The relationship between dietary quality and the local food environment differs according to level of educational attainment: A cross-sectional study

Abstract

There is evidence that food outlet access differs according to level of neighbourhood deprivation but little is known about how individual circumstances affect associations between food outlet access and diet. This study explored the relationship between dietary quality and a measure of overall food environment, representing the balance between healthy and unhealthy food outlet access in individualised activity spaces. Furthermore, this study is the first to assess effect modification of level of educational attainment on this relationship. A total of 839 mothers with young children from Hampshire, United Kingdom (UK) completed a cross-sectional survey including a 20-item food frequency questionnaire to measure diet and questions about demographic characteristics and frequently visited locations including home, children’s centre, general practitioner, work, main food shop and physical activity location. Dietary information was used to calculate a standardised dietary quality score for each mother. Individualised activity spaces were produced by creating a 1000m buffer around frequently visited locations using ArcGIS. Cross-sectional observational food outlet data were overlaid onto activity spaces to derive an overall food environment score for each mother. These scores represented the balance between healthy and unhealthy food outlets using weightings to characterise the proportion of healthy or unhealthy foods sold in each outlet type. Food outlet access was dominated by the presence of unhealthy food outlets; only 1% of mothers were exposed to a healthy overall food environment in their daily activities. Level of educational attainment moderated the relationship between overall food environment and diet (mid vs low, p = 0.06; high vs low, p = 0.04). Adjusted stratified linear regression analyses showed poorer food environments were associated with better dietary quality among mothers with degrees (β = -0.02; 95%CI: -0.03, -0.001) and a tendency toward poorer dietary quality among mothers with low educational attainment, however this relationship was not statistically significant (β = 0.01; 95%CI: -0.01, 0.02). This study showed that unhealthy food outlets, like takeaways and convenience stores, dominated mothers’ food outlet access, and provides some empirical evidence to support the concept that individual characteristics, particularly educational attainment, are protective against exposure to unhealthy food environments. Improvements to the imbalance of healthy and unhealthy food outlets through planning restrictions could be important to reduce dietary inequalities.

Food environments and dietary intakes among adults: does the type of spatial exposure measurement matter? A systematic review

“…The statistical findings from included studies may not apply to all individuals, particularly for those studies that made use of large population data sets. The relationships between spatial exposure to food outlets and dietary intake may vary for particular sub-groups or individuals with certain demographic characteristics [ 74 ]. Furthermore, it was not possible to standardise all effect sizes, so conclusions regarding the comparative magnitude of some within-study effects should also be interpreted with caution.…”

‘Obesogenic’ School Food Environments? An Urban Case Study in The Netherlands

“…These healthiness scores were included to avoid a dichotomous categorization of retail outlets into either ‘healthy’ or ‘unhealthy’ and to give a more nuanced indication of the healthiness of school food environments, based on the overall number of retailers selling food. Based on the methodology of and in line with international research [ 34 , 35 ], the healthiness score was derived from an online Delphi study including 20 academics and nutrition experts from The Netherlands working in the field of public health nutrition, epidemiology, health science or eating psychology [ 36 ]. In several (anonymous) rounds, scores and rationales for each outlet were provided by each expert.…”

Preconception health in England: a proposal for annual reporting with core metrics

“…The Food environment assessment tool (Feat) provides data on the density of fast food outlets and supermarkets by local authority, and can be used to assess density by neighbourhood deprivation. [19] Fast food outlets are most prevalent in deprived neighbourhoods [20,21] and monitoring using Feat could support local authority planning decisions to help improve preconception health among disadvantaged groups [22]. EuroMonitor data could be used to track sales of vitamin and mineral supplements, such as folic acid, recommended before conception by the NHS, as an indicator of increasing societal awareness of the importance of micronutrient sufficiency for a healthy pregnancy.…”