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Behavioural nutrition
Food purchasing behaviour, diet quality and nutrient intakes vary across groups of differing socio-economic status (SES) in a diversity of countries(1,2). Australian evidence indicates that those from high-SES groups (education, income and occupation), as measured by individual-, household- or community-level indicators, tend to buy and eat healthier foods. Higher levels of education and household income are associated with food purchasing and consumption that adheres more closely to dietary guidelines, including consumption of a wider variety of foods and of more fruits and vegetables(3-9). Those living in low-SES neighbourhoods tend to eat less fruits and vegetables, eat more fast foods and have diets that are higher in fat, salt and sugar, although some of these relationships are attenuated once individual- or household-level characteristics are taken into account. Evidence is still unclear on the relationship between availability of healthy foods in these areas and dietary patterns(7,10,11).
Alternative explanations have been offered for SES (education, income and occupation) variations in diet and other health behaviours. Compared with low-SES groups, high-SES groups may have better health knowledge; greater access to the means to be healthy via financial, social and community capital(1,2,12); greater ability to defer gratification to maintain a healthy weight(13); and greater efficacy in pursuing healthy eating behaviours(1,2). However, isolating the causal effects of SES on diet, and designing appropriate interventions, is made more difficult because SES indicators have been used somewhat interchangeably in the empirical literature(3,12,14). Few studies use multiple indicators of SES and those that do rarely control for different SES indicators simultaneously or in a systematic way. In one of the few Australian studies to do so, Turrell et al.(3)used survey data for Brisbane to find that occupation-based SES gradients in healthy eating are no longer significant once income and education are controlled for. Likewise, education gradients in fruit and vegetable purchasing were attenuated by controlling for household income. These studies suggest that an omnibus relationship between SES and diet is...