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Socioeconomic and ethnic differences in the relation between dietary costs and dietary quality: the HELIUS study.

ABSTRACT: BACKGROUND:Healthier dietary patterns are generally more costly than less healthy patterns, but dietary costs may be more important for dietary quality in lower educated and ethnic minority groups. The aim of this study was to investigate the association between dietary costs and dietary quality and interactions with ethnicity and socioeconomic position (SEP). METHODS:We used cross-sectional data from 4717 Dutch, Surinamese, Turkish and Moroccan origin participants of the multi-ethnic HELIUS study (the Netherlands), who completed an ethnic-specific food frequency questionnaire (FFQ). The primary outcome measure was dietary quality according to adherence to the Dutch Healthy Diet index 2015 (DHD15-index, range 0-130). Individual dietary costs (the monetary value attached to consumed diets in Euros) were estimated by merging a food price variable with the FFQ nutrient composition database. Regression analyses were used to examine main and interaction effects. Analyses were adjusted for age, sex, smoking, energy intake, physical activity, ethnicity and educational level. RESULTS:Having higher dietary costs was associated with higher dietary quality. Analyses stratified by educational level showed that associations were stronger in higher educated (Btertile3?=?8.06, 95%CI?=?5.63; 10.48) than in lower educated participants (Btertile3?=?5.09, 95%CI?=?2.74; 7.44). Stratification by ethnic origin showed strongest associations in Turkish participants (Btertile2?=?9.31, 95%CI?=?5.96; 12.65) and weakest associations in Moroccan participants (Btertile3?=?4.29, 95%CI?=?0.58; 8.01). Regardless of their level of education, Turkish and Moroccan individuals consumed higher quality diets at the lowest cost than Dutch participants. CONCLUSIONS:The importance of dietary costs for dietary quality differs between socioeconomic and ethnic subgroups. Increasing individual food budgets or decreasing food prices may be effective for the promotion of healthy diets, but differential effects across socioeconomic and ethnic subgroups may be expected.

SUBMITTER: Mackenbach JD

PROVIDER: S-EPMC6440156 | biostudies-literature | 2019 Mar

REPOSITORIES: biostudies-literature

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Socioeconomic and ethnic differences in the relation between dietary costs and dietary quality: the HELIUS study.

Mackenbach Joreintje D JD Dijkstra S Coosje SC Beulens Joline W J JWJ Seidell Jacob C JC Snijder Marieke B MB Stronks Karien K Monsivais Pablo P Nicolaou Mary M

Nutrition journal 20190328 1

<h4>Background</h4>Healthier dietary patterns are generally more costly than less healthy patterns, but dietary costs may be more important for dietary quality in lower educated and ethnic minority groups. The aim of this study was to investigate the association between dietary costs and dietary quality and interactions with ethnicity and socioeconomic position (SEP).<h4>Methods</h4>We used cross-sectional data from 4717 Dutch, Surinamese, Turkish and Moroccan origin participants of the multi-et ...[more]

PMID: 30922320

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Project description:ObjectiveTo determine the extent to which socioeconomic and racial/ethnic differences in cancer screening discussion between a patient and his/her primary care physician are due to "within-physician" differences (the fact that patients were treated differently by the same physicians) versus "between-physician" differences (that they were treated by a different group of physicians).Data sourcesWe use data from the baseline patient and physician surveys of two community trials from the Communication in Medical Care (CMC) research series. The two studies combined provide an analysis sample of 5,978 patients ages 50-80 nested within 191 primary care physicians who practiced throughout Southern California.Study designOur main outcomes of interest are whether the physician has ever talked to the patient about fecal occult blood test (FOBT; for colorectal cancer screening), mammogram (for breast cancer screening, female patients only) and the prostate-specific antigen test (PSA, male patients only). We consider five racial/ethnic groups: non-Hispanic white, non-Hispanic black, Hispanic, Asian, and other race/ethnicity. We measure socioeconomic status by both income and education. For each type of cancer screening discussion, we first estimate a probit model that includes patient characteristics as the only covariates to assess the overall differences. We then add physician fixed effects to derive estimates of "within-" versus "between-" physician differences.Principal findingsThere was a strong education gradient in the discussion of all three types of cancer screening and most of the education differences arose within physicians. Disparities by income were less consistent across different screening methods, but seemed to have arisen mainly because of "between-physician" differences. Asians were much less likely, compared with whites, to have received discussion about FOBT and PSA and these differences were mainly "within-physician" differences. Black female patients, however, were much more likely, compared with whites treated by the same physicians, to have discussed mammogram with their physicians.ConclusionsDifferences in cancer screening discussion along the different dimensions of patient SES may have arisen because of very different mechanisms and therefore call for a combination of interventions. Physicians need to be aware of the persistent disparities by patient education in clinical communication regarding cancer screening and tailor their efforts to the needs of low-education patients. Quality-improvement efforts targeted at physicians practicing in low-income communities may also be effective in addressing disparities in cancer screening communication by patient income.

Project description:Sedentary behaviour is increasingly recognised as a health risk. While differences in this behaviour might help explain ethnic differences in disease profiles, studies on sedentary behaviour in ethnic minorities are scarce. The aim of this study was to compare the levels and the socio-demographic and lifestyle-related correlates of objectively measured sedentary time among five ethnic groups in Amsterdam, the Netherlands.Data were collected as part of the HELIUS study. The sample consisted of adults from a Dutch, Moroccan, African Surinamese, South-Asian Surinamese and Turkish ethnic origin. Data were collected by questionnaire, physical examination, and a combined heart rate and accelerometry monitor (Actiheart). Sedentary time was defined as waking time spent on activities of <1.5 metabolic equivalents. Ethnic differences in the levels of sedentary time were tested using ANOVA and ANCOVA analyses, while ethnic differences in the correlates of sedentary time were tested with interactions between ethnicity and potential correlates using general linear models. Associations between these correlates and sedentary time were explored using linear regression analyses stratified by ethnicity (pre-determined). All analyses were adjusted for gender and age.447 participants were included in the analyses, ranging from 73 to 109 participants per ethnic group. Adjusted levels of sedentary time ranged from 569 minutes/day (9.5 hours/day) for participants with a Moroccan and Turkish origin to 621 minutes/day (10.3 hours/day) in African Surinamese participants. There were no statistically significant differences in the levels or correlates of sedentary time between the ethnic groups. Meeting the physical activity recommendations (150 minutes/week) was consistently inversely associated with sedentary time across all ethnic groups, while age was positively associated with sedentary time in most groups.No statistically significant differences in the levels of objectively measured sedentary time or its socio-demographic and lifestyle-related correlates were observed among five ethnic groups in Amsterdam, the Netherlands.

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Socioeconomic and ethnic differences in the relation between dietary costs and dietary quality: the HELIUS study.

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Socioeconomic and ethnic differences in the relation between dietary costs and dietary quality: the HELIUS study.

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