Socioeconomic inequalities in food purchasing: the contribution of respondent-perceived and actual (objectively measured) price and availability of foods

BACKGROUND: Research has shown that lower socioeconomic groups purchase foods that are less consistent with dietary recommendations. The price and availability of foods are thought to be important mediating factors between socioeconomic position and food purchasing. OBJECTIVES: We examined the relative contribution of the perceived and objectively measured price and availability of recommended foods to household income differences in food purchasing. METHODS: Using a face-to-face interview, a random sample of Brisbane residents (n=812) were asked about their food purchasing choices in 2000. They were also asked about their perceptions of the price and availability of 'recommended' foods (i.e. choices lower in fat, saturated fat, sugar, salt or higher in fibre) in the supermarkets where they usually shopped. Audits measuring the actual availability and price of identical foods were conducted in the same supermarkets. RESULTS: Lower socioeconomic groups were less likely to make food purchasing choices consistent with dietary guideline recommendations. Objective availability and price differences were not associated with purchasing choices, nor did they contribute to socioeconomic inequalities in food purchasing choices. Perceived availability and price differences were associated with the purchase of recommended foods. Perceived availability made a small contribution to inequalities in food purchasing, however perceived price differences did not. CONCLUSION: Socioeconomic inequalities in food purchasing are not mediated by differential availability of recommended foods and differences in price between recommended and regular foods in supermarkets, or by perceptions of their relative price. However, differential perceptions of the availability of recommended foods may play a small role in food purchasing inequalities.     

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.     

Australian children's food and drink preferences: Implications for health professionals

Aim: Children's food and drink preferences play an important role in determining their consumption behaviours, but data pertaining to Australian children's preferences are lacking. The present study investigated children's preferences and health practitioners' assumptions relating to these preferences. Methods: Five hundred and twenty‐four Australian primary schoolchildren completed a written survey to explore their food and drink preferences and 576 health professionals (HPs) participated in an online survey to identify their perceptions of children's preferences. The traffic light system of food classification was used to determine the healthiness of the foods and drinks nominated as favourites by children and HPs. Data were analysed using chi‐square tests to assess the extent to which children's and HPs' responses differed. Differences according to socio‐demographic variables were investigated. Results: Children's reported preferences were healthier than HPs expected. Younger children had healthier preferences than their older peers, and girls chose healthier items than boys. Children from the medium socioeconomic schools preferred healthier foods compared with their low socioeconomic peers, but low socioeconomic children preferred healthier drinks compared to medium socioeconomic children. There were no differences between the HPs' results according to demographic variables. Conclusions: Given that children are reporting preferences for healthy options yet intakes of healthy foods are suboptimal among Australian children, efforts to improve the health status of Australian children should include strategies to encourage adults to make healthy foods and drinks more available and accessible.     

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.     

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.     

Employment status,residential and workplace food environments: Associations with women's eating behaviours

There remains a lack of consistent evidence linking food environments with eating behaviours. Studies to date have largely ignored the way different individuals interact with their local food environment and have primarily focussed on exposures within the residential neighbourhood without consideration of exposures around the workplace, for example. In this study we firstly examine whether associations between the residential food environment and eating behaviours differ by employment status and, secondly, whether food environments near employed women's workplaces are more strongly associated with dietary behaviours than food environments near home. Employment status did not modify the associations between residential food environments and eating behaviours, however results showed that having access to healthy foods near the workplace was associated with healthier food consumption. Policies focused on supportive environments should consider commercial areas as well as residential neighbourhoods.     

Sales promotions and food consumption

Sales promotions are widely used to market food to adults, children, and youth. Yet, in contrast to advertising, practically no attention has been paid to their impacts on dietary behaviors, or to how they may be used more effectively to promote healthy eating. This review explores the available literature on the subject. The objective is to identify if and what literature exists, examine the nature of this literature, and analyze what can be learned from it about the effects of sales promotions on food consumption. The review finds that while sales promotions lead to significant sales increases over the short-term, this does not necessarily lead to changes in food-consumption patterns. Nevertheless, there is evidence from econometric modeling studies indicating that sales promotions can influence consumption patterns by influencing the purchasing choices of consumers and encouraging them to eat more. These effects depend on the characteristics of the food product, sales promotion, and consumer. The complexity of the effects means that sales promotions aiming to encourage consumption of nutritious foods need to be carefully designed. These conclusions are based on studies that use mainly sales data as a proxy for dietary intake. The nutrition (and economics) research communities should add to this existing body of research to provide evidence on the impact of sales promotions on dietary intake and related behaviors. This would help support the development of a sales promotion environment conducive to healthy eating.     

Documenting the reasons people have for choosing their food

Understanding the reasons that people have for choosing their food, and why these choices vary, may affect the dietary advice and assumptions about the nutrient adequacy of future food intake. One group of respondents living in Jakarta, Indonesia completed two interviews with the same combined food frequency and qualitative technique, called Food Choice Map (FCM) over a one-month period. Another group of Indonesian respondents from a town in Java completed an FCM interview and a 24-hour recall interview. The Food Choice Map identified the same major foods as contributing to individual intakes as are identified by a 24-hr recall interview. The FCM also identified reasons for changes in food choice. The reasons for food choices varied less than the different food items chosen. The FCM links data on dietary behaviours with perceptions that respondents use to explain of those behaviours. Such data can be used to develop communication strategies for health promotion.     

Couples' gender role preferences and management of family food preferences

OBJECTIVE: To learn how couples stratified by gender role preference (GRP) manage food preferences. DESIGN: One-time individual semistructured qualitative interview with each partner in a couple representing 1 of 3 GRP pairings. Settings/PARTICIPANTS: Volunteers were recruited using advertising and snowball sampling and met the criteria of both parents living at home, wife no older than 40 years, and at least one child under age 6 years and, if present, all others under age 18 years. Both partners in volunteer couples completed a 31-item GRP scale, and the scores of each partner were categorized as traditional (lowest 25% of possible scores), transitional (middle 50%), or egalitarian (top 25%). No traditional couples volunteered. A purposeful sample of 10 transitional and 10 egalitarian wives representing 20 couples was interviewed. Variables Measured: Each partner was asked how food preference patterns were established and how family member food preferences affect foods served at evening meals now. ANALYSIS: Thematic content analysis, constant comparison, and consensus produced the final thematic analysis. RESULTS: Transitional wives married to transitional husbands established a pattern of deference to the husband's preferences that could make alteration of food choices difficult. Egalitarian wives married to egalitarian husbands established a fairer pattern of balancing partner's food preferences. CONCLUSIONS AND IMPLICATIONS: Nutrition education for transitional and egalitarian couples should use different approaches.     

Adelaide Healthy Food Basket: A survey on food cost, availability and affordability in five local government areas in metropolitan Adelaide, South Australia

Aim: There is evidence that some people in Australia do not have access to affordable, healthy foods. Information on food accessibility and affordability is essential in pubic health nutrition to assist in policy making and determining areas of intervention. The aim of the present study assess and compare the cost, availability and affordability of a standardised healthy food basket (HFB) in five local government areas (LGAs) in metropolitan Adelaide. Methods: Five LGAs in metropolitan Adelaide were selected based on ranges of socioeconomic status (SES). A reference family was used as the basis for the costing a HFB. Prices of food items were collected in selected suburbs in May, August and September in 2005. Cost of the Adelaide HFB was compared with welfare payment and average weekly earnings (AWE). Results: Average weekly cost of Adelaide HFB was $245.63 for the 11 suburbs: lowest in Coolabah, in low SES City of Fordlow ($224.17), and highest in Banksia, in high SES City of Sidehigh ($271.87). The proportion of AWE taken up by the average HFB was 35%, while that of the welfare payments was 31%. Conclusion: The study showed that the cost of HFB was lower in low‐SES suburbs. Items in the HFB were found in most supermarkets surveyed; therefore, availability of healthy food at this geographical level is not a concern. However, the study highlighted the proportionately high costs of a healthy diet for families on welfare or on a single income based on AWE, which needs to be considered in programs encouraging healthy food choices.     

Both food preferences and food frequency scores predict fat intakes of women with breast cancer

OBJECTIVE: To determine whether self-reported frequencies of food use were linked to self-reported preferences for the same foods. The hypothesis was that both food frequencies and food preferences can predict nutrient intakes. RESPONDENTS: Participants were adult women patients (n = 339), recruited through the University of Michigan Breast Care Center. The sample included both persons with breast cancer and persons who were cancer-free. DESIGN: All women completed a 98-item food frequency questionnaire and rated preferences for many of the same foods using a 9-point category scale. Percent energy from fat and saturated fat, and intakes of dietary fiber and vitamin C were estimated from analyses of 4-day food records. STATISTICAL ANALYSES: Pearson correlations coefficients were used for data analysis. RESULTS: Dislike was a strong predictor of nonuse. In contrast, the more preferred foods were also reported as more frequently consumed. Significant correlations between preference and frequency scores were obtained for virtually all item pairs. Median Pearson correlation coefficient was 0.30 (range 0.04 to 0.56). Correlations improved when foods were aggregated into the chief dietary sources of fat, saturated fat, and vitamin C. Food frequencies and food preferences showed the same strength of association with percent energy from fat and saturated fat (r = 0.20 to 0.25). Food frequencies showed a stronger association with vitamin C intakes than did preferences for vegetables and fruit. APPLICATIONS: Food preferences may provide a potential alternative to the food frequency approach.     

Awareness and Acceptance of Current Food Safety Recommendations During Pregnancy

OBJECTIVES: To better understand pregnant women's food safety attitudes and beliefs that affect food selection, preparation and handling behaviors, sources of food safety information, motivators and barriers to adopting current recommendations, and preferences for receiving food safety materials. METHODS: Eleven focus groups were conducted with 69 women (57 pregnant and 12 less than 6 months postpartum). The Health Belief Model guided development of the moderator's guide. In the presence of each focus group, participants completed a food safety attitude/behavior questionnaire. Sessions were audiotaped, transcribed, and analyzed for common themes across and within groups. RESULTS: Most participants indicated moderate concern about food safety and had made some food handling or consumption changes since becoming pregnant; however, many were not following 7 of the 12 specific recommendations discussed. Further, there was resistance to change habits, especially for less well-known recommendations. The women assumed their food is safe, and wanted strong evidence regarding why they should change current practices. Common barriers included lack of prior awareness of most recommendations, no prior illness from implicated foods and the convenience, perceived health benefits of, and personal preference for many risky foods discussed. Participants wanted food safety information that was quick and easy to read, sufficiently thorough, and specifically targeted to pregnant women. CONCLUSIONS: The women studied had not internalized the connection between risky food consumption during pregnancy and risk to the unborn child, but expressed interest in valid information that might cause them to change their behaviors. The information gained will be useful in developing food safety educational materials for pregnant women.     

Relevance of food‐based dietary guidelines to food and nutrition security: A South African perspective

Food‐based dietary guidelines are often developed at country level to assist in bringing dietary intakes closer to nutrient intake goals and, ultimately, to prevent nutrition‐related diseases. However, high food prices, alongside growing inflation, increasingly restrict food choices. This can leave those who are already vulnerable and less well off more exposed to the associated health implications of a nutrient deficient diet. With food and nutrition security being a high priority on the global nutrition agenda, this paper explores the feasibility of food‐based dietary guidelines to assist in improving food and nutrition security, focusing on nutritionally vulnerable groups in South Africa. It is argued that increased food prices, together with population growth, urbanisation and inflation, constrain everyday healthy food choices of a large proportion of South Africans. The South African food‐based dietary guidelines released in 2012 advocate the consumption of a daily diet containing a variety of foods. Unfortunately, even when the most basic and low‐cost food items are selected to make up a recommended daily diet, the associated costs are well out of reach of poor individuals residing in South Africa. The average household income of the poor in South Africa equips many households to procure mainly low‐cost staple foods such as maize meal porridge, with limited added variety. Although the ability to procure enough food to maintain satiety of all family members might categorise them as being food secure, the nutritional limitations of such monotonous diets may have severe implications in terms of their health, development and quality of life. Food‐based dietary guidelines alone have little relevance in such circumstances where financial means limit food choice. Alternative interventions are therefore required to equip the poor to follow recommended healthy diets and to improve individual food intake and nutrition security.     

Cluster analysis and food group consumption in a national sample of Australian girls

Background: Food preferences develop early in life and track into later life. There is limited information on food consumption and dietary patterns in Australian girls. The present study aimed to: (i) determine the frequency of food groups consumed over 1 day; (ii) identify dietary clusters based on food group consumption; and (iii) compare dietary intakes and activity variables between clusters. Methods: A cross‐sectional analysis of 9–16‐year‐old girls (n = 1114) from the 2007 Australian National Children’s Nutrition and Physical Activity Survey was performed. Results: Over the whole day, 30% of all girls consumed carbonated sugar drinks, 46% consumed take‐away food, 56% consumed fruit, 70% consumed at least one vegetable, and 19% and 30% consumed white and/or red meat, respectively. K‐means cluster analysis derived four clusters. Approximately one‐third of girls were identified in a Meat and vegetable cluster; these girls had the highest intakes of red meat and vegetables, and tended to have higher intakes of fruit, whole grain breads, low fat yoghurt, and lower intakes of take‐away foods and soft drinks. They also had the highest intakes of protein, fibre and micronutrients; and tended to perform more physical activity, compared to girls in the remaining clusters. Conclusions: Girls identified in the Meat and vegetable cluster, on average, consumed more lean red meat, vegetables, fruits, and low‐fat dairy products, and had a higher intakes of many nutrients. The high percentage of girls not identified in this cluster suggests the need to inform them on how to make healthy, nutrient dense food choices, and why they require increased nutrient intakes at this time.     

An investigation into school children's knowledge and awareness of food and nutrition

With the diet and exercise behaviours of UK school children showing little improvement over recent years, the need for dietary change is clearly indicated. This study aimed to assess the nutritional knowledge and understanding of primary school children in order to identify the most effective format for future nutrition messages. A qualitative methodology was employed and 114 children, aged 7–11 years, took part in 23 focus groups separated by age, gender and socio-economic status (SES). Issues discussed included parental food rules, children's perceptions of `good' and `bad' foods, diet–disease links and food groupings.
Across the groups restrictive food rules were most frequently reported whilst between groups gender and SES differences were apparent in relation to parental control over food and children's nutritional knowledge. The limitations of the children's cognitive development could be seen in their conceptualization of food groups, where concrete grouping schemes were frequently used, and in the lack of understanding inherent in their food–health or food–nutrient associations. Taste and preference were confirmed as consistent influences in children's food classification.
Primary school children may be receptive to food based dietary guidelines based on familiar, concrete food classifications. These should be cognitively appropriate and possibly need to be gender specific.     

A Novel Dietary Assessment Method to Measure a Healthy and Sustainable Diet Using the Mobile Food Record: Protocol and Methodology

The world-wide rise in obesity parallels growing concerns of global warming and depleting natural resources. These issues are often considered separately but there may be considerable benefit to raising awareness of the impact of dietary behaviours and practices on the food supply. Australians have diets inconsistent with recommendations, typically low in fruit and vegetables and high in energy-dense nutrient-poor foods and beverages (EDNP). These EDNP foods are often highly processed and packaged, negatively influencing both health and the environment. This paper describes a proposed dietary assessment method to measure healthy and sustainable dietary behaviours using 4-days of food and beverage images from the mobile food record (mFR) application. The mFR images will be assessed for serves of fruit and vegetables (including seasonality), dairy, eggs and red meat, poultry and fish, ultra-processed EDNP foods, individually packaged foods, and plate waste. A prediction model for a Healthy and Sustainable Diet Index will be developed and tested for validity and reliability. The use of the mFR to assess adherence to a healthy and sustainable diet is a novel and innovative approach to dietary assessment and will have application in population monitoring, guiding intervention development, educating consumers, health professionals and policy makers, and influencing dietary recommendations.     

Australian parents' views on their 5-6-year-old children's food choices

The home food environment is central to the development of healthy eating behaviours, but associations between the home food environment and children's food choices are not yet fully understood. The aims of this study were to explore parents' views regarding factors that influence children's food choices and parents' decision-making regarding the food they provide to their children. In-depth one-on-one interviews were conducted using a semi-structured interview schedule. Key concepts and themes were coded independently by two investigators. Participants include seventeen parents (16 mothers and 1 father) of children in their first year of formal schooling (aged 5-6 years). Five main themes emerged from the interviews: food marketing, food availability/food exposure, feeding strategies, modelling of eating and opportunities for food involvement. Parents believed that food marketing influenced their child's food preferences but differed in the ways they managed these influences. The food made available to children was also seen to influence what a child ate. Yet, although some parents believed it was the parents' role to determine what foods were made available to their child, others offered food on the basis of the child's tastes or preferences. The use of food as a reward was a feeding strategy employed by many parents. Family mealtimes were seen as an important opportunity for modelling of eating behaviour by parents. Peers were also seen to influence children's food preferences and eating behaviour. Finally, many parents believed that involving children in the preparation of food had a positive impact on children's food choices. Associations between the home food environment and children's food choices are complex and involve multiple mediators. Parents' views on the promoters and reinforcers of their decision-making regarding food and their child's food choices provide useful insights into these mediating factors. Increased understanding of these relationships is likely to enhance obesity prevention efforts.     

The development of childhood dietary preferences and their implications for later adult health

The food fed to infants and young children not only determines their health in childhood but also predicts the foods that they eat in later life. Because adult dietary preferences are partially formed in childhood, the childhood diet inevitably contributes to the long‐term health of the individual. We are all aware of preferences that have endured since childhood, and that our dietary habits only change if we have reason to adapt them, perhaps for a healthier lifestyle. Adopting a healthy diet in adulthood is likely to be considerably easier if we have developed healthy food preferences during our childhood. Current information shows that toddlers are fed diets high in fat, sugar and salt and that mothers are confused about what toddlers should be eating. A healthy diet for toddlers combines foods from all the five food groups. This combination involves mixing high‐calorie and low‐calorie foods. Healthy food options should be introduced from weaning, and offered repeatedly through the infant and toddler years. Furthermore, the whole family should model a healthy eating lifestyle in order to foster the acceptance of foods that constitute a well‐balanced diet.