Craveiro Daniela, Marques Sibila, Zvěřinová Iva, Máca Vojtěch, Ščasný Milan, Chiabai Aline, Suarez Cristina, Martinez-Juarez Pablo, García de Jalón Silvestre, Quiroga Sonia, Taylor Timothy
Instituto Universitário de Lisboa (ISCTE-IUL), CIS-IUL, Lisbon, Portugal; Lisbon School of Economics and Management, CSG/SOCIUS-ISEG, Universidade de Lisboa, Lisbon, Portugal.
Instituto Universitário de Lisboa (ISCTE-IUL), CIS-IUL, Lisbon, Portugal.
Appetite. 2021 Oct 1;165:105283. doi: 10.1016/j.appet.2021.105283. Epub 2021 May 12.
People who do not eat enough fruit and vegetables (F&V) have incremental health risks. Most Europeans do not comply with health recommendations relating to F&V consumption and this is especially true for those with lower-level education, which reinforces structural inequalities in health and wellbeing among Europeans. This study investigated the role of key behavioural triggers - capabilities, opportunities and motivation (in the COM-B model) - as pathways for educational differentials in F&V intake in Europe. A cross-sectional survey-based study was conducted in five European countries differing widely in their consumption habits, wealth, and climatic conditions. A structural equation model was designed to study how capabilities (diet perceived knowledge, health purchase criteria), opportunities (financial availability, social norms), and motivations (health value, habits strength) affect educational inequalities in the intake of F&V (5 portions a day) as mediators. Multi-group comparisons assessed country differences. People with higher levels of education were more likely to eat the recommended diet, i.e., at least 5 portions of F&V a day. Countries in the sample vary significantly in the percentage of people complying with the recommendation, but not significantly in terms of relative education differentials. The educational gap in the intake of F&V is mainly explained by education differentials in financial availability, diet knowledge, and habits in inserting F&V in main meals. Policies targeting dietary inequalities should address behavioural triggers affecting dietary intake, for example by subsidising F&V, developing targeted dietary awareness campaigns, or by intervening in mass catering contexts to facilitate the implementation of healthy habits.
水果和蔬菜摄入量不足的人健康风险会增加。大多数欧洲人未遵守与水果和蔬菜消费相关的健康建议，受教育程度较低的人尤其如此，这加剧了欧洲人在健康和福祉方面的结构性不平等。本研究调查了关键行为触发因素——能力、机会和动机（在COM-B模型中）——作为欧洲水果和蔬菜摄入量教育差异途径的作用。在五个饮食习惯、财富和气候条件差异很大的欧洲国家开展了一项基于横断面调查的研究。设计了一个结构方程模型，以研究能力（饮食认知知识、健康购买标准）、机会（经济可承受性、社会规范）和动机（健康价值、习惯强度）如何作为中介影响水果和蔬菜摄入量（每天5份）方面的教育不平等。多组比较评估了国家间的差异。受教育程度较高的人更有可能遵循推荐饮食，即每天至少食用5份水果和蔬菜。样本中的国家在遵守该建议的人口百分比方面差异显著，但在相对教育差异方面差异不显著。水果和蔬菜摄入量方面的教育差距主要由经济可承受性、饮食知识以及在主餐中加入水果和蔬菜的习惯方面的教育差异来解释。针对饮食不平等的政策应解决影响饮食摄入的行为触发因素，例如通过补贴水果和蔬菜、开展有针对性的饮食意识宣传活动，或通过干预集体餐饮环境来促进健康习惯的养成。
