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Home » Diets that Work » Associations of childhood and adult socioeconomic circumstances with recommended food habits among young and midlife Finnish employees – BMC Nutrition…

Main findings of the study

This study examined the associations of childhood and adult SEC with recommended food habits among 1939-year-old Finnish municipal employees. Both childhood and adult SEC were positively associated with the recommended consumption of fresh or cooked vegetables, fruit or berries, dark bread, skimmed milk products, fish, and cooking oil, but inconsistently associated with red or processed meat and fat spread. When investigating all eight food habits together, we observed clear socioeconomic gradients in having several [6,7,8] recommended food habits, regardless of the SEC measure used. The strongest associations were found for participants own education, occupational class, and current financial difficulties. Participants own education, however, explained a considerable part of the associations between participants own occupational class and having several recommended food habits. Although adult SEC were more strongly associated with recommended food habits than childhood SEC, childhood SEC remained associated with having several recommended food habits after adjustment for participants own education, occupational class, and household income. Participants country of birth, marital status and children living in the household did not contribute to the associations of childhood and adult SEC with food habits. However, since only a minority of all participants (16% of women and 8% of men) had several recommended food habits, improvements in food habits are needed among all employees, including those with advantageous SEC.

Of the single food habits, the found associations of more advantaged SEC with more frequent consumption of fruit and vegetables have been broadly supported in previous studies [7, 9, 10, 40]. In addition to quantity, the variety of consumed fruit and vegetables has been shown to be greater among individuals with more advantaged SEC [41]. Beyond fruit and vegetables, we found that consumption of skimmed milk products, fish, and vegetable-based cooking fat were socioeconomically patterned. A recent systematic review showed that more advantaged SEC, especially higher parental education, were associated with greater consumption of fruit and vegetables and dairy products, and lower consumption of sugary sweetened beverages and energy-dense foods among adolescents and young adults in high-income countries [9]. Another review found that fresh fruit and vegetables, whole grains, lean meats, fish, and low-fat dairy products were more likely to be consumed among individuals with more advantaged SEC, whereas refined grains and added fats were less likely to be consumed among these individuals [7]. Moreover, a systematic review on the Australian population showed that socioeconomically more advantaged groups were more likely to consume healthier food groups in general, but variations existed between and within studies depending on the SEC measure and food group used [40].

The inconsistent findings for fat spread in our study might be explained by the modernity hypothesis: although butter consumption has traditionally been higher among individuals with more disadvantaged SEC in Finland [11], the increasing selections of oil butter spreads (whose fat compositions are not as recommended) may attract more individuals with advantaged SEC who are more open to new and fashionable food products [2, 21]. Additionally, the inverse associations of housing tenure and household wealth with recommended red or processed meat consumption may suggest that individuals with greater wealth can afford to buy a variety of expensive meat products. However, other socioeconomic measures such as occupational class and parental and participants own education showed positive associations with recommended red or processed meat consumption, which is in line with a recent study on Finnish adults [12].

While there exist some heterogeneities in the associations between different SEC measures and single food habits, the associations between advantaged SEC and healthier overall diets have been consistent [9, 40]. These studies have used dietary patterns and scores, for instance, to measure diets more broadly [9, 40]. Our findings, which indicated that multiple adult SEC were associated with having several recommended food habits, are in line with our previous study on midlife employees [25]. In both studies, childhood SEC did not explain these associations. In contrast to the previous study [25], however, we found that more advantaged childhood SEC were also associated with having several recommended food habits, independently of conventional adult SEC measures. One probable explanation for this is that childhood is temporally closer in young than in midlife adults, thus, the impacts of childhood SEC on current health behaviours can be stronger for younger adults. Parental food habits and eating behaviours, which are socioeconomically patterned, commonly transfer to offspring [42, 43], and these probably mirror young adults food habits. Another difference between this study of younger employees and our previous study of midlife employees [25] is that in this study, participants own education explained most of the associations between occupational class and food habits, but not vice versa. Thus, educational attainment, which often precedes occupational class [24], seems to play a central role in how SEC are associated with younger adults food habits. A recent systematic review also found that education, more than occupational class and income, showed a clear association with overall diet among adolescents and young adults [9]. The effect of occupational class can possibly increase over time as employees are longer influenced by work-related characteristics such as working conditions [44].

The associations between material circumstances, especially current financial difficulties and household wealth, showed consistent and independent positive associations with both single food habits and the dichotomous several recommended food habits variable. Financial difficulties, in particular, have shown a strong and consistent association with food habits in previous studies [4]. Subjective experiences of material challenges presumably affect the diversity of foods individuals buy, and consequently how nutritious their diets are. An Australian systematic review found that although socioeconomically disadvantaged groups spent less money on food than socioeconomically advantaged groups, they used proportionally more of their household budget on food [45]. Moreover, cost acts more often as a barrier to consuming healthy foods among individuals with disadvantaged SEC [46]. Diet cost has also been shown to mediate the pathway between income and diet quality [18]. Although individuals can experience financial difficulties across all socioeconomic groups, these problems have a larger influence on everyday food choices and eating practices of individuals with disadvantaged SEC [25, 47].

The 14-item FFQ provides only limited information on participants food and dietary habits. Portion sizes were not available, which limits the possibilities to make strong conclusions about the healthiness of participants diets. For instance, consumption of vegetables, fruit, or berries at least twice a day may not reach the recommended amount of at least 500g a day [28]. However, we did not use a stricter criterion for the consumption of vegetables, fruit, and berries since few participants (12% of women and 5% of men) met this criterion (Table S10, Additional file 1). Supplementary analyses for women showed that the associations between SEC and recommended food habits were mostly similar or slightly stronger when using the stricter criterion (Table S11, Additional file 1). The FFQ did not enable us to estimate participants energy intake, which could have provided more information about the healthiness of their diets. Participants consumption of each food was based on self-reports, which are known to be affected by recall and social desirability biases [48, 49]. The ability to quantify consumed foods may also be less developed among individuals with disadvantaged SEC [10]. Additionally, retrospective data on childhood SEC may be influenced by recall bias, especially among individuals with disadvantaged SEC [50] and among older participants.

We analysed women and men together in our main analyses because of the small number of men in the study (and target) population, which disregards potential gender differences in the associations. A previous study of midlife employees of the City of Helsinki showed that the associations between SEC and food habits were mostly parallel but varied somewhat by gender [25]. For instance, participants occupational class showed stronger associations with healthy food habits among women than men, whereas home ownership and financial difficulties in adulthood showed stronger associations for men than women. However, we did not observe gender interaction in the associations between SEC measures and food habits. The supplementary analyses confirmed that the associations were mostly parallel between genders, though statistically significant associations were more often observed in women (Tables S3S6, Additional file 1).

The response rate for the survey was 51.5%, and we further excluded participants with telephone interviews and with missing data on key variables (22%), which may produce selection bias. Non-respondents were more often men, manual workers, and from the lowest income quartile [27], thus it is possible that the socioeconomic gradient is stronger in the target population (see 2.1 Data and participants). However, our sensitivity analyses suggested that the participants in this study (N=4621) did not differ from participants in the initial study sample (N=5898) in terms of socioeconomic characteristics and vegetable consumption (Table S9, Additional file 1). Differences in the distributions of socioeconomic and health-related factors have also been shown to be small in general between the target population (N=11,459) and the initial study sample (N=5898) [27]. Thus, although the results are not generalisable to the general Finnish population (since the participants are municipal employees and mostly women), the data represent the target population reasonably well. Additionally, the large proportion of women (80%) in this study well corresponds to their proportion in the Finnish municipal sector.

Another strength of this paper is the use of multiple measures of both SEC and food habits, which provides a comprehensive view on socioeconomic differences in employees food habits. Research on socioeconomic differences in food habits in younger adults has been scarcer than in older adults [9], although younger adults are an important population group from the prevention point of view. For example, a previous study showed that most of adult weight gain occurred in early adulthood where socioeconomic differences in body weight already existed [51]. Thus, our findings provide useful and up-to-date information for employers and policy makers to plan targeted interventions to reduce socioeconomic differences in employees food habits. This is topical especially now as the COVID-19 pandemic is likely to further increase socioeconomic differences in food habits [20].

Since our study showed that socioeconomic differences in employees food habits were consistent, regardless of the SEC measure used, policy actions should ensure that individuals with less material resources can afford diverse selections of healthy foods. Environmental changes to promote choosing healthy foods might be efficient; for instance, improving the availability of staff canteens in workplaces characterised by employees of lower socioeconomic groups could increase consumption of healthy foods among these employees [52, 53]. Additionally, targeted interventions to promote nutrition knowledge among individuals with disadvantaged SEC may increase healthy food choices among these individuals [6, 54]. Overall, improvements in material and structural factors (e.g., working conditions, food taxes, and subsidies) that consider sociocultural and cognitive aspects of adhering to healthy diets are needed among individuals with disadvantaged SEC, so that socioeconomic differences in food habitsand in health more broadlycan be diminished.

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Associations of childhood and adult socioeconomic circumstances with recommended food habits among young and midlife Finnish employees - BMC Nutrition...

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Home » Diets that Work » Associations of childhood and adult socioeconomic circumstances with recommended food habits among young and midlife Finnish employees – BMC Nutrition…