Perceptions that fruit and vegetables are expensive are more common among the socio-economically disadvantaged groups and are linked to poor dietary outcomes. Such perceptions may be exacerbated in countries recently affected by natural disasters, where devastation of fruit and vegetable crops has resulted in increase in prices of fruit and vegetables. Examining the associations of perceptions of fruit and vegetable affordability and children's diets can offer insights into how the high prices of fruit and vegetables might have an impact on the diets of children.
We analysed the data from 546 socio-economically disadvantaged mother–child pairs to assess the relationship between maternal perceptions of fruit and vegetable affordability and the diets of their children.
Fruit consumption was lower among children whose mothers felt the cost of fruit was too high. Maternal perceptions of fruit and vegetable affordability were not associated with any other aspect of child's diet.
Our results suggest a possible role for maternal perceptions of fruit affordability in children's diet, though further research is warranted.
The cost of food is the second most important factor affecting food decisions, besides taste (Glanz et al., 1998). Some evidence shows that healthy foods offer lower economic value than calorie-dense foods that are high in sugar and fat (Drewnowski and Darmon, 2005; Drewnowski, 2009). Obesity and nutrition follow a socio-economic gradient, with higher rates observed among those residing in deprived areas, who have low incomes or poor education (McLaren, 2007). Therefore, as the costs of fruit and vegetables increase, families with limited resources may perceive healthy food as unaffordable and consequently turn towards more affordable options, high in sugar and fat, that potentially increase their risk of poor nutrition and obesity.
Perceptions that fruit and vegetables are expensive may be particularly exacerbated, following a series of recent natural disasters that, for several nations, including Japan (US Department of Health and Human Services, US Food and Drug Administration, 2011) and Australia, have devastated local agricultural commodities, resulting in depleted fruit and vegetable crops and consequently soaring the prices of a wide range of commonly-consumed fruit and vegetables. For example, earlier this year, the Australian agricultural sector was devastated by cyclone and floods, with crop losses estimated at $1.4 billion. More than 85% of banana crops were eradicated, with prices consequently expected to increase by 400–500%. Bananas were not the only lost commodity; flood- and cyclone-related food shortages are anticipated to drive up the prices of a wide range of fruit and vegetables.
Perceptions of healthy food as unaffordable are more prevalent among socio-economically disadvantaged women, and these perceptions have been linked to poor dietary outcomes (Williams et al., 2010). Less is known about the role of mother's perceptions of fruit and vegetable affordability in the diets of their children. Such evidence can offer insights into the expected impact that rising prices of fruit and vegetables might have on the diets of children.
Participants were drawn from a larger study of 4349 women who participated in the Resilience for Eating and Physical Activity Despite Inequality (READI) study, a longitudinal cohort study examining resilience to obesity among women and children residing in socially and economically disadvantaged neighbourhoods in rural and urban areas of Victoria, Australia (McFarlane et al., 2010). Using the data from 546 mother–child pairs, we assessed whether mother's perceptions of fruit and vegetable affordability were related to children's diet. To assess the perceived costs of fruit and vegetables, mothers were asked to indicate their level of agreement with the statement ‘I do not buy many fruits (vegetables) because they costs too much’. Responses ‘Strongly disagree’, ‘Disagree’ and ‘Neither agree nor disagree’ were collapsed into one category, ‘Do not agree’. Responses ‘Agree’ and ‘Strongly agree’ were collapsed into the category, ‘Agree’.
Participants were asked how many serves of fruit and vegetables their child consumed per week. They were also asked how often their child ate the following foods: salty snacks, chocolate/lollies, cakes/doughnuts/sweet biscuits and fast foods. Because of severe skewness, consumption frequencies of salty snacks, chocolate/lollies and cakes/doughnuts/sweet biscuits were dichotomized into ‘Up to once per week’ and ‘More than once per week’. Similarly, consumption of fast food was dichotomized into ‘Less than once per month’ and ‘At least once per month’.
To determine whether mothers' perceptions of the costs of fruit and vegetables were related to children's intake of fruit and vegetables, two linear regression models were examined, one with child's fruit consumption as the outcome and maternal perceived costs of fruit as a predictor, and the other with child's vegetable consumption as the outcome and maternal perceived costs of vegetables as a predictor. Also, to determine whether mothers' perceived costs of fruit and vegetables were related to children's intake of unhealthy foods, a number of binary logistic regression models were tested with consumption of salty snacks, chocolate/lollies and cakes/doughnuts/sweet biscuits as the outcomes. For each outcome a separate model was examined with perceived cost of fruit and perceived cost of vegetables as predictors. All analyses included child age, maternal education and household income as covariates, and controlled for clustering by suburb.
Descriptive data for covariates, mean weekly serves of fruit and vegetables, percentage for categories of snacks and fast food consumption frequency, and percentage of mothers who agreed/did not agree that the costs of fruit/vegetables was too high are presented in Table 1. Mothers' perceptions of the cost of fruit was significantly associated with children's fruit consumption (β=−0.15, 95% CI: −0.23 to 0.06, P<0.0005). Children whose mothers felt the cost of fruit was too high consumed a mean of 11.7 (s.d.=7.1) serves of fruit per week (or 1.7 serves per day), whereas children whose mothers did not feel this way consumed a mean of 15.2 (s.d.=7.5) serves per week or 2.2 serves per day. Mothers' perceptions of vegetable affordability were not associated with children's vegetable intakes. There were no associations between perceived fruit and vegetable affordability and children's intake of fast foods or unhealthy snack foods.
One limitation of this study is that the one-item measure of perceived fruit and vegetable affordability utilised may not capture all aspects of participant's perceptions around cost. Furthermore, although area-level disadvantage is associated with indicators of poor health, independent of individual-level indicators of socio-economic position (that is, education level and income King et al., 2006), approximately one quarter of our sample were highly educated and/or had a high income. This finding could account for the lower-than-expected rates of poor perceptions of fruit and vegetable affordability observed in the current study (15% and 8%, respectively) compared with values (approaching 50%) observed elsewhere (Dibsdall et al., 2003; Bihan et al., 2010). Consequently, personal income and education were included as covariates in all analyses. The low numbers maintaining negative perceptions of fruit and vegetable affordability, although statistically adequate, may have limited our ability to detect significant associations between maternal perceptions of fruit and vegetable affordability and vegetable and snack consumption.
Acknowledging these limitations and the cross-sectional design of this study, our results suggest that negative perceptions of fruit affordability may lead to lower fruit intakes for children. Nutrition promotion efforts should focus on alternative sources of fruit, such as tinned, frozen and other seasonal produce, which are not as affected by price inflation. It is encouraging that children's vegetable intakes were not associated with mothers' perceptions of vegetable affordability. It is possible that vegetables are considered as a core, or non-negotiable, component of children's diets and as such, demand is inelastic; mothers may be more prepared to pay higher prices to provide vegetables for their children. There is some reassurance; we found no evidence that mothers who perceived fruit and vegetables as unaffordable provided more fast food or unhealthy snacks as alternatives for their children.
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International Journal of Behavioral Nutrition and Physical Activity (2014)