Abstract
Purpose
To examine the underlying reasons for the positive relation between socio-economic status (SES) and the diet quality of adolescents.
Methods
In 2081 adolescents (12.5–17.5 years) of the European HELENA study, a continuous variable on diet quality via 2-day 24-h recalls was available. SES was reflected by parental education, parental occupation and family affluence. Mediation by several psychosocial determinants was tested: self-efficacy, availability at school and home, social support, barriers, benefits, awareness and some self-reported influencers (parents, school, taste, health, friends, food readily available, easy preparation, hunger, price and habits). Multiple mediation analyses were adjusted for age, sex and country.
Results
The availability of soft drinks and fruit at home, social support, parental influence, barriers, price influence, taste influence, health influence and food being readily available were significant mediators. The multiple mediation indirect effect accounted for 23–64% of the total effect. Both occupation and education and both maternal and paternal factors could be explained by the mediation. The unavailability of soft drinks was the strongest mediator (17–44% of the total effect).
Conclusion
Up to 64% of the positive relation between SES and the diet quality in adolescence could be explained by several healthy eating determinants. Focusing on these factors in low-SES populations can minimize social inequalities in diet and health by improving the diet of these specific adolescents.
Similar content being viewed by others
References
Aranceta J, Perez-Rodrigo C, Ribas L, Serra-Majem L (2003) Sociodemographic and lifestyle determinants of food patterns in Spanish children and adolescents: the enKid study. Eur J Clin Nutr 57(Suppl 1):S40–S44. doi:10.1038/sj.ejcn.1601813
Ball K, Crawford D, Mishra G (2006) Socio-economic inequalities in women’s fruit and vegetable intakes: a multilevel study of individual, social and environmental mediators. Public Health Nutr 9:623–630
Ball K MA, Crawford D, Savige G, Andrianopaulos N, Worsley A (2009) Can social cognitive theory constructs explain socio-economic variations in adolescent eating behaviours? A mediation analysis. Health Educ Res 24:496–506
Bere E KK (2004) Correlates of fruit and vegetable intake among Norwegian schoolchildren: parental and self-reports. Public Health Nutr 7:991–998
Beydoun M, Wang Y (2008) 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
Brug J, Lechner L, De Vries H (1995) Psychosocial determinants of fruit and vegetable consumption. Appetite 25:285–296. doi:10.1006/appe.1995.0062
Campbell KJ, Crawford DA, Salmon J, Carver A, Garnett SP, Baur LA (2007) Associations between the home food environment and obesity-promoting eating behaviors in adolescence. Obesity 15:719–730 doi:10.1038/oby.2007.553
Cole TJ, Bellizzi MC, Flegal KM, Dietz WH (2000) Establishing a standard definition for child overweight and obesity worldwide: international survey. Bmj 320:1240–1243
Cole TJ, Freeman JV, Preece MA (1995) Body-Mass Index Reference Curves for the Uk, 1990. Arch Dis Child 73:25–29
Currie C, Molcho M, Boyce W, Holstein B, Torsheim T, Richter M (2008) Researching health inequalities in adolescents: the development of the Health Behaviour in School-Aged Children (HBSC) family affluence scale. Soc Sci Med 66:1429–1436. doi:10.1016/j.socscimed.2007.11.024
Currie J, Stabile M (2003) Socioeconomic status and health: why is the relationship stronger for older children? Am Econ Rev 93:1813–1823
Darmon N. DA (2008) Does social class predict diet quality? Am J Clin Nutr 87:1107–1117
Dehne LI, Klemm C, Henseler G, Hermann-Kunz E (1999) The German Food Code and Nutrient Data Base (BLS II.2). Eur J Epidemiol 15:355–359
Hallström L, Vereecken C, Ruiz J, Patterson E, Gilbert C, Catasta G, Diaz L, Gomez-Marinez S, Gonzalez Gross M, Gottrand F, Hegyi A, Lehoux C, Mouratidou T, Widham K, Aström A, Moreno L, Sjöström M (2011) Breakfast habits and factors influencing food choices at breakfast in relation to socio-demographic and family factors among European adolescents—the HELENA Study. Appetite 56:649–657
Hallström L. VC, Ruiz J, Patterson E, Gilbert C, Catasta G, Diaz L, Gomez-Marinez S, Gonzalez Gross M, Gottrand F, Hegyi A, Lehoux C, Mouratidou T, Widham K, Aström A, Moreno L, Sjöström M (2011) Breakfast habits and factors influencing food choices at breakfast in relation to socio-demographic and family factors among European adolescents—the HELENA Study. Appetite 56:649–657
Hanson N, Neumark-Sztainer D, Eisenberg M, Story M, Wall M (2004) Associations between parental report of the home food environment and adolescent intakes of fruits, vegetables and dairy foods. Public Health Nutr 8:77–85
Haubrock J, Hartigg U, Souverein O, Boeing H (2010) An improved statistical tool for estimating usual intake distributions: the Multiple Source Method (MSM). Arch Publ Health 68:14–15
Hayes AF (2009) Beyond Baron and Kenny: Statistical Mediation Analysis in the New Millennium. Commun Monogr 76:408–420
Hoppu U, Lehtisalo J, Tapanainen H, Pietinen P (2010) Dietary habits and nutrient intake of Finnish adolescents. Publ Health Nutr 13:965–972. doi:10.1017/S1368980010001175
Hu FB (2002) Dietary pattern analysis: a new direction in nutritional epidemiology. Curr Opin Lipidol 13:3–9
Huybrechts I, Vereecken C, De Bacquer D, Vandevijvere S, Van Oyen H, Maes L, Vanhauwaert E, Temme L, De Backer G, De Henauw S (2010) Reproducibility and validity of a diet quality index for children assessed using a FFQ. Brit. J Nutr 104:135–144 doi:10.1017/S0007114510000231
Iliescu C, Beghin L, Maes L, De Bourdeaudhuij I, Libersa C, Vereecken C, Gonzalez-Gross M, Kersting M, Molnar D, Leclercq C, Sjostrom M, Manios Y, Wildhalm K, Kafatos A, Moreno LA, Gottrand F, Group HS (2008) Socioeconomic questionnaire and clinical assessment in the HELENA Cross-Sectional Study: methodology. Int J Obes (Lond) 32 Suppl 5:S19–25. doi:10.1038/ijo.2008.178
Inglis V. BKCD (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
Johnson JS, Nobmann ED, Asay E, Lanier AP (2009) Dietary intake of Alaska Native people in two regions and implications for health: the Alaska Native Dietary and Subsistence Food Assessment Project. Int J Circumpolar Health 68:109–122
Krolner R, Rasmussen M, Brug J, Klepp K-I, Wind M, Due P (2011) Determinants of fruit and vegetable consumption among children and adolescents: a review of the literature. Part II: qualitative studies. Int J Behav Nutr Phys Activity 8
Lake AA, Mathers JC, Rugg-Gunn AJ, Adamson AJ (2006) Longitudinal changes in food habits between adolescence (11–12 years) and adulthood (32–33 years): the ASH30 study. J Publ Health (Oxf) 28:10–16
MacFarlane A, Crawford D, Ball K, Savige G, Worsley A (2007) Adolescent home food environments and socioeconomic position. Asia Pac J Clin Nutr 16:748–756
McLaughlin C, Tarasuk V, reiger N (2003) An examination of at home preparation activity among low-income, food-insecure women. J Am Diet Assoc 103:1506–1512
Monge-Rojas RGC, Sanchez M, Munoz L (2005) Barriers to and motivators for healthful eating as perceived by rural an urban Costa Rican adolescents. J Nutr Educ Behav 37:33–40
Moreno L, De Henauw S, González-Gross M, Kersting M, Molnár D, Gottrand F, Barrios L, Sjöström M, Manios Y, Gilbert CC, Leclercq C, Widhalm K, Kafatos A, Marcos A, on behalf of the HELENA Study Group (2008) Design and implementation of the Healthy Lifestyle in Europe by Nutrition in Adolescence Cross-Sectional Study. Int J Obesity 32:S4–S11
Moreno LA, De Henauw S, Gonzalez-Gross M, Kersting M, Molnar D, Gottrand F, Barrios L, Sjostrom M, Manios Y, Gilbert CC, Leclercq C, Widhalm K, Kafatos A, Marcos A, Group HS (2008) Design and implementation of the healthy lifestyle in europe by nutrition in adolescence cross-sectional study. Int J Obes (Lond) 32 Suppl 5:S4–11. doi:10.1038/ijo.2008.177
Moreno LA, Gonzalez-Gross M, Kersting M, Molnar D, de Henauw S, Beghin L, Sjostrom M, Hagstromer M, Manios Y, Gilbert CC, Ortega FB, Dallongeville J, Arcella D, Warnberg J, Hallberg M, Fredriksson H, Maes L, Widhalm K, Kafatos AG, Marcos A, Helena Study Group (2008) Assessing, understanding and modifying nutritional status, eating habits and physical activity in European adolescents: the HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescence) Study. Public Health Nutr 11:288–299. doi:10.1017/S1368980007000535
Neumark-Sztainer D, Story M, Perry C, Casey MA (1999) Factors influencing food choices of adolescents: findings from focus-group discussions with adolescents. J Am Diet Assoc 99:929–937. doi:10.1016/S0002-8223(99)00222-9
Neumark-Sztainer D, Wall M, Perry C, Story M (2003) Correlates of fruit and vegetable intake among adolescents—findings from Project EAT. Prev Med 37:198–208. doi:10.1016/S0091-7435(03)00114-2
Neumark-Sztainer D, Wall M, Perry C, Story M (2003) Correlates of fruit and vegetable intake among adolescents findings from project EAT. Prev Med 37:198–208
Ottevaere C. H, I., Benser J, De Bourdeaudhuij I, Cuenca-Garcia M, Dallongeville J, Zaccaria M, Gottrand F, Kersting M, Rey-López JP, Manios Y, Molnár D, Moreno LA, Smpokos E, Widhalm K, De Henauw, S, The HELENA Study Group (2011) Clustering patterns of physical activity, sedentary and dietary behavior among European adolescents: The HELENA study. BMC Public Health 11:328
Pearson N, Biddle S, Gorely T (2008) Family correlates of fruit and vegetable consumption in children and adolescents: a systematic review. Public Health Nutrition 12:267–283
Rasmussen M, Krolner R, Klepp K-I, Lytle L, Brug J, Bere E, Due P (2006) Determinants of fruit and vegetable consumption among children and adolescents: a review of the literature. Part I: quantitative studies. Int J Behav Nutr Phys Activity 3
Richter A, Heidemann C, Schulze MB, Roosen J, Thiele S, Mensink GB (2012) Dietary patterns of adolescents in Germany–associations with nutrient intake and other health related lifestyle characteristics. BMC Pediatr 12:35. doi:10.1186/1471-2431-12-35
Sandvik C GR, Samdal O, Brug J, Klepp KI (2010) Does socio-economic status moderate the associations between psycho-social predictors and fruit intake in schoolchildren? The Pro Children study. Health Educ Res 25:121–134
Serra-Majem L, Ribas L, Perez-Rodrigo C, Garcia-Closas R, Pena-Quintana L, Aranceta J (2002) Determinants of nutrient intake among children and adolescents: results from the enKid Study. Ann Nutr Meta 46:31–38
Serra-Majem L, Ribas L, Perez-Rodrigo C, Garcia-Closas R, Pena-Quintana L, Aranceta J (2002) Determinants of nutrient intake among children and adolescents: results from the enKid study. Ann Nutr Metab 46:31–38. doi:10.1159/000066398
Skardal M, Western IM, Ask A, Overby N (2014) Socioeconomic differences in selected dietary habits among Norwegian 13–14 year-olds: a cross-sectional study. Food Nutr Res 58
Srinath Reddy K, Katan MB (2004) Diet, nutrition and the prevention of hypertension and cardiovascular diseases. Public Health Nutr 7:167–186
Story M, Neumark-Sztainer D, French S (2002) Individual and environmental influences on adolescent eating behaviors. J Am Diet Assoc 102:S40–S51
Taylor JP, Evers S, McKenna M (2005) Determinants of healthy eating in children and youth. Can J Public Health 96(Suppl 3):S22–S29
Tiffin R, Salois M (2012) Inequalities in diet and nutrition. Proceeds of the Nutrition. Society 75:105–111
Timperio A BK, Roberts R, Campbell K, Andrianopoulos N, Crawford D (2008) Children’s fruit and vegetable intake: associations with the neighbourhood food environment. Prev Med 46:331–335
Vandevijvere S, Geelen A, Gonzalez-Gross M, Van’t Veer P, Dallongeville J, Mouratidou T, Dekkers A, Bornhorst C, Breidenassel C, Crispim SP, Moreno LA, Cuenca-Garcia M, Vyncke K, Beghin L, Grammatikaki E, De Henauw S, Catasta G, Hallstrom L, Sjostrom M, Warnberg J, Esperanza L, Slimani N, Manios Y, Molnar D, Gilbert CC, Kafatos A, Stehle P, Huybrechts I (2012) Evaluation of food and nutrient intake assessment using concentration biomarkers in European adolescents from the Healthy Lifestyle in Europe by Nutrition in Adolescence study. Br J Nutr:1–12. doi:10.1017/S0007114512002012
Vereecken C, De Henauw S, Maes L, Moreno L, Manios Y, Phillipp K, Plada M, De Bourdeaudhuij I, Group HS (2009) Reliability and validity of a healthy diet determinants questionnaire for adolescents. Public Health Nutr 12:1830–1838. doi:10.1017/S1368980008004655
Vereecken C, Dohogne S, Covents M, Maes L (2010) How accurate are adolescents in portion-size estimation using the computer tool Young Adolescents’ Nutrition Assessment on Computer (YANA-C)? Brit. J Nutr 103:1844–1850. doi:10.1017/S0007114510000127
Vereecken CA, Covents M, Matthys C, Maes L (2005) Young adolescents’ nutrition assessment on computer (YANA-C). Eur J Clin Nutr 59:658–667. doi:10.1038/sj.ejcn.1602124
Vereecken CA, Covents M, Sichert-Hellert W, Alvira JM, Le Donne C, De Henauw S, De Vriendt T, Phillipp MK, Beghin L, Manios Y, Hallstrom L, Poortvliet E, Matthys C, Plada M, Nagy E, Moreno LA, Group HS (2008) Development and evaluation of a self-administered computerized 24-h dietary recall method for adolescents in Europe. Int J Obes (Lond) 32 Suppl 5:S26–34. doi:10.1038/ijo.2008.180
Vereecken CA, Inchley J, Subramanian SV, Hublet A, Maes L (2005) The relative influence of individual and contextual socio-economic status on consumption of fruit and soft drinks among adolescents in Europe. Eur J Pub Health 15:224–232. doi:10.1093/eurpub/cki005
Vereecken CA VDW, Maes L (2005) Measuring attitudes, self-efficacy, and social and environmental influences on fruit and vegetable consumption of 11- and 12-year-old children: reliability and validity. J Am Diet Assoc 105:257–261
VIGeZ (2006) De actieve voedingsdriehoek: een praktische voedings- en beweeggids (The active Food Pyramid: A practical guide to diet and physical activity). Vlaams Instituut voor Gezondheidspromotie en Ziektepreventie (VIGeZ), Brussels
Vyncke K, Cruz Fernandez E, Fajo-Pascual M, Cuenca-Garcia M, De Keyzer W, Gonzalez-Gross M, Moreno LA, Beghin L, Breidenassel C, Kersting M, Albers U, Diethelm K, Mouratidou T, Grammatikaki E, De Vriendt T, Marcos A, Bammann K, Bornhorst C, Leclercq C, Manios Y, Dallongeville J, Vereecken C, Maes L, Gwozdz W, Van Winckel M, Gottrand F, Sjostrom M, Diaz LE, Geelen A, Hallstrom L, Widhalm K, Kafatos A, Molnar D, De Henauw S, Huybrechts I (2012) Validation of the diet quality index for adolescents by comparison with biomarkers, nutrient and food intakes: the HELENA study. Br J Nutr:1–12. doi:10.1017/S000711451200414X
WHO (2003) Diet, nutrition, and the prevention of chronic diseases. In: Consultation. RoaJWFE (ed) WHO technical report series 916. WHO, Geneva
Xie B, Gilliland FD, Li YF, Rockett HRH (2003) Effects of ethnicity, family income, and education on dietary intake among adolescents. Prev Med 36:30–40. doi:10.1006/pmed.2002.1131
Zarnowiecki DM, Dollman J, Parletta N (2014) Associations between predictors of children’s dietary intake and socioeconomic position: a systematic review of the literature. Obesity reviews 15:375–391
Acknowledgements
We would like to thank all fieldworkers and all participating adolescents. We acknowledge the work of Louise Sarrazyn and Laura Vancoppernolle in doing some preliminary analyses during their master thesis.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Financial support
The HELENA Study was carried out with the financial support of the European Community Sixth RTD Framework Programme (Contract FOODCT-2005-007034). The writing group takes sole responsibility for the content of this article. The European Community is not liable for any use that may be made of the information contained therein.
Electronic supplementary material
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Michels, N., Vynckier, L., Moreno, L.A. et al. Mediation of psychosocial determinants in the relation between socio-economic status and adolescents’ diet quality. Eur J Nutr 57, 951–963 (2018). https://doi.org/10.1007/s00394-017-1380-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00394-017-1380-8