Neighbourhood socioeconomic disadvantage and fruit and vegetable consumption: a seven countries comparison

Background: Low fruit and vegetable consumption is a risk factor for poor health. Studies have shown consumption varies across neighbourhoods, with lower intakes in disadvantaged neighbourhoods. However, findings are inconsistent, suggesting that socio-spatial inequities in diet could be context-specific, highlighting a need for international comparisons across contexts. This study examined variations in fruit and vegetable consumption among adults from neighbourhoods of varying socioeconomic status (SES) across seven countries (Australia, Canada, Netherlands, New Zealand, Portugal, Scotland, US). Methods: Data from seven existing studies, identified through literature searches and knowledge of co-authors, which collected measures of both neighbourhood-level SES and fruit and vegetable consumption were used. Logistic regression was used to examine associations between neighbourhood-level SES and binary fruit and vegetable consumption separately, adjusting for neighbourhood clustering and age, gender and education. As much as possible, variables were treated in a consistent manner in the analysis for each study to allow the identification of patterns of association within study and to examine differences in the associations across studies. Results: Adjusted analyses showed evidence of an association between neighbourhood-level SES and fruit consumption in Canada, New Zealand and Scotland, with increased odds of greater fruit intake in higher SES neighbourhoods. In Australia, Canada, New Zealand and Portugal, those residing in higher SES neighbourhoods had increased odds of greater vegetable intake. The other studies showed no evidence of a difference by neighbourhood-level SES. Conclusions: Acknowledging discrepancies across studies in terms of sampling, measures, and definitions of neighbourhoods, this opportunistic study, which treated data in a consistent manner, suggests that associations between diet and neighbourhood-level socioeconomic status vary across countries. Neighbourhood socioeconomic disadvantage may differentially impact on access to resources in which produce is available in different countries. Neighbourhood environments have the potential to influence behaviour and further research is required to examine the context in which these associations arise.KB was supported by a National Health and Medical Research Council (NHMRC) Principal Research Fellowship, ID 1042442. The contents of this manuscript are the responsibility of the authors and do not reflect the views of the NHMRC. KEL was supported by a Deakin University Alfred Deakin Postdoctoral Research Fellowship. JP was supported by a grant from the European Research Council [ERC-2010-StG Grant 263501]. AE is supported by the UK Medical Research Council (MC_UU_12017/8). The authors are grateful to Nick Andrianopoulos for advice on the analytical approach. The Detroit Healthy Environments Partnership (HEP) (www.hepdetroit.org) is a community-based participatory research project affiliated with the Detroit Community-Academic Urban Research Center (www.detroiturc.org). The authors thank the members of the HEP Steering Committee for their contributions to the work presented here, including representatives from Brightmoor Community Center, Detroit Department of Health and Wellness Promotion, Detroit Hispanic Development Corporation, Friends of Parkside, Henry Ford Health System, Warren Conner Development Coalition/Detroit Neighborhood Partnership East, and University of Michigan School of Public Health. The authors gratefully acknowledge support from the National Institute of Environmental Health Sciences (R01ES10936, R01ES014234). The authors recognise the Crown as the owner, and the New Zealand Ministry of Health as the funder, of the 2002/03 New Zealand Health Survey. The authors would like to thank Greater Glasgow Health Board for supplying the Greater Glasgow Health Board Health and Wellbeing survey data