Socioeconomic differences in food habits in Germany. Consumption of fruits and vegetables.

1. Socioeconomic differences in food habits in Germany. Consumption of fruits and vegetables. Berg Gabriele, Almendinger Gudrun, Altenhoener Thomas, Mensink Gerd School of Public Health, University of Bielefeld Germany & Robert Koch Institute, Berlin, Germany

2. Social inequality in a Society • Refer to goods that are valuable in a society • Valuable goods are unequally distributed Hradil, 2001

3. Factors describing social inequality • Main describing factors (vertical): • Occupational status • Educational level (school and occupational) • Income • Capital • Additional describing factors (horizontal): • Gender • Age • Nationality • Region • Family status • unemployment Mielck, 2000

4. Research question • Are there differences in fruit and vegetable consumption between low, middle, and high SES in Germany? If yes: • Are the differences explainable by school education, income or occupational position?

5. Men (95%CI) Women (95%CI) Norway Finland Sweden Denmark Germany Netherland Basque C. Navarre Catalonia Andalusia Pooled differences -150 -100 -50 0 50 100 150 -150 -100 -50 0 50 100 150 More in lower edu-cational level More in higher educational level More in lower edu- cational level More in higher educational level Intake of vegetables differences between the highest and the lowest educational level Irala-Estévez et al., 2000

6. Study design • German National Health and Nutrition survey 1998 • Cross sectional study • In total 7,124 women and men a sub sample of 4,030 was used • Personal interview about their SES, lifestyle and eating habit • Age: 18 to 79 years Mensink & Beitz, 2004

7. Diet assessment • In the sub sample of 4,030 person • DISHES 98 • validated dietary assessment software • computer assisted personal Interview: • diet history • All data were coded German food code (BLS) • Information on fruit and vegetable consumption was grouped Mensink et al., 2001

8. Estimation of socio economic strata (SES) • SES was estimated by • Education level (school and occupational) • Point value 1 to 7 • Occupational status • Point value 1 to 7 • Household income • Point value 1 to 7 • Three levels were summarized (3 to 21) • 3-8 = lower class • 9-14 = middle class • 15-21 = upper class Winkler & Stolzenberg., 1999

9. Statistical Analysis • Multiple linear regression model • Dependent variable: • Fruit and/or vegetable consumption • Independent variable: • Socioeconomic situation (or school education, income, occupational position) • Sex, • Region, • Age, • BMI, • Smoking habits • Energy intake • Pregnant and lactating women were excluded

10. Description of the Study population

11. Social Stratum and Gender Female Male

12. Social Stratum, Gender and East/West Germany East Germany West Germany Female Male Female Male

13. Linear Regression of SES on fruit and vegetable consumption *Adjusted for: age, gender, energy intake, region, BMI, and smoking habits

14. Linear Regression of SES on fruit and vegetable consumption *Adjusted for: age, gender, energy intake, region, BMI, and smoking habits

15. Linear regression model of school education, income and occupational status on fruit and vegetable consumption (I) School education: Adjusted for: age, gender, energy intake, region, BMI, and smoking habits Adjusted for: age, gender, energy intake, region, BMI, smoking habits, occupational position, and income

16. Linear regression model of school education, income and occupational status on fruit and vegetable consumption (II) Household income: Adjusted for: age, gender, energy intake, region, BMI, and smoking habits Adjusted for: age, gender, energy intake, region, BMI, smoking habits, occupational position, and school education

17. Linear regression model of school education, income and occupational position on fruit and vegetable consumption School education Household Income Occupational status Adjusted for: age, gender, energy intake, region, BMI, and smoking habits

18. Limitation Socioeconomic situation • Estimation of income was based on household income • Occupational education was not considered • Particular in single level of income, school education, and occupational status missing values are common Nutritional assessment • Problem of underreporting in the diet history program Statistical analysis • Dependent variable was not normally distributed.

19. Discussion • There is a clear association between socioeconomic stratum and fruit and vegetable consumption in Germany. • Its mainly explained by school education. • Stratum index by Winkler reveals a good opportunity in estimating SES differences. • School education on its own reveals also an opportunity in estimating SES differences.

20. Literature • De Irala-Estévez, Groth M, Johansson L, Oltersdorf U, Prättälä R, González M : A systematic review of socio-economic differences in food habits in Europe: consumption of fruit and vegetables Eur J Clin Nutr 54, 706-714, 2000 • Geißler R: Die Sozialstruktur Deutschlands. Die gesellschaftliche Entwicklung nach der Vereinigung. Wiesbaden: Westdeutscher Verlag, 2002 • Hradil S: Soziale Ungleichheit in Deutschland. Opladen: Leske und Budrick 2001 • Mensink G, Beitz R: Food and nutrient intake in East and West Germany 8 years after the reunification – The German Nutrition Survey 1998 Eur J Clin Nutr 58, 1000-1010, 2004 • Mielck A: Soziale Ungleichheit und Gesundheit. Empirische Ergebnisse, Erklärungsansätze, Interventionsmöglichkeiten. Bern, Verlag Hans Huber, 2000. • Mensink G, Haftenberger M, Thamm M: Validity of DISHES 98, a computerised dietary history interview: energy and macronutrient intake. Eur J Clin Nutr. 55, 409-417, 2001. • Winkler J, Stolzenberg H : Der Sozialschichtindex im Bundesgesundheitssurvey. Gesundheitswesen 61 (Suppl 2: S174-183, 1999

21. Social stratum in West-Germany German Elite under 1% Foreigner self-employed middle class upper attendance stratum 23% 7% foreign middle class (self-employed, middle and upper attendance) 2% middle attendance stratum 22% farmer 1% worker elite 2% performer attandance-stratum skilled 6% 2% foreign skilled worker skilled worker 14% foreign un-, skilled 6% un-, skilled worker 12% Geißler 2002, (SOEP), N=17.850) poverty level, below to live about 7% of German and 21% of Foreigner un-, skilled 3%

22. Linear regression model of school education, income and occupational status on fruit and vegetable consumption (III) Occupational status: Adjusted for: age, gender, energy intake, region, BMI, smoking habits, income, and school education Adjusted for: age, gender, energy intake, region, BMI, and smoking habits