Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

How do socio-economic status, perceived economic barriers and nutritional benefits affect quality of dietary intake among US adults?

European Journal of Clinical Nutrition volume 62, pages 303–313 (2008)Cite this article

Abstract

Background:

Socio-economic factors may affect diet quality, perhaps differentially across gender and ethnicity. The mechanism of this association is still largely unknown.

Objectives:

We examined the independent effects of socio-economic status (SES), perceived barrier of food price (PBFP) and perceived benefit of diet quality (PBDQ) on diet quality indicators and indices (DQIj,k), across gender and ethnicity. Additionally, we estimated the mediation proportion of the effect of SES on DQIj,k through PBFP and PBDQ.

Methods:

Data from two cross-sectional surveys, the Continuing Survey of Food Intakes by Individuals (CSFII) and Diet and Health Knowledge Survey (DHKS) 1994–96 were used. Our sample consisted of 4356 US adults aged 20–65 years. With principal components analysis, SES (an index) was measured using household income per capita and education, and PBDQ was measured using an 11-item scale. PBFP was defined as the ratio of importance of food price score relative to nutrition. DQIj,k were assessed by a set of indicators and two indices including the Healthy Eating Index.

Results:

The associations between SES, PBFP, PBDQ and DQIj,k varied significantly across gender and ethnic groups. PBFP acted as a mediator in the association between SES and selected DQIj indicators, namely energy, fat intake, sodium and simple sugar consumption (mediation proportion >10%), but not PBDQ.

Conclusions:

SES, PBFP and PBDQ all affect dietary intake, and vary by ethnicity and gender. Positive effect of SES on DQIj,k may be mediated by PBFP but not PBDQ which is an independent protective factor. Nutrition education is important to promote healthy eating.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1
Figure 2
Figure 3

Similar content being viewed by others

References

  • Appel LJ (2000). The role of diet in the prevention and treatment of hypertension. Curr Atheroscler Rep 2, 521–528.

    Article  CAS  Google Scholar 

  • Bender R, Lange S (2001). Adjusting for multiple testing – when and how? J Clin Epidemiol 54, 343–349.

    Article  CAS  Google Scholar 

  • Bodnar LM, Siega-Riz AM (2002). A Diet Quality Index for Pregnancy detects variation in diet and differences by sociodemographic factors. Public Health Nutr 5, 801–809.

    Article  Google Scholar 

  • Bowman SA, Vinyard BT (2004). Fast food consumption of US adults: impact on energy and nutrient intakes and overweight status. J Am Coll Nutr 23, 163–168.

    Article  Google Scholar 

  • Byrne B (2001). Structural Equation Modeling with Amos: Basic Concepts, Applications, and Programming. USA.

    Google Scholar 

  • Dennis LK, Snetselaar LG, Nothwehr FK, Stewart RE (2003). Developing a scoring method for evaluating dietary methodology in reviews of epidemiologic studies. J Am Diet Assoc 103, 483–487.

    PubMed  Google Scholar 

  • Ding EL, Mozaffarian D (2006). Optimal dietary habits for the prevention of stroke. Semin Neurol 26, 11–23.

    Article  Google Scholar 

  • Ditlevsen S, Christensen U, Lynch J, Damsgaard MT, Keiding N (2005). The mediation proportion: a structural equation approach for estimating the proportion of exposure effect on outcome explained by an intermediate variable. Epidemiology 16, 114–120.

    Article  Google Scholar 

  • Drewnowski A (2004). Obesity and the food environment: dietary energy density and diet costs. Am J Prev Med 27, 154–162.

    Article  Google Scholar 

  • Drewnowski A, Darmon N (2005a). The economics of obesity: dietary energy density and energy cost. Am J Clin Nutr 82, 265S–273S.

    Article  CAS  Google Scholar 

  • Drewnowski A, Darmon N (2005b). Food choices and diet costs: an economic analysis. J Nutr 135, 900–904.

    Article  CAS  Google Scholar 

  • Ford ES, Mokdad AH, Liu S (2005). Healthy Eating Index and C-reactive protein concentration: findings from the National Health and Nutrition Examination Survey III, 1988–1994. Eur J Clin Nutr 59, 278–283.

    Article  CAS  Google Scholar 

  • Friel S, Kelleher CC, Nolan G, Harrington J (2003). Social diversity of Irish adults nutritional intake. Eur J Clin Nutr 57, 865–875.

    Article  CAS  Google Scholar 

  • Fung TT, McCullough ML, Newby PK, Manson JE, Meigs JB, Rifai N et al. (2005). Diet-quality scores and plasma concentrations of markers of inflammation and endothelial dysfunction. Am J Clin Nutr 82, 163–173.

    Article  CAS  Google Scholar 

  • Giskes K, Lenthe Fv F, Brug HJ, Mackenbach J (2004). Dietary intakes of adults in the Netherlands by childhood and adulthood socioeconomic position. Eur J Clin Nutr 58, 871–880.

    Article  CAS  Google Scholar 

  • Gittelsohn J, Anliker JA, Sharma S, Vastine AE, Caballero B, Ethelbah B (2006). Psychosocial determinants of food purchasing and preparation in American Indian households. J Nutr Educ Behav 38, 163–168.

    Article  Google Scholar 

  • Greenland S, Robins JM (1991). Empirical-Bayes adjustments for multiple comparisons are sometimes useful. Epidemiology 2, 244–251.

    Article  CAS  Google Scholar 

  • Groth MV, Fagt S, Brondsted L (2001). Social determinants of dietary habits in Denmark. Eur J Clin Nutr 55, 959–966.

    Article  CAS  Google Scholar 

  • Guo X, Warden BA, Paeratakul S, Bray GA (2004). Healthy Eating Index and obesity. Eur J Clin Nutr 58, 1580–1586.

    Article  CAS  Google Scholar 

  • Hatcher L (1994). A step-by-step approach to using the SAS system for factor analysis ad structural equation modeling,. SAS, Cary, NC.

    Google Scholar 

  • Hulshof KF, Brussaard JH, Kruizinga AG, Telman J, Lowik MR (2003). Socio-economic status, dietary intake and 10 y trends: the Dutch National Food Consumption Survey. Eur J Clin Nutr 57, 128–137.

    Article  CAS  Google Scholar 

  • Inglis V, Ball K, Crawford D (2005). Why do women of low socioeconomic status have poorer dietary behaviours than women of higher socioeconomic status? A qualitative exploration. Appetite 45, 334–343.

    Article  CAS  Google Scholar 

  • Kant AK, Schatzkin A, Graubard BI, Schairer C (2000). A prospective study of diet quality and mortality in women. JAMA 283, 2109–2115.

    Article  CAS  Google Scholar 

  • Kaufman JS, MacLehose RF, Kaufman S, Greenland S (2005). The mediation proportion. Epidemiology 16, 710.

    Article  Google Scholar 

  • Kennedy ET, Bowman SA, Spence JT, Freedman M, King J (2001). Popular diets: correlation to health, nutrition, and obesity. J Am Diet Assoc 101, 411–420.

    Article  CAS  Google Scholar 

  • Mai V, Kant AK, Flood A, Lacey Jr JV, Schairer C, Schatzkin A (2005). Diet quality and subsequent cancer incidence and mortality in a prospective cohort of women. Int J Epidemiol 34, 54–60.

    Article  Google Scholar 

  • McCullough ML, Feskanich D, Rimm EB, Giovannucci EL, Ascherio A, Variyam JN et al. (2000). Adherence to the Dietary Guidelines for Americans and risk of major chronic disease in men. Am J Clin Nutr 72, 1223–1231.

    Article  CAS  Google Scholar 

  • Moser RP, Green V, Weber D, Doyle C (2005). Psychosocial correlates of fruit and vegetable consumption among African–American men. J Nutr Educ Behav 37, 306–314.

    Article  Google Scholar 

  • Onwujekwe O (2005). Inequities in healthcare seeking in the treatment of communicable endemic diseases in Southeast Nigeria. Soc Sci Med 61, 455–463.

    Article  Google Scholar 

  • Parmenter K, Waller J, Wardle J (2000). Demographic variation in nutrition knowledge in England. Health Educ Res 15, 163–174.

    Article  CAS  Google Scholar 

  • Perneger TV (1999). Adjusting for multiple testing in studies is less important than other concerns. Bmj 318, 1288.

    Article  CAS  Google Scholar 

  • Popkin BM, Duffey K, Gordon-Larsen P (2005). Environmental influences on food choice, physical activity and energy balance. Physiol Behav 86, 603–613.

    Article  CAS  Google Scholar 

  • Rothman KJ (1990). No adjustments are needed for multiple comparisons. Epidemiology 1, 43–46.

    Article  CAS  Google Scholar 

  • Schimek MG (2000). Smoothing and regression: approaches, computations and application. Wiley series in probability and statistics, John Wiley & sons Inc., USA.

    Book  Google Scholar 

  • Schroder H, Marrugat J, Covas MI (2006). High monetary costs of dietary patterns associated with lower body mass index: a population-based study. Int J Obes (Lond) 30, 1574–1579.

    Article  CAS  Google Scholar 

  • Sharma S (1996). Applied multivariate techniques,. Wiley: USA.

    Google Scholar 

  • Srinath Reddy K, Katan MB (2004). Diet, nutrition and the prevention of hypertension and cardiovascular diseases. Public Health Nutr 7, 167–186.

    CAS  PubMed  Google Scholar 

  • STATA (2003). Stata Corporation, Texas.

  • Trichopoulou A, Costacou T, Bamia C, Trichopoulos D (2003). Adherence to a Mediterranean diet and survival in a Greek population. N Engl J Med 348, 2599–2608.

    Article  Google Scholar 

  • Trichopoulou A, Kouris-Blazos A, Wahlqvist ML, Gnardellis C, Lagiou P, Polychronopoulos E et al. (1995). Diet and overall survival in elderly people. BMJ 311, 1457–1460.

    Article  CAS  Google Scholar 

  • Turrell G, Kavanagh AM (2006). Socio-economic pathways to diet: modelling the association between socio-economic position and food purchasing behaviour. Public Health Nutr 9, 375–383.

    Article  Google Scholar 

  • US Department of Agriculture ARS, FSRG. Publisher: National Technical Information Service Accession, Washington, DC.

Download references

Acknowledgements

The study was supported by the Johns Hopkins Bloomberg School of Public Health, the US Department of Agriculture (2044-05322), the NIDDK/NIH (R01 DK63383) and the Johns Hopkins Center for a Livable Future.

Author information

Authors and Affiliations

  1. Department of International Health, Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    M A Beydoun & Y Wang

Authors
  1. M A Beydoun
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Y Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Y Wang.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Beydoun, M., Wang, Y. How do socio-economic status, perceived economic barriers and nutritional benefits affect quality of dietary intake among US adults?. Eur J Clin Nutr 62, 303–313 (2008). https://doi.org/10.1038/sj.ejcn.1602700

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.ejcn.1602700

Keywords

This article is cited by

Search

Advanced search

Quick links