Effective interventions to increase fruit and vegetables consumption in children
There is a positive association between parents’ high level of education and children’s consumption of fruit and vegetables
Understanding how socioeconomic status is linked to children’s diets is important for tackling inequalities in dietary intake. As home food environment is linked to socioeconomic status and children’s diet, it is important to study both its social aspects (such as parental role modeling) and its physical aspects (such as food availability). This study shows that the positive association between high parental educational level and children’s fruit and vegetables consumption is partially mediated by parental role modeling, higher availability of fruit and vegetables and lower availability of sugary food and drink.
Acording to 2017 WHO report, adequate consumption of fruits and vegetables is considered a key component of a healthy diet. As the positive influence of higher family socioeconomic status on children’s fruit and vegetables consumption is well-documented (Rashid et al., 2018, Tarasuket al., 2010, Boelenset al., 2022, Quezada-Sánchezet al., 2020), this study (Serasinghe et al, 2023) had two aims:
- The first was to determine the associations between both parental educational level and relative family income and the fruit and vegetables consumption of preschool children in Finland.
- The second was to explore the mediation roles (see below) of the availability of fruit and vegetables and sugary food and drink and of parental role-modeling.
Parental educational level is positively associated with children’s fruit and vegetables consumption
Relative family income was not directly associated with children’s fruit and vegetables consumption ; same findings were shown in cross-sectional analyses with similar or compatible variables conducted in Finland, Australia, and the United Kingdom (Manyanga, 2017et al., Ambrosini et al., 2009). Finland is a country with less income disparities in society, despite the different educational levels of the population. This can be one reason why family income did not predict children’s consumption of fruit and vegetables like parental educational level did.
Parental educational level is a stronger predictor of children’s fruit and vegetables consumption than relative family income in Finland. Several studies focusing on adults have identified education as a stronger socioeconomic status indicator predicting food behaviors, including fruit and vegetables consumption, than other socioeconomic status indicators such as income and profession (de Irala-Estévez et al., 2000, Groth et al., 2001, Roos et al., 2007). High-educated people are generally considered more knowledgeable than less-educated people (Parmenter et al., 2000). Therefore, knowledge of a healthy diet may be more important for increased fruit and vegetables consumption than income. Indeed, income does not always reflect expenditure on food: even families with higher incomes might struggle to prioritize a healthy diet and adequate nutrition due to other expenditures.
Parental role modeling is a mediator of the association between parental educational level and children’s fruit and vegetables consumption
Parental role-modeling of fruit and vegetables consumption appeared to be a mediator of the associations between the two exposures (parental educational level and relative family income) and fruit and vegetables consumption in different stages of childhood. Many studies have identified parental role-modeling as a mediator of the association between parental educational level and children’s fruit and vegetables consumption (Lioret et al., 2015, Rodenburg et al., 2012, van Ansem et al., 2014). In addition, a systematic review has concluded that parental role-modeling is a consistent mediator of socioeconomic inequalities in children’s food consumption during youth (Mekonnen et al., 2020). However, none of the above-mentioned studies focused solely on preschool-aged children. Therefore, this study provides evidence to support the consistency of the mediation role of parental role-modeling throughout childhood.
Increasing availability of fruit and vegetables at home must be considered alongside the reduction in the availability of sweet products
This study identified the availability of fruit and vegetables as a mediator of the associations between socioeconomic status indicators and fruit and vegetables consumption. Several studies of adolescents (Ball et al., 2009) and 11-year-old children (van Ansem et al., 2014, Lehto et al., 2015) have also found comparable evidence. Moreover, a systematic review concluded that fruit and vegetables availability has a consistent mediation role in the socioeconomic inequalities of fruit and vegetables consumption during youth (Mekonnen et al., 2020).
Availability of sugary food and drinks showed a negative mediation effect on the association between parental educational level and children’s fruit and vegetables consumption. In addition, a very recent multivariate analysis concluded that reducing the availability of unhealthy food at home, including sugary food and drinks, more effectively improves healthy dietary behaviors among school-aged children than increasing the availability of fruit and vegetables (Pereira et al., 2021). A possible explanation for this could be that higher availability of sugary food and drink leads to a higher intake of sugary food and drinks during and in between main meals, replacing the amount of fruit and vegetables consumed during main meals. On the other hand, low availability of sugary food and drink could simply be a better indicator of a greater preference for fruit and vegetables consumption.
Based on: Serasinghe, N. et al. Associations between socioeconomic status, home food availability, parental role-modeling, and children’s fruit and vegetable consumption: a mediation analysis. BMC Public Health 23, 1037 (2023).
The concept of “mediation” can be defined as the transference of the effect of an independent/ predictor variable on a dependent/ outcome variable through a third variable called a mediator variable (Baron, 1986). Mediation analysis can be used to study intermediate variables, such as social or physical home food environments, which may act between the independent (socioeconomic status) and outcome (diet) variables (Gunzler, 2013). Previous mediation studies of children’s diets have largely focused on psychosocial variables, such as parents’ self-efficacy, attitudes, and knowledge (Wyse, 2015) and a limited number of studies have assessed the mediation roles of the home food environment. In addition, most previous mediation studies have focused on older children.
- Participants: 728 children aged 3-6 years old (preschooled) in 2 municipalities in Southern Finland
- Parental questionnaires (completed by the parents) :
– Educational level and relative family income
– Food Frequency Questionnaire (FFQ)
– Potential mediators: food availability / parental role-modeling
- Statistical analyses conducted with the Statistical Package for Social Sciences (SPSS).
- Parental educational level is a stronger predictor of children’s fruit and vegetables consumption than relative family income in Finland
- Parental role modeling has been identified as a mediator of the association between parental educational level and children’s fruit and vegetables consumption
- Reducing the avaibility of unhealthy food at home improves healthy dietary behaviors among school-aged children