a1 Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
a2 Center for Health and the Social Sciences, University of Chicago, Chicago, IL, USA
a3 School of Social Work, Columbia University, New York, NY, USA
a4 Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 West 168th Street, Room 730, New York, NY 10032, USA
a5 Institute for Social and Economic Research and Policy, Columbia University, New York, NY, USA
a6 Department of Sociology, American University, Washington, DC, USA
a7 New York City Department of Health and Mental Hygiene, New York, NY, USA
a8 Department of Health Policy and Management, New York Medical College, Valhalla, NY, USA
Objective Recommendations for fruit and vegetable consumption are largely unmet. Lower socio-economic status (SES), neighbourhood poverty and poor access to retail outlets selling healthy foods are thought to predict lower consumption. The objective of the present study was to assess the interrelationships between these risk factors as predictors of fruit and vegetable consumption.
Design Cross-sectional multilevel analyses of data on fruit and vegetable consumption, socio-demographic characteristics, neighbourhood poverty and access to healthy retail food outlets.
Setting Survey data from the 2002 and 2004 New York City Community Health Survey, linked by residential zip code to neighbourhood data.
Subjects Adult survey respondents (n 15 634).
Results Overall 9·9 % of respondents reported eating ≥5 servings of fruits or vegetables in the day prior to the survey. The odds of eating ≥5 servings increased with higher income among women and with higher educational attainment among men and women. Compared with women having less than a high-school education, the OR was 1·12 (95 % CI 0·82, 1·55) for high-school graduates, 1·95 (95 % CI 1·43, 2·66) for those with some college education and 2·13 (95 % CI 1·56, 2·91) for college graduates. The association between education and fruit and vegetable consumption was significantly stronger for women living in lower- v. higher-poverty zip codes (P for interaction < 0·05). The density of healthy food outlets did not predict consumption of fruits or vegetables.
Conclusions Higher SES is associated with higher consumption of produce, an association that, in women, is stronger for those residing in lower-poverty neighbourhoods.
(Received May 15 2012)
(Revised October 18 2012)
(Accepted October 22 2012)
(Online publication February 07 2013)