastern North Carolina, using typical case and snowball sampling. They responded to questions about multilevel influences on food choice in semi-structured, in-depth interviews.

Results: Women perceived differences between urban and rural food environments, with rural areas having fewer supermarkets and fast food restaurants compared to urban areas, which had fewer produce stands. Workplace food choices were affected by the social environment (co-workers), personal health concerns, and the surrounding food environment. Food chosen at home was primarily influenced by family members, health concerns, and convenient food sources.

Discussion: While future studies should explore findings in more representative populations, potential intervention strategies can be inferred, including emphasizing healthful aspects of the food environment. Intervention and advocacy efforts are needed to improve aspects of the food environment that make healthy choices difficult.