Gender, socioeconomic status and family status as determinants of food behaviour

Abstract

This study examines social structural and family status factors as determinants of food behaviour. The data were derived from the FINMONICA Risk Factor Survey, collected in Finland in spring 1992. A multidimensional framework of the determinants of food behaviour was used, including social structural position, family status and gender. The associations between the determinants of food behaviour were estimated by multivariate logistic regression models, adjusted for age and regional differences. Food behaviour was measured by an index including six food items which were chosen based on Finnish dietary guidelines. In general, women's food behaviour was more in accordance with the dietary guidelines than that of men. The pattern of association between educational level and food behaviour was similar for both genders, but slightly stronger for men than women. Employment status was associated only with women's food behaviour, but the tendency was the same for men. Marital status was associated with men's as well as women's food behaviour. The food behaviour of married men and women was more in line with the dietary guidelines than the food behaviour of those who had been previously married. Parental status, however, was only associated with women's food behaviour, that is, the food behaviour of women with young children was more closely in line with the dietary guidelines than that of the rest of the women.

Introduction

This study focuses on the social determinants of food behaviour among Finnish men and women. Our previous study (Roos et al., 1996) showed that only small differences existed in nutrient intake but more evident differences in food consumption according to educational level. If we look only at nutrient intake we cannot conclude that those with higher educational level had a healthier diet, which has been found in other studies (Axelson, 1986; Hulshof et al., 1991; Murphy et al., 1992; Prättälä et al., 1992; Osler, 1993; Anderson et al., 1994). If, however, we look at food intake we can conclude that those with higher socioeconomic status preferred modern healthy foods, such as fruits and vegetables, but ate less of traditional healthy foods, such as potatoes and bread. It was difficult to compare the nutrient and food quality of the overall diet between different socioeconomic groups, because we used only single nutrients and food items in the analyses. We also find it difficult to draw conclusions without including other social factors, such as employment status and family status in the analyses.

Our general aim in this study is to have a comprehensive picture of food behaviour as it relates to national dietary guidelines (National Nutrition Council, 1989) among men and women, using a multidimensional approach. It has recently been noted that “any concept of health lifestyles needs to go beyond an emphasis on socioeconomic status to focus on alternative status variables such as age and gender, that provide a structure to health practices” (Cockerham et al., 1997). There is an extensive literature addressing quantitative aspects of the relationship between socioeconomic status and diet (Mennel et al., 1992; Smith and Baghurst, 1992; Shimakawa et al., 1994; Hupkens et al., 1995, Hupkens et al., 1997; Popkin et al., 1996; Roos et al., 1996), but other alternative social status variables have rarely been included, the only exception being gender. Family and diet is, however, a common area of research, but studies typically use a qualitative approach with small numbers of selected subjects (Charles and Kerr, 1988; Ekström, 1991, Beardsworth and Keil, 1997).

This study examines, in a quantitative design, the social patterning of healthy eating behaviour and compares this patterning in men and women. We use a multidimensional framework taking into account simultaneously social structural position as well as family status and gender. Therefore, the following sets of social determinants of food behaviour were included: educational attainment, employment status, marital status and parental status. Previous studies on health inequalities applying a multidimensional framework suggest that these factors are particularly important in the analysis of women and in comparisons between women and men (Arber, 1989, Arber, 1991, Arber, 1997; Bartley et al., 1992; Arber and Lahelma, 1993; Hunt and Annandale, 1993; Popay et al., 1993; Lahelma and Arber, 1994).

The predominant approach in research on men's health and health related behaviours has been a structural one devoting attention to their socioeconomic status, employment status and material living conditions (Davey Smith et al., 1990; Townsend and Davidson, 1992). For women role analysis has been predominant, particularly in the United States (Nathanson, 1980; Arber, 1991; Hibbard and Pope, 1991; Lorber, 1997). According to this type of analysis women's family status, that is their marital status, parental status and domestic roles, determine their health and health related behaviours. However, contrasting hypotheses have been put forward concerning the significance of family status and domestic roles in addition to women's other roles: whether multiple roles as a spouse, a mother and an employee are beneficial or detrimental to women's health and health related behaviours. The role-stress model suggests a detrimental overload due to multiple roles, whereas the role-expansion model has suggests benefits from role accumulation and multiple attachment to the community (Gove and Hughes, 1979; Nathanson, 1980; Kendel et al., 1985; Whetherall et al., 1994; Martikainen, 1995).

An analysis that concentrates exclusively on the social structural position for men and on family status and domestic roles for women fails to take into account the simultaneous bearing and mutual relationships of both structural position and family status. Such an approach also fails to compare the mutual patterning of social and family determinants among men and women.

Men's social position is still very much determined by their socioeconomic status and employment status. This holds true for women as well, but additionally their family status, whether they have a spouse or not and whether they have dependent children or not, further determines their social position. Domestic responsibilities including housework and child-rearing for married women differ from married men. Therefore domestic circumstances in addition to socioeconomic status shape women's living conditions, much more than men's and subsequently also their health and health related behaviours (Arber and Lahelma, 1993; Popay et al., 1993).

Labour market position is one of the most conspicuous differences in men's and women's social position in western countries. First, men's labour market participation is much higher over the life course. Secondly, employed women hold part-time jobs much more often than men. Thirdly, the occupational structure is strongly gender segregated. Fourthly, employed women are paid less than men.

However, in Finland women hold full-time paid jobs almost as often as men and it makes little difference to women's full-time employment whether or not they have a partner and/or dependent children. The educational structure of men and women is also fairly equal (Arber and Lahelma, 1993; Lahelma and Arber, 1994). Socioeconomic research on health and health behaviours in Finland (Luoto, 1991) has for a long time applied an “individualistic” approach in which women as well as men are characterised by their own socioeconomic status, not by that of their spouse as in the “conventional” or “dominance” approach (Arber, 1991).

We believe that a multidimensional framework taking into account simultaneously social structural position and family status is essential for an analysis of the determinants of food behaviour among men and women. Furthermore gender comparisons of food behaviour using a multidimensional framework may be particularly suitable in the Finnish context, where employment participation and educational attainment are fairly equal between men and women. Nevertheless, an unequal domestic division of labour as well as job segregation continue to exist between Finnish men and women. Women occupy poorer positions in paid work and employed married women still do the bulk of housework, including child-rearing, shopping and preparing meals. This suggests that differences in food behaviour between men and women can be found not only for different socioeconomic statuses, but also between different family statuses particularly for women.

This study aims to examine the social determinants of the patterning of men's and women's food behaviour as it relates to the national dietary guidelines. We do this in a comprehensive framework combining social structural and family status factors among men and women. We first examine the association between social structural factors and food behaviour. Secondly we examine the association between family factors and food behaviour. Thirdly we use a multidimensional framework including both social structural factors and family status factors as determinants of food behaviour. As it is a major interest of this study to compare the patterning of the determinants of food behaviour among men and women, an “individualistic” approach is used, that is married women (and men) are characterised by their own social status, not by that of their spouse.

The specific questions that the study seeks to illuminate include:

(1) What are the associations of social structural factors (socioeconomic status and employment status) with food behaviour among women and men? We expect that the food behaviour of employed people and of those with higher education is more in line with the recommended dietary guidelines than the food behaviour of non-employed and of those with lower education. Additionally, we expect the structural pattern to be similar among men and women as educational attainment and employment participation are fairly equal in Finland.

(2) What are the associations of family status factors (marital status and parental status), in addition to the social structural factors, with food behaviour among women and men? We expect that married people and those with children have food behaviour more in line with the recommended dietary guidelines, as they are responsible for other family members. Additionally, we expect that family status factors show a stronger pattern for women since they undertake the bulk of housework and child-rearing.