Hostname: page-component-7c8c6479df-27gpq Total loading time: 0 Render date: 2024-03-28T11:55:38.544Z Has data issue: false hasContentIssue false

Food poverty and health among schoolchildren in Ireland: findings from the Health Behaviour in School-aged Children (HBSC) study

Published online by Cambridge University Press:  01 April 2007

Michal Molcho*
Affiliation:
Department of Health Promotion, National University of Ireland, Galway, Ireland
Saoirse Nic Gabhainn
Affiliation:
Department of Health Promotion, National University of Ireland, Galway, Ireland
Colette Kelly
Affiliation:
Department of Health Promotion, National University of Ireland, Galway, Ireland
Sharon Friel
Affiliation:
National Centre for Epidemiology and Population Health, Australian National University, Dublin, Ireland
Cecily Kelleher
Affiliation:
UCD School of Public Health and Population Science, University College Dublin, Dublin, Ireland
*
*Corresponding author: Email michal.molcho@nuigalway.ie
Rights & Permissions [Opens in a new window]

Abstract

Objectives

To investigate the relationships between food poverty and food consumption, health and life satisfaction among schoolchildren.

Design

Analysis of the 2002 Health Behaviour in School-aged Children (HBSC) study, a cross-sectional survey that employs a self-completion questionnaire in a nationally representative random sample of school classrooms in the Republic of Ireland.

Subjects

A total of 8424 schoolchildren (aged 10–17 years) from 176 schools, with an 83% response rate from children.

Results

Food poverty was found to be similarly distributed among the three social classes (15.3% in the lower social classes, 15.9% in the middle social classes and 14.8% in the higher social classes). It was also found that schoolchildren reporting food poverty are less likely to eat fruits, vegetables and brown bread, odds ratio (OR) from 0.66 (95% confidence interval (CI) 0.45–0.87) to 0.81 (95% CI 0.63–0.99); more likely to eat crisps, fried potatoes and hamburgers, OR from 1.20 (95% CI 1.00–1.40) to 1.62 (95% CI 1.39–1.85); and more likely to miss breakfast on weekdays, OR from 1.29 (95% CI 0.33–1.59) to 1.72 (95% CI 1.50–1.95). The risk of somatic and mental symptoms is also increased, OR from 1.48 (95% CI 1.18–1.78) to 2.57 (95% CI 2.33–2.81); as are negative health perceptions, OR from 0.63 (95% CI 0.43–0.83) to 0.52 (95% CI 0.28–0.76) and measures of life dissatisfaction, OR from 1.88 (95% CI 1.64–2.12) to 2.25 (95% CI 2.05–2.45). Similar results were found for life dissatisfaction in an international comparison of 32 countries. All analyses were adjusted for age and social class.

Conclusions

Food poverty in schoolchildren is not restricted to those from lower social class families, is associated with a substantial risk to physical and mental health and well-being, and requires the increased attention of policy makers and practitioners.

Type
Research Paper
Copyright
Copyright © The Authors 2006

Adolescence is a time when the physiological need for nutrients increases and the consumption of a diet of high nutritional quality is particularly importantReference Dwyer, Garrow and James1. A balanced and appropriate diet during childhood and adolescence is likely to reduce the risk of both immediate and long-term health problems2Reference Gordon5. Poorer quality diet is consistently observed among the more socially disadvantaged groups in societiesReference Roos, Johansson, Kasmel, Klumbiene and Prattala69. Social gradients in nutritional intake have been proposed as a possible explanation for the social inequalities observed in a variety of nutrition-related health outcomes among adultsReference James, Nelson, Ralph and Leather10, 11.

Food poverty may be defined as the inability to access a nutritionally adequate diet and the related impact on health, culture and social participationReference Friel and Conlon12, Reference Dowler13. Experiencing food poverty during adolescence has been associated with poor diet and may therefore expose young people to various health risksReference Alaimo, Olson and Frongillo14, Reference Giskes, Turrel, Patterson and Newman15. Previous studies suggested that among children in the USA, household food insecurity, defined as limited or uncertain availability of nutritionally adequate and safe foods, is associated with poor health-related outcomesReference Casey, Szeto, Robbins, Stuff, Connell and Gossett16, Reference Alaimo, Olson, Frongillo and Briefel17.

The topic of food poverty, food insecurity and food deserts has received some attention in the recent pastReference Cummins and Macintyre18, Reference Dowler19. Within the general population, there is agreement that food poverty is associated with poverty and lower social class status. For example, the UK Food Poverty (Eradication) Bill was passed in 2001 aimed at taking government and local action to eradicate food poverty20. However, despite increased understanding of the parameters of the problem, such policy responses are not widespreadReference Friel and Conlon12.

Moreover, there appears to be a paucity of work investigating the extent of food poverty among adolescents and its associations with social class, food consumption, health and well-being. The present report aims to describe reported food poverty among school-aged children, to investigate the associations between food intake and the experience of food poverty, and to assess the risks of self-reported health and well-being associated with food poverty.

Methods

Sample

This study utilised data from the 2002 Irish Health Behaviour in School-aged Children study, a part of the World Health Organization International collaborative study (WHO-HBSC), carried out among 162 305 schoolchildren in 35 countries. Research teams in all participating countries must follow the same research protocolReference Currie, Samdal, Boyce and Smith21 in order to facilitate entry into the international database and subsequent international analyses. Following this protocolReference Currie, Samdal, Boyce and Smith21, the sampling unit for this study was the classroom. A nationally representative sample of schools (stratified by geographical region) was randomly selected, and individual classrooms within these schools were subsequently randomly selected for inclusion. All mainstream schools, both public and private, were included in the sample frame. Data were collected using a self-completion questionnaire, in April–June and September–October 2002, from 8424 schoolchildren. The response rate in this study was 83% of schoolchildren.

Measurement

The questionnaire was designed by researchers from all 35 participating countries (see Acknowledgements)Reference Currie, Samdal, Boyce and Smith21. Food poverty was defined as those schoolchildren who responded always, often or sometimes to the question ‘Some young people go to school or to bed hungry because there is not enough food at home. How often does this happen to you?’ This question has been validated within the HBSCReference Mullan, Currie, Boyce, Morgan, Kalnins, Holstein, Currie, Samdal, Boyce and Smith22 and in studies in the USAReference Alaimo, Olson and Frongillo14, Reference Alaimo, Olson, Frongillo and Briefel17, and its relevance and applicability has also been demonstrated elsewhere23, Reference Riches24. Children were also asked to report on their father's occupation from which a three-category social class scale was created (social classes 1–2, social classes 3–4 and social classes 5–6). Data on paternal occupation were available for 83% of respondents. Food consumption was measured by a set of questions regarding the frequency of the consumption of a variety of foodstuffs. The various foodstuffs were chosen to capture the relative intake of fibre and calcium, and the consumption foods high in fat, sugar and sodium. The validity and the reliability of this set of questions have been validated among schoolchildren in various countries in Europe and the USAReference Maes, Vereecken, Johnston, Currie, Samdal, Boyce and Smith25Reference Vereecken, Inchley, Subramanian, Hublet and Maes27. These variables were dichotomised at daily consumption or less of the foodstuffs. The questionnaire also included a question on the frequency of having breakfast, a behaviour associated with nutritional statusReference Resincow28, Reference Siega-Riz, Carson and Popkin29 and which can be reliably assessed with this age groupReference Maes, Vereecken, Johnston, Currie, Samdal, Boyce and Smith25. Breakfast eating was dichotomised at ever missing breakfast or not.

Self-rated health was assessed by the question ‘Would you say your health is?’, with the response options dichotomised at excellent vs. good, fair or poor. Self-rated health is employed as a proxy indicator of health status, with demonstrated applicability for both children and adultsReference Idler and Benyamini30, Reference Torsheim, Currie, Boyce and Samdal31. Children were also asked to report the frequency, in the 6 months prior to the survey, that they experienced a variety of symptoms. These items were used for calculating two indices: those reporting emotional symptoms (feeling low, nervous, bad tempered, afraid, or tired and exhausted) at least once a week during the last 6 months; and those reporting physical symptoms (headache, stomach-ache, backache, dizzy, or neck and shoulder pain) at least once a week in the last 6 months. This symptom checklist represents a non-clinical measure of mental healthReference Haugland, Wold, Stevenson, Aaro and Woynarowska32, Reference Ghandour, Overpeck, Huang, Kogan and Scheidt33. Based on Huebner's (1991)Reference Huebner34 students' life satisfaction scale, children were asked six questions concerning feelings about their life: ‘I like the way things are going for me’, ‘I feel that my life is going well’, ‘I would like to change many things in my life’, ‘I wish I had a different life’, ‘I feel I have a good life’ and ‘I feel good about what is happening to me’. For these six questions, the response options were dichotomised at never and sometimes vs. always and often. Self-reported happiness was measured by the question ‘How do you feel about your life in general?’ and the responses were dichotomised at very happy vs. quite happy, not very happy and not happy at all. Finally, children were asked to rank themselves from 0 to 10 on a life satisfaction ladderReference Cantril35. This scale was used to identify those with low life satisfaction (response < 6). The appropriateness of these well-being items have been previously tested and reported elsewhereReference Hagquist and Andrich36, Reference Torsheim, Ravens-Sieberer, Hetland, Välimaa, Danielson and Overpeck37.

Statistical analyses

Associations between reported food poverty and likelihood of the various outcome measures described above are expressed in odds ratios (ORs) from logistic regression models in SPSS, version 12.0. All analyses were adjusted for age and social class (according to the father's occupation), and were conducted independently for girls and boys. Each table represents a separate logistic regression model. Employing the classroom as the sampling unit, but the individual as the unit of analysis, has the potential to mask clustering effects; nevertheless, previous literature has shown that a cluster effect is less likely in the variables under investigationReference Roberts, Tynjala, Currie, King, Currie, Roberts, Morgan, Smith, Settertobulte and Samdal38.

Results

Compared with 14.6% of schoolchildren in Europe who reported food poverty (ranging from 5.1% in Portugal to 26.8% in Italy), 16.1% of the Irish pupils reported experiencing food poverty (18.7% of boys, 14.2% of girls). This ranged from 15.3% of children from families of lower social classes (SC5–6), to 15.9% from middle social classes (SC3–4) families and to 14.8% of children from higher social classes (SC1–2) (P = 0.50). Small and statistically non-significant differences were also found between the three age groups, with 16.5% of 10- to 11-year-old children, 16.4% of 12- to 14-year-old children and 15.3% of 15- to 17-year-old children reporting food poverty (P = 0.41).

Experiencing food poverty was significantly associated with a poorer diet (less fruit, vegetables and brown bread, and more crisps among girls and fried potatoes and hamburgers among boys) (Table 1). Children reporting food poverty were more likely to miss breakfast on weekdays, with adjusted ORs of 1.29 (95% confidence interval (CI) 0.99–1.59) for boys and 1.72 (95% CI 1.50–1.95) for girls.

Table 1 Associations between food poverty and daily consumption or less of various foodstuffs, by gender

OR – odds ratio; CI – confidence interval.

* Adjusted for age and paternal social class.

Reported food poverty was also found to be significantly associated with frequent mental and somatic symptoms, poor health (Table 2) and low life satisfaction (Table 3). ORs of ≥ 2 were found among boys experiencing food poverty, indicating an increased likelihood of reporting stomach-ache, feeling low and dizziness. Similarly, among girls experiencing food poverty ORs of >2 were found, indicating an increased likelihood of reporting dizziness, feeling afraid, and feeling tired and exhausted. Both boys and girls experiencing food poverty were significantly less likely to report excellent health. On all measures of life satisfaction, children reporting food poverty were significantly more likely to feel dissatisfied with their life, and were less likely to report that they feel happy. A comparison of the 32 HBSC countries that asked these questions (Fig. 1) confirms this as an international pattern, though showing some variability in the strength of the association, with Ireland ranking about mid-way.

Table 2 Associations between food poverty and measures of health perception, by gender

OR – odds ratio; CI – confidence interval.

* Adjusted for age and paternal social class.

Table 3 Associations between food poverty and measures of reported life satisfaction, by gender

OR – odds ratio; CI – confidence interval.

* Adjusted for age and paternal social class.

Fig. 1 Associations between food poverty and low life satisfaction, by country. *Adjusted for age and paternal social class. Germany, Italy and Russia are represented by regional rather than national samples; Be-VLG – Belgium, Flanders

Discussion

These data indicate a substantial level of food poverty among Irish schoolchildren. They also show that experiencing food poverty is significantly associated with poorer diet, frequent mental and somatic symptoms and low life satisfaction, but not with paternal social class. The current study is based on a large nationally representative sample of schoolchildren and the questionnaire in use was piloted and validated in Ireland as well as in other countries that took part in the international HBSC study in 2001/02Reference Currie, Samdal, Boyce and Smith21, Reference Currie, Roberts, Morgan, Smith, Settertobulte and Samdal39.

It is important to note that this study is cross-sectional in design and thus casual interpretations cannot be made. The response rate in this study is very high; nevertheless, there could be a bias due to non-response, because those absent from school might be particularly different from attendees. In addition, there is a relatively high level of missing data on socio-economic status, which must be considered when interpreting the lack of social class differences in reported food poverty. All data employed here are based on self-reports from children. Although the items employed have been extensively piloted and tested, it is important to bear in mind that there will inevitably be error within these data. Nevertheless, the patterns reported here are both substantial and internally consistent, and thus deserve further consideration.

The association between socio-economic status, diet and health is well established among adultsReference Friel and Conlon12, Reference Dowler13, Reference Giskes, Turrel, Patterson and Newman15 and young childrenReference Alaimo, Olson and Frongillo14, Reference Alaimo, Olson, Frongillo and Briefel17, but not among adolescents. These findings concur with previous literature on the associations between social class and health in adolescence. Whereas strong evidence exists with respect to the importance of socio-economic inequalities in health among adults and young childrenReference Woodroffe, Glickman, Baker and Power40, Reference MacIntyre41, the patterns among adolescents are rarely so clear. Contradictory findings abound in the literature, and vary by measure of socio-economic status, health behaviour or outcome, as well as countryReference West42Reference Goodman44. Thus adolescence is perceived as a period of relative healthfulness and equality. Although parental occupation is still considered a reliable measure in this age groupReference West42, Reference Abramson, Gofin, Habib, Pridan and Gofin45, Reference Townsend46, other possible measures of socio-economic status among adolescents is an important avenue of investigationReference Currie, Elton, Todd and Platt43, Reference Batista-Foguet, Fortiana, Currie and Villalbi47. However the role of other sources of social inequality also requires consideration.

According to the findings presented here, the association of food poverty with poor diet, negative health and poor life satisfaction among children is over and above measures of social class and is generally stronger among boys than girls. Casey and colleagues previously reported similar gender effectsReference Casey, Szeto, Robbins, Stuff, Connell and Gossett16, which suggest, together with the international comparison presented here, that the associations between food poverty and low life satisfaction are not unique to Ireland and may exhibit considerable cultural variability. Thus, the necessity of considering the different pathways of association between food poverty and health within specific population subgroups is highlighted.

The unequal distribution of the material, social and cultural resources in society results in social inequalities in food, and often in food poverty among some population groupsReference Friel and Conlon12, Reference Shaw, Dorling, Gordon and Davey Smith48. Research in the UK and Ireland has clearly identified material and structural issues of access to and availability of healthy foods as the two main determinants of food povertyReference Dowler and Dobson49. It appears from this study that the risk of being hungry due to lack of food at home can exist across all social classes. This suggests a more complex aetiology of food poverty among children, including matters of material circumstance, psychosocial support, work–life balance of parents, family (dis)organisation, as well as personal and family nutrition knowledge and beliefs, many of which could operate independently of occupational or socio-economic statusReference DeRose, Messer and Millman50.

Access to a safe and varied healthy diet is a fundamental human right. Yet, up until recently, food poverty per se has not received much attention at a policy level in Ireland. However, the recognition of the need for equal access to food for all members of society is embedded within Ireland's new National Nutritional Policy, launched in Summer 2006. One of the key strategic objectives is to help reduce food poverty51. No single approach to tackling food poverty is believed to address all the relevant issues. However, with regard to food poverty among children and adolescents, schools are a powerful, potentially supportive setting, in a position to provide much of the structural and skills development necessary for healthy living. The provision of school meals is a proven beneficial support measure for schoolchildren52, 53. Ongoing dietary programmes in schools are to be commended, but need to be developed and supported nationwide as part of a long-term strategic approach to ensure provision of nutritionally balanced meals for all children.

Acknowledgements

The international 2001/2002 HBSC comprises data from the following countries (principal investigators at that time are given in parentheses): Austria (Wolfgang Dür), Belgium-Flemish (Lea Maes), Belgium-French (Danielle Piette), Canada (William Boyce), Croatia (Marina Kuzman), Czech Republic (Ladislav Csémy), Denmark (Pernille Due), England (Antony Morgan), Estonia (Mai Maser, Kaili Kepler), Finland (Jorma Tynjälä), France (Emmanuelle Godeau), Germany (Klaus Hurrelmann), Greece (Anna Kokkevi), Greenland (Michael Pedersen), Hungary (Anna Aszmann), Ireland (Saoirse Nic Gabhainn), Israel (Yossi Harel), Italy (Franco Cavallo), Latvia (Ieva Ranka), Lithuania (Apolinaras Zaborskis), Macedonia (Lina Kostorova Unkovska), Malta (Marianne Massa), The Netherlands (Wilma Vollebergh), Norway (Oddrun Samdal), Poland (Barbara Woynarowski), Portugal (Margarida Gaspar De Matos), Russia (Alexander Komkov), Scotland (Candace Currie), Slovenia (Eva Stergar), Spain (Carmen Moreno Rodriguez), Sweden (Ulla Marklund), Switzerland (Holger Schmid), Ukraine (Olga Balakireva), USA (Mary Overpeck, Peter Scheidt) and Wales (Chris Roberts).

This study was supported by grant aid from the Health Promotion Unit of the Department of Health and Children, Government of Ireland and by a research project grant from the Health Research Board (HRB). The authors' work was independent of the funders.

References

1Dwyer, JT. Childhood, youth and old age. In: Garrow, JS, James, WPT, eds. Human Nutrition and Dietetics. Edinburgh: Churchill-Livingstone, 1993; 394408.Google Scholar
2Joint WHO/FAO Expert Consultation. Diet, Nutrition and the Prevention of Chronic Disease. Geneva: World Health Organisation, 2003. (WHO Technical Report Series, No. 916).Google Scholar
3Pollitt, E, Mathews, R. Breakfast and cognition: an integrative summary. American Journal of Clinical Nutrition 1998; 67: 804S–13S.CrossRefGoogle ScholarPubMed
4Weinreb, L, Wehler, C, Perloff, J, Scott, R, Hosmer, D, Sagor, L, et al. . Hunger: its impact on children's health and mental health. Pediatrics 2002; 110: 41.CrossRefGoogle ScholarPubMed
5Gordon, N. Some influences on cognition in early life: a short review of recent opinions. European Journal of Paediatric Neurology 1998; 2(1): 1–5.CrossRefGoogle Scholar
6Roos, G, Johansson, L, Kasmel, A, Klumbiene, J, Prattala, R. Disparities in vegetable and fruit consumption: European cases from the north to the south. Public Health Nutrition 2001; 4: 3544.CrossRefGoogle ScholarPubMed
7Nelson, M. Childhood nutrition and poverty. Proceedings of the Nutrition Society 2000; 59: 307–15.CrossRefGoogle ScholarPubMed
8Friel, S, Kelleher, CC, Nolan, G, Harrington, J. Social diversity of Irish adults nutritional intake. European Journal of Clinical Nutrition 2003; 57: 865–75.Google Scholar
9Vincentian Partnership for Social Justice. One Long Struggle – A Study of Low Income Families. Dublin: Vincentian Partnership for Social Justice, 2001.Google Scholar
10James, WPT, Nelson, M, Ralph, A, Leather, S. The contribution of nutrition to inequalities in health. British Medical Journal 1997; 314: 1545–9.CrossRefGoogle ScholarPubMed
11Eurodiet. Nutrition and diet for healthy lifestyles in Europe: science and policy implications. Public Health Nutrition 2002; 4(2A): 265–73.Google Scholar
12Friel, S, Conlon, C. Policy Response to Food Poverty in Ireland. Dublin: Combat Poverty Agency, 2004.Google Scholar
13Dowler, EA. Food poverty and food policy. IDS Bulletin 1998; 29: 58–65.CrossRefGoogle Scholar
14Alaimo, K, Olson, CM, Frongillo, EA. Low family income and food insufficiency in relation to overweight in children: is there a paradox? Archives of Pediatrics & Adolescent Medicine 2001; 155: 1161–7.Google Scholar
15Giskes, K, Turrel, G, Patterson, C, Newman, B. Socioeconomic differences among Australian adults in consumption of vitamins A, C and folate. Journal of Human Nutrition Dietetics 2002; 15: 375–85.CrossRefGoogle Scholar
16Casey, PH, Szeto, KL, Robbins, JM, Stuff, JE, Connell, C, Gossett, JM, et al. . Child health-related quality of life and household food security. Archives of Paediatrics & Adolescent Medicine 2005; 159: 51–6.CrossRefGoogle ScholarPubMed
17Alaimo, K, Olson, CM, Frongillo, EA, Briefel, RB. Food insufficiency, family income, and health in US preschool and school-aged children. American Journal of Public Health 2001; 108: e4453.Google Scholar
18Cummins, S, Macintyre, S. ‘Food deserts’ – evidence and assumption in health policy making. British Medical Journal 2001; 325: 436–8.Google Scholar
19Dowler, E. Food and poverty – insights from the ‘North’. Development Policy Review 2003; 21: 569–80.CrossRefGoogle Scholar
20Food Poverty (Eradication) Bill.http://www.joeshort.net/foodjustice/thebill.htm (accessed 9 December 2005).Google Scholar
21Currie, C, Samdal, O, Boyce, W, Smith, R, eds. Health Behaviour in School-aged Children: A World Health Organization Cross-national Study: Research Protocol for the 2001/02 Survey. Edinburgh: University of Edinburgh, 2002.Google Scholar
22Mullan, E, Currie, C, Boyce, W, Morgan, A, Kalnins, I, Holstein, B. Social inequality. In: Currie, C, Samdal, O, Boyce, W, Smith, R, eds. Health Behaviour in School-aged Children: A World Health Organization Cross-national Study: Research Protocol for the 2001/02 Survey. Edinburgh: University of Edinburgh, 2002; 175–250.Google Scholar
23British Medical Journal, News Extra. More than 1% of Canadian population suffers hunger. British Medical Journal 2000; 321: 1042.Google Scholar
24Riches, G. Hunger, food security and welfare policies: issues and debates in first world societies. Proceedings of the Nutrition Society 1997; 56: 63–74.CrossRefGoogle ScholarPubMed
25Maes, L, Vereecken, C, Johnston, M. Eating and dying. In: Currie, C, Samdal, O, Boyce, W, Smith, R, eds. Health Behaviour in School-aged Children: A World Health Organization Cross-national Study: Research Protocol for the 2001/02 Survey. Edinburgh: University of Edinburgh, 2002; 39–58.Google Scholar
26Vereecken, C, Maes, LA. A Belgian study on the reliability and relative validity of the Health Behaviour in School-Aged Children food frequency questionnaire. Public Health Nutrition 2003; 6: 581–8.CrossRefGoogle Scholar
27Vereecken, CA, Inchley, J, Subramanian, SV, Hublet, A, Maes, L. The relative influence of individual and contextual socio-economic status on consumption of fruit and soft drinks among adolescents in Europe. European Journal of Public Health 2005; 15: 224–32.Google Scholar
28Resincow, K. The relationship between breakfast habits and plasma cholesterol levels in schoolchildren. Journal of School Health 1991; 61: 81–5.CrossRefGoogle Scholar
29Siega-Riz, AM, Carson, T, Popkin, B. Three squares or mostly snack – what do teens really eat? A sociodemographic study of meal patterns. Journal of Adolescence Health 1998; 22: 29–36.Google Scholar
30Idler, EL, Benyamini, Y. Self-rated health and mortality: a review of twenty-seven community studies. Journal of Health and Social Behavior 1997; 38: 21–37.CrossRefGoogle ScholarPubMed
31Torsheim, T, Currie, C, Boyce, W, Samdal, O. Country material distribution and adolescents' perceived health: multilevel study of adolescents in twenty-seven countries. Journal of Epidemiology and Community Health 2006; 60: 156–61.Google Scholar
32Haugland, S, Wold, B, Stevenson, J, Aaro, LE, Woynarowska, B. Subjective health complaints in adolescence – a cross national comparison of prevalence and dimensionality. European Journal of Public Health 2001; 11: 4–10.Google Scholar
33Ghandour, RM, Overpeck, MD, Huang, ZJ, Kogan, MD, Scheidt, PC. Headache, stomachache, backache, and morning fatigue among adolescent girls in the United States: associations with behavioral, sociodemographic, and environmental factors. Archives of Pediatrics & Adolescent Medicine 2004; 158: 797803.Google Scholar
34Huebner, ES. Initial development of the students life satisfaction scale. School Psychology International 1991; 12: 231–40.Google Scholar
35Cantril, H. The Pattern of Human Concerns. New Brunswick: Rutgers University Press, 1965.Google Scholar
36Hagquist, C, Andrich, D. Measuring subjective health among adolescents in Sweden. Social Indicators Research 2004; 68: 201–20.Google Scholar
37Torsheim, T, Ravens-Sieberer, U, Hetland, J, Välimaa, R, Danielson, M, Overpeck, M. Cross-national variation of gender differences in adolescent subjective health in Europe and North America. Social Science & Medicine 2006; 62: 815–27.CrossRefGoogle ScholarPubMed
38Roberts, C, Tynjala, J, Currie, D, King, M. Methods. In: Currie, C, Roberts, C, Morgan, A, Smith, R, Settertobulte, W, Samdal, O, et al. ., eds. Young People's Health in Context. Copenhagen: World Health Organization Regional Office for Europe, 2004; 217–28.Google Scholar
39Currie, C, Roberts, C, Morgan, A, Smith, R, Settertobulte, W, Samdal, O, et al. ., eds. Young People's Health in Context. Health Policy for Children and Adolescents No. 4. Copenhagen: World Health Organization Regional Office for Europe, 2004.Google Scholar
40Woodroffe, C, Glickman, M, Baker, M, Power, C. Children, Teenagers and Health: The Key Data. Buckingham: Open University Press, 1993.Google Scholar
41MacIntyre, S. Socioeconomic variations in Scotland's health: a review. Health Bulletin (Edinburgh) 1994; 52: 456–71.Google Scholar
42West, P. Health inequalities in the early years: is there equalisation in youth? Social Science & Medicine 1997; 44: 833–58.CrossRefGoogle ScholarPubMed
43Currie, CE, Elton, RA, Todd, J, Platt, S. Indicators of socioeconomic status for adolescents: the WHO Health Behaviour in School-aged Children Survey. Health Education Research 1997; 13: 385–97.Google Scholar
44Goodman, E. The role of socioeconomic status gradients in explaining differences in US adolescents' health. American Journal of Public Health 1999; 89: 1522–8.Google Scholar
45Abramson, JH, Gofin, R, Habib, J, Pridan, H, Gofin, J. Indicators of social class: a comparative appraisal of measures for use in epidemiological studies. Social Science & Medicine 1982; 16: 1739–46.Google Scholar
46Townsend, P. Widening inequalities of health in Britain: a rejoinder to Rudolph Klein. International Journal of Health Services 1990; 20: 363–72.CrossRefGoogle Scholar
47Batista-Foguet, JM, Fortiana, J, Currie, C, Villalbi, JR. Socioeconomic indexes in surveys for comparisons between countries. an applied comparison using the Family Affluence Scale. Social Indicators Research 2004; 67: 315–32.CrossRefGoogle Scholar
48Shaw, M, Dorling, D, Gordon, D, Davey Smith, G. The Widening Gap: Health Inequalities and Policy in Britain. Bristol: The Policy Press, 1999.Google Scholar
49Dowler, EA, Dobson, BM. Nutrition and poverty in Europe: an overview. Proceedings of the Nutrition Society 1997; 56: 51–62.CrossRefGoogle ScholarPubMed
50DeRose, L, Messer, E, Millman, S. Who's Hungry? and How Do We Know? Food Shortage, Poverty, and Deprivation. New York: United Nations University Press, 1998.Google Scholar
51Take 5 steps … to a healthier you.http://www.healthpromotion.ie/news/?id = 46 (accessed 15 December 2005).Google Scholar
52Department of Health. Healthy Start: Proposals for Reform of the Welfare Food Scheme. London: Department of Health Publications, 2002.Google Scholar
53Department of Social and Family Affairs. Review of Urban and Gaeltacht School Meals Schemes. Dublin: Department of Social and Family Affairs, 2003.Google Scholar
Figure 0

Table 1 Associations between food poverty and daily consumption or less of various foodstuffs, by gender

Figure 1

Table 2 Associations between food poverty and measures of health perception, by gender

Figure 2

Table 3 Associations between food poverty and measures of reported life satisfaction, by gender

Figure 3

Fig. 1 Associations between food poverty and low life satisfaction, by country. *Adjusted for age and paternal social class. Germany, Italy and Russia are represented by regional rather than national samples; Be-VLG – Belgium, Flanders