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. 2017 Aug 25;12(8):e0183700.
doi: 10.1371/journal.pone.0183700. eCollection 2017.

The Relationship Between Dietary Quality and the Local Food Environment Differs According to Level of Educational Attainment: A Cross-Sectional Study

Free PMC article

The Relationship Between Dietary Quality and the Local Food Environment Differs According to Level of Educational Attainment: A Cross-Sectional Study

Christina Vogel et al. PLoS One. .
Free PMC article


There is evidence that food outlet access differs according to level of neighbourhood deprivation but little is known about how individual circumstances affect associations between food outlet access and diet. This study explored the relationship between dietary quality and a measure of overall food environment, representing the balance between healthy and unhealthy food outlet access in individualised activity spaces. Furthermore, this study is the first to assess effect modification of level of educational attainment on this relationship. A total of 839 mothers with young children from Hampshire, United Kingdom (UK) completed a cross-sectional survey including a 20-item food frequency questionnaire to measure diet and questions about demographic characteristics and frequently visited locations including home, children's centre, general practitioner, work, main food shop and physical activity location. Dietary information was used to calculate a standardised dietary quality score for each mother. Individualised activity spaces were produced by creating a 1000m buffer around frequently visited locations using ArcGIS. Cross-sectional observational food outlet data were overlaid onto activity spaces to derive an overall food environment score for each mother. These scores represented the balance between healthy and unhealthy food outlets using weightings to characterise the proportion of healthy or unhealthy foods sold in each outlet type. Food outlet access was dominated by the presence of unhealthy food outlets; only 1% of mothers were exposed to a healthy overall food environment in their daily activities. Level of educational attainment moderated the relationship between overall food environment and diet (mid vs low, p = 0.06; high vs low, p = 0.04). Adjusted stratified linear regression analyses showed poorer food environments were associated with better dietary quality among mothers with degrees (β = -0.02; 95%CI: -0.03, -0.001) and a tendency toward poorer dietary quality among mothers with low educational attainment, however this relationship was not statistically significant (β = 0.01; 95%CI: -0.01, 0.02). This study showed that unhealthy food outlets, like takeaways and convenience stores, dominated mothers' food outlet access, and provides some empirical evidence to support the concept that individual characteristics, particularly educational attainment, are protective against exposure to unhealthy food environments. Improvements to the imbalance of healthy and unhealthy food outlets through planning restrictions could be important to reduce dietary inequalities.

Conflict of interest statement

Competing Interests: CV, DL, GN, SC and GM have not conflicts of interest to declare. JB has received grant research support from Danone Nutricia Early Life Nutrition and CC has received consultancy, lecture fees and honoraria from AMGEN, GKS, Alliance for Better Bone Health, MSD, Eli Lilly, Pfizer, Novartis, Servier, Medtronic and Roche. The study described in this manuscript is not related to these relationships and they do not alter our adherence to PLOS ONE policies on sharing data and materials. However, data cannot be made openly available because of ethical concerns about potential identification of individuals through the data demographic and postcode variables. Postcode denotes a very small geographical area in the UK. These postcode variables cannot be removed as they are fundamental to the development of the exposure variables. The dataset can be made available upon request, subject to appropriate approvals. Researchers wishing to use the data can make a formal application to the Southampton Initiative for Health Oversight Group by emailing Subject to approval that the intended purpose is compatible with the study’s ethical approval and formal agreements regarding confidentiality and secure data storage being signed, the data would then be provided.


Fig 1
Fig 1. An example of a mother’s activity space with food outlets and food environment score calculation.
Fig 2
Fig 2. Thirds of food environment score (FES U-H) by mothers’ dietary quality according to their level of educational attainment.

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    1. Bloom D.E., Cafiero E.T.,Jane-Llopis E., Abrahams-Gessel S., Bloom L.R., Fathima S. et al. , The Global Economic Burden of Noncommunicable Diseases. 2011, World Economic Forum: Geneva.
    1. Department of Health UK, Our Health and Wellbeing. 2010: London.
    1. Barker, D.J.P., Nutrition in the womb: how better nutrition during development will prevent heart disease, diabetes and stroke. 1st ed. 2008, USA.
    1. Department of Health UK, Healthy Lives, Healthy People: Our strategy for public health in England. 2010: London.
    1. US National Institutes of Health, Strategic Plan for NIH Obesity Research. 2011: Washington DC.