The Relationships among Socioeconomic Status,Fruit and Vegetable Intake,and Alcohol Consumption

Abstract

Purpose.

We examined the relationships among fruit and vegetable intake, alcohol consumption, and socioeconomic status (SES). We hypothesized that fruit and vegetable consumption would be inversely associated with alcohol consumption and the relationship would differ by SES.

Design.

A cross-sectional analysis.

Setting.

Large, urban Midwestern county.

Subjects.

A unique, racially/ethnically diverse sample of 9959 adults (response rate: 66.3%).

Measures.

Fruit and vegetable intake was measured using two items that assessed servings per day. Alcohol consumption was measured in terms of volume of alcohol consumed and binge drinking. Individual measures of SES included education and household income.

Analysis.

Weighted multivariate linear and Poisson regression were used to estimate effects.

Results.

The relationship between fruit and vegetable intake and alcohol consumption varied by SES. Those with lower household incomes who consumed five or more servings of fruits and vegetables per day were less likely to engage in binge drinking relative to those consuming zero to one servings of fruits and vegetables per day (risk ratio = .66; 95% confidence interval: .46, .95). No association was observed for higher–household-income individuals.

Conclusion.

We observed an inverse relationship between fruit and vegetable consumption and alcohol intake in those with lower household incomes but not in those with higher household incomes. Results suggest that the relationship between diet and alcohol consumption may be more relevant in populations with more restricted economic choices. Results are, however, based on cross-sectional data.

Keywords

Diet Fruit and Vegetable Intake Alcohol Consumption Binge Drinking Excessive Drinking Socioeconomic Status Prevention Research Manuscript format: research Research purpose: descriptive Study design: cross-sectional study Outcome measure: behavioral—alcohol consumption Setting: Midwestern county,local community Health focus: nutrition,alcohol,social health Strategy: behavior change Target population age: adults Target population circumstances: low income

Get full access to this article

View all access options for this article.

References

US Dept of Health and Human Services. Healthy People 2020. Washington, DC: US Government Printing Office; 2010.

Mokdad

Marks

Stroup

Gerberding

. Actual causes of death in the United States, 2000. JAMA. 2004;291:1238–1245.

Casagrande

Wang

Anderson

Gary

. Have Americans increased their fruit and vegetable intake? The trends between 1988 and 2002. Am J Prev Med. 2007;32:257–263.

Block

Patterson

Subar

. Fruit, vegetables, and cancer prevention: A review of the epidemiological evidence. Nutr Cancer. 1992;18:1–29.

Ness

Powles

. Fruit and vegetables, and cardiovascular disease: A review. Int J Epidemiol. 1997;26:1–13.

Corrao

Bagnardi

Zambon

La Vecchia

. A meta-analysis of alcohol consumption and the risk of 15 diseases. Prev Med. 2004;38:613–619.

Rehm

Room

Monteiro

. Alcohol as a risk factor for global burden of disease. Eur Addict Res. 2003;9:157–164.

Rehm

Bondy

Sempos

Vuong

. Alcohol consumption and coronary heart disease morbidity and mortality. Am J Epidemiol. 1997;146:495–501.

Alaniz

. Alcohol availability and targeted advertising in racial/ethnic minority communities. Alcohol Health Res World. 1998;22:286–289.

10.

Scribner

Cohen

Kaplan

Allen

. Alcohol availability and homicide in New Orleans: Conceptual considerations for small area analysis of the effect of alcohol outlet density. J Stud Alcohol. 1999;60:310–316.

11.

Breslow

Guenther

Juan

Graubard

. Alcoholic beverage consumption, nutrient intakes, and diet quality in the US adult population, 1999–2006. J Am Diet Assoc. 2010;110:551–562.

12.

Breslow

Guenther

Smothers

. Alcohol drinking patterns and diet quality: The 1999–2000 National Health and Nutrition Examination Survey. Am J Epidemiol. 2006;163:359–366.

13.

Serdula

Byers

Mokdad

. The association between fruit and vegetable intake and chronic disease risk factors. Epidemiology. 1996;7:161–165.

14.

Barefoot

Gronbaek

Feaganes

. Alcoholic beverage preference, diet, and health habits in the UNC Alumni Heart Study. Am J Clin Nutr. 2002;76:466–472.

15.

La Vecchia

Negri

Franceschi

. Differences in dietary intake with smoking, alcohol, and education. Nutr Cancer. 1992;17:297–304.

16.

Kesse

Clavel-Chapelon

Slimani

van Liere

. Do eating habits differ according to alcohol consumption? Results of a study of the French cohort of the European Prospective Investigation into Cancer and Nutrition (E3N-EPIC). Am J Clin Nutr. 2001;74:322–327.

17.

Mannisto

Uusitalo

Roos

. Alcohol beverage drinking, diet and body mass index in a cross-sectional survey. Eur J Clin Nutr. 1997;51:326–332.

18.

Veenstra

Schenkel

van Erp-Baart

. Alcohol consumption in relation to food intake and smoking habits in the Dutch National Food Consumption Survey. Eur J Clin Nutr. 1993;47:482–489.

19.

Schroder

Marrugat

Elosua

Covas

. Tobacco and alcohol consumption: Impact on other cardiovascular and cancer risk factors in a southern European Mediterranean population. Br J Nutr. 2002;88:273–281.

20.

Jessor

Graves

Hanson

Jessok

. Society, Personality, and Deviant Behavior: A Study of a Tri-Ethnic Community. New York, NY: Holt, Rinehart & Winston; 1968.

21.

Jessor

. Risk behavior in adolescence: A psychosocial framework for understanding and action. J Adolesc Health. 1991;12:597–605.

22.

Braveman

Cubbin

Marchi

. Measuring socioeconomic status/position in studies of racial/ethnic disparities: Maternal and infant health. Public Health Rep. 2001;116:449–463.

23.

Romley

Cohen

Ringel

Sturm

. Alcohol and environmental justice: The density of liquor stores and bars in urban neighborhoods in the United States. J Stud Alcohol Drugs. 2007;68:48–55.

24.

Pollack

Cubbin

Ahn

Winkleby

. Neighbourhood deprivation and alcohol consumption: Does the availability of alcohol play a role? Int J Epidemiol. 2005;34:772–780.

25.

Bluthenthal

Cohen

Farley

. Alcohol availability and neighborhood characteristics in Los Angeles, California and southern Louisiana. J Urban Health. 2008;85:191–205.

26.

Moore

Roux

Diez AV

. Associations of neighborhood characteristics with the location and type of food stores. Am J Public Health. 2006;96:325–331.

27.

Powell

Slater

Mirtcheva

. Food store availability and neighborhood characteristics in the United States. Prev Med. 2007;44:189–195.

28.

Zenk

Schulz

Hollis-Neely

. Fruit and vegetable intake in African Americans income and store characteristics. Am J Prev Med. 2005;29:1–9.

29.

Krieger

. Theories for social epidemiology in the 21st century: An ecosocial perspective. Int J Epidemiol. 2001;30:668–677.

30.

Drewnowski

Specter

. Poverty and obesity: The role of energy density and energy costs. Am J Clin Nutr. 2004;79:6–16.

31.

Armour

Pitts

Lee

. Cigarette smoking and food insecurity among low-income families in the United States, 2001. Am J Health Promot. 2008;22:386–392.

32.

Miller

Sales

Kopjar

. Adherence to heart-healthy behaviors in a sample of the US population. Prev Chronic Dis. 2005;2:A18.

33.

Kant

Graubard

. Secular trends in the association of socio-economic position with self-reported dietary attributes and biomarkers in the US population: National Health and Nutrition Examination Survey (NHANES) 1971–1975 to NHANES 1999–2002. Public Health Nutr. 2007;10:158–167.

34.

De Irala-Estevez

Groth

Johansson

. A systematic review of socio-economic differences in food habits in Europe: Consumption of fruit and vegetables. Eur J Clin Nutr. 2000;54:706–714.

35.

Mossakowski

. Is the duration of poverty and unemployment a risk factor for heavy drinking? Soc Sci Med. 2008;67:947–955.

36.

Center for Disease Control and Prevention. Behavioral Risk Factor Surveillance System survey data. Available at: http://www.cdc.gov/brfss/technical_infodata/surveydata.htm. Accessed January 16, 2011.

37.

Dawson

Grant

Chou

Pickering

. Subgroup variation in US drinking patterns: Results of the 1992 national longitudinal alcohol epidemiologic study. J Subst Abuse. 1995;7:331–344.

38.

Mulia

Zemore

Greenfield

. Social disadvantage, stress, and alcohol use among black, Hispanic, and white Americans: Findings from the 2005 US National Alcohol Survey. J Stud Alcohol Drugs. 2008;69:824–833.

39.

Karlamangla

Zhou

Reuben

. Longitudinal trajectories of heavy drinking in adults in the United States of America. Addiction. 2006;101:91–99.

40.

Casswell

Pledger

Hooper

. Socioeconomic status and drinking patterns in young adults. Addiction. 2003;98:601–610.

41.

Greenfield

Midanik

Rogers

. A 10-year national trend study of alcohol consumption, 1984–1995: Is the period of declining drinking over? Am J Public Health. 2000;90:47–52.

42.

Droomers

Schrijvers

Mackenbach

. Educational differences in starting excessive alcohol consumption: Explanations from the longitudinal GLOBE study. Soc Sci Med. 2004;58:2023–2033.

43.

Droomers

Schrijvers

Stronks

. Educational differences in excessive alcohol consumption: The role of psychosocial and material stressors. Prev Med. 1999;29:1–10.

44.

Hilton

. Demographic characteristics and the frequency of heavy drinking as predictors of self-reported drinking problems. Br J Addict. 1987;82:913–925.

45.

Hilton

. A note on measuring drinking problems in the 1984 Alcohol Survey. In: University

, ed. Alcohol in America: Drinking Practices and Problems. Albany, NY: New York Press; 1991:26–70.

46.

Lantz

Lynch

House

. Socioeconomic disparities in health change in a longitudinal study of US adults: The role of health-risk behaviors. Soc Sci Med. 2001;53:29–40.

47.

US Census. US Census Bureau decennial data. Available at: http://www.census.gov/geo/www/cen_tract.html. Accessed October 18, 2010.

48.

SHAPE Methodology Report—Human Services and Public Health Department. Minneapolis, Minn: Hennepin County Assessment Unit, Human Services and Public Health Dept; 2004.

49.

Dillman

Phelps

. Response rate and measurement differences in mixed-mode surveys using mail, telephone, interactive voice response (IVR) and the Internet. Soc Sci Res. 2009;38:1–18.

50.

Stahre

Naimi

Brewer

Holt

. Measuring average alcohol consumption: The impact of including binge drinks in quantity-frequency calculations. Addiction. 2006;101:1711–1718.

51.

Naimi

Brewer

Mokdad

. Binge drinking among US adults. JAMA. 2003;289:70–75.

52.

Midanik

. Comparing usual quantity/frequency and graduated frequency scales to assess yearly alcohol consumption: Results from the 1990 US National Alcohol Survey. Addiction. 1994;89:407–412.

53.

Greenfield

Kerr

. Alcohol measurement methodology in epidemiology: Recent advances and opportunities. Addiction. 2008;103:1082–1099.

54.

Resnicow

Odom

Wang

. Validation of three food frequency questionnaires and 24-hour recalls with serum carotenoid levels in a sample of African-American adults. Am J Epidemiol. 2000;152:1072–1080.

55.

Krieger

Williams

Moss

. Measuring social class in US public health research: Concepts, methodologies, and guidelines. Annu Rev Public Health. 1997;18:341–378.

56.

Lynch

Kaplan

. Socioeconomic position. In: Berkman

Kawachi

, eds. Social Epidemiology. Vol 1. Oxford, United Kingdom: Oxford University Press; 2000.

57.

Singh

Siahpush

. Ethnic-immigrant differentials in health behaviors, morbidity, and cause-specific mortality in the United States: An analysis of two national data bases. Hum Biol. 2002;74:83–109.

58.

Ball

Crawford

Mishra

. Socioeconomic inequalities in women's fruit and vegetable intakes: A multilevel study of individual, social and environmental mediators. Public Health Nutr. 2006;9:623–630.

59.

George

Park

Leitzmann

. Fruit and vegetable intake and risk of cancer: A prospective cohort study. Am J Clin Nutr. 2009;89:347–353.

60.

Caetano

. Alcohol-related health disparities and treatment-related epidemiological findings among whites, blacks, and Hispanics in the United States. Alcohol Clin Exp Res. 2003;27:1337–1339.

61.

McNutt

Xue

Hafner

. Estimating the relative risk in cohort studies and clinical trials of common outcomes. Am J Epidemiol. 2003;157:940–943.

62.

Royston

. Multiple imputation of missing values. Stata J. 2004;4:227–241.

63.

Rubin

. Multiple Imputation for Nonresponse in Surveys. New York, NY: John Wiley & Sons; 1987.

64.

Randall

Marshall

Graham

Brasure

. High-risk health behaviors associated with various dietary patterns. Nutr Cancer. 1991;16:135–151.

65.

Le Marchand

Kolonel

Hankin

Yoshizawa

. Relationship of alcohol consumption to diet: A population-based study in Hawaii. Am J Clin Nutr. 1989;49:567–572.

66.

Serdula

Gillespie

Kettel-Khan

. Trends in fruit and vegetable consumption among adults in the United States: Behavioral Risk Factor Surveillance System, 1994–2000. Am J Public Health. 2004;94:1014–1018.

67.

Blanck

Gillespie

Kimmons

. Trends in fruit and vegetable consumption among U.S. men and women, 1994–2005. Prev Chronic Dis. 2008;5:A35.

68.

Greenfield

Midanik

Rogers

. Effects of telephone versus face-to-face interview modes on reports of alcohol consumption. Addiction. 2000;95:277–284.

69.

Truong

Sturm

. Alcohol outlets and problem drinking among adults in California. J Stud Alcohol Drugs. 2007;68:923–933.

70.

Schonlau

Scribner

Farley

. Alcohol outlet density and alcohol consumption in Los Angeles county and southern Louisiana. Geospat Health. 2008;3:91–101.

71.

Scribner

Mason

Theall

. The contextual role of alcohol outlet density in college drinking. J Stud Alcohol Drugs. 2008;69:112–120.

72.

Gruenewald

Johnson

Treno

. Outlets, drinking and driving: A multilevel analysis of availability. J Stud Alcohol. 2002;63:460–468.

73.

Scribner

Cohen

Fisher

. Evidence of a structural effect for alcohol outlet density: A multilevel analysis. Alcohol Clin Exp Res. 2000;24:188–195.

74.

Lytle

. Measuring the food environment: State of the science. Am J Prev Med. 2009;36(4 suppl):S134–S144.