Vogel Christina, Ntani Georgia, Inskip Hazel, Barker Mary, Cummins Steven, Cooper Cyrus, Moon Graham, Baird Janis
Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Tremona Road, Southampton, United Kingdom.
Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Tremona Road, Southampton, United Kingdom.
Am J Prev Med. 2016 Aug;51(2):e27-e34. doi: 10.1016/j.amepre.2016.02.030. Epub 2016 Apr 5.
Supermarkets are a major source of food for many families. Knowledge of how educational attainment affects the relationship between in-store environments of supermarkets and diet is needed. This study examined the relationship between maternal dietary quality and overall in-store supermarket environment, and assessed the effect modification of educational attainment.
Dietary quality z-scores were calculated for 829 mothers with young children using cross-sectional data collected in 2010-2011 from a 20-item food frequency questionnaire. Information about nine in-store factors (variety, price, quality, promotion, shelf placement, store placement, nutrition information, healthier alternatives, and single fruit sale) on 12 foods known to discriminate between better and poorer dietary quality were collected to create a standardized "healthfulness" z-score for each supermarket where mothers shopped.
Multilevel unadjusted linear regression analysis completed in 2014-2015 showed that shopping at more-healthful supermarkets was associated with better dietary quality (β=0.39 SD/SD, p=0.01, 95% CI=0.10, 0.68). However, the relationship differed according to educational attainment (interaction, p=0.006). Among mothers who left school at age 16 years, those who shopped at less healthful supermarkets had poorer dietary quality (β=0.31 SD/SD, 95% CI=0.07, 0.55). Among mothers with degrees, those who shopped at less healthful supermarkets had better dietary quality (β=-0.59 SD/SD, 95% CI=-1.19, 0.00).
Mothers with low educational attainment show greater susceptibility to less healthful in-store environments than mothers with higher educational attainment who may be protected by greater psychological and financial resources. Policy initiatives to improve supermarket environments may be necessary to address dietary inequalities.
超市是许多家庭的主要食物来源。我们需要了解教育程度如何影响超市店内环境与饮食之间的关系。本研究调查了母亲的饮食质量与超市整体店内环境之间的关系，并评估了教育程度的效应修正作用。
利用2010 - 2011年收集的横断面数据，通过一份包含20项内容的食物频率问卷，为829名有幼儿的母亲计算饮食质量z分数。收集了12种已知能区分饮食质量优劣的食物在九个店内因素（种类、价格、质量、促销、货架摆放、店铺位置、营养信息、更健康的选择以及单份水果销售）方面的信息，为每位母亲购物的超市创建一个标准化的“健康程度”z分数。
2014 - 2015年完成的多水平未调整线性回归分析表明，在更健康的超市购物与更好的饮食质量相关（β = 0.39标准差/标准差，p = 0.01，95%置信区间 = 0.10，0.68）。然而，这种关系因教育程度而异（交互作用，p = 0.006）。在16岁就辍学的母亲中，那些在健康程度较低的超市购物的母亲饮食质量较差（β = 0.31标准差/标准差，95%置信区间 = 0.07，0.55）。在拥有学位的母亲中，那些在健康程度较低的超市购物的母亲饮食质量更好（β = -0.59标准差/标准差，95%置信区间 = -1.19，0.00）。
与受更多心理和经济资源保护的高学历母亲相比，低学历母亲对不健康的店内环境更为敏感。改善超市环境的政策举措可能是解决饮食不平等问题所必需的。
