Why do some socioeconomically disadvantaged women eat better than others?
Socioeconomic position and nutrition among women While those of low socioeconomic position (SEP) tend to consume less favourable diets than those of high SEP, not all socioeconomically disadvantaged persons eat poorly1-2. In terms of efforts to promote better nutrition among low SEP groups, there may be valuable lessons to be learned by examining the characteristics of those low SEP individuals who, despite their disadvantaged circumstance, consume adequate intakes of fruit and vegetables. This phenomenon has previously been described as resilience3, and it has been suggested as a potentially useful avenue for addressing socioeconomic inequalities in nutrition.
Understanding resilience among women is particularly important. Women tend to eat less than men, and consequently risk falling short of key food and nutrient requirements for good health. In addition, despite significant changes to the workforce in recent years, women typically still have the role as food gatekeepers within their families and this role has the potential to influence the diets of other family members.
Consistent with social ecological models of health behaviours4, evidence suggests that variations in individual (e.g. nutrition knowledge, high self-efficacy for healthy eating, enjoyment for cooking), social (e.g., social support for consumption of fruit and vegetables from family and friends), subjective environmental factors (e.g., perceived cost of fruit and vegetables) and objective environmental factors (e.g., distance from residence to fruit and vegetable store) explain much of the SEP gradients in healthy eating among women2, 5-9. Rather than focussing on SEP gradients in healthy eating however, the aim of the study was to examine the individual, social and environmental determinants of resilience to fruit and vegetable consumption exclusively among low SEP women.
Factors that support resilience to poor fruit and vegetable consumption among low SEP women
Survey data from 355 low SEP women (mean age 49.5 years) revealed that 54% and 30% of women were high (resilient) fruit and vegetable consumers respectively. Women who were older, dieting to lose weight, with a high taste preference for fruit, who perceived that a wide range of healthy food options were locally available and perceived the cost of fruit to be lower were more likely to be high fruit consumers. Women who had a high BMI and perceived that a wide range of healthy food options were locally available were more likely to be high vegetable consumers.
A key prerequisite to improving the nutritional health of low SEP women is to better understand the mechanisms underlying healthy eating within this group. The results from this study show that strategies aimed at increasing fruit and vegetable consumption among low SEP women should focus on perceptions about the cost, availability and taste of fruit and vegetables. This could include education and awareness of cost breakdown of fruit and vegetables relative to other snacks and food ingredients, increased opportunities to taste a range of fruit (i.e. through store samples / taste testing) and provision of information detailing local availability of healthy food (i.e. a list of healthy options for eating out, locations where high quality fresh produce is locally available). Tailoring nutrition interventions to accommodate différences in age, weight control practices and weight status may also prove beneficial.
In conclusion, not all low SEP women consume inadequate intakes of fruit and vegetables. The results from this study highlight several potentially modifiable correlates of fruit and vegetable consumption among low SEP women that will be valuable in informing the development of nutrition promotion strategies. Further research that builds on the understanding of the determinants of fruit and vegetable consumption among low SEP women may be the most fruitful avenue for tackling socioeconomic inequalities in nutrition and health.
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