title: Understanding socio-economic inequalities in food choice behaviour: can Maslow's pyramid help?
abstract: Socio-economic groups differ in their material, living, working and social circumstances, which may result in different priorities about their daily-life needs, including the priority to make healthy food choices. Following Maslow's hierarchy of human needs, we hypothesised that socio-economic inequalities in healthy food choices can be explained by differences in the levels of need fulfilment. Postal survey data collected in 2011 (67·2 % response) from 2903 participants aged 20-75 years in the Dutch GLOBE (Gezondheid en Levens Omstandigheden Bevolking Eindhoven en omstreken) study were analysed. Maslow's hierarchy of human needs (measured with the Basic Need Satisfaction Inventory) was added to age- and sex-adjusted linear regression models that linked education and net household income levels to healthy food choices (measured by a FFQ). Most participants (38·6 %) were in the self-actualisation layer of the pyramid. This proportion was highest among the highest education group (47·6 %). Being in a higher level of the hierarchy was associated with a higher consumption of fruits and vegetables as well as more healthy than unhealthy bread, snack and dairy consumption. Educational inequalities in fruit and vegetable intake (B= -1·79, 95 % CI -2·31, -1·28 in the lowest education group) were most reduced after the hierarchy of needs score was included (B= -1·57, 95 % CI - ·09, -1·05). Inequalities in other healthy food choices hardly changed after the hierarchy of needs score was included. People who are satisfied with higher-level needs make healthier food choices. Studies aimed at understanding socio-economic inequalities in food choice behaviour need to take differences in the priority given to daily-life needs by different socio-economic groups into account, but Maslow's pyramid offers little help.
authors.affiliation: Department of Public Health,Erasmus MC,Rotterdam,The Netherlands.
authors.forename: Frank J
authors.initials: FJ
authors.lastname: van Lenthe
authors.affiliation: Department of Public Health,Erasmus MC,Rotterdam,The Netherlands.
authors.forename: Tessa
authors.initials: T
authors.lastname: Jansen
authors.affiliation: Department of Public Health,Erasmus MC,Rotterdam,The Netherlands.
authors.forename: Carlijn B M
authors.initials: CB
authors.lastname: Kamphuis
mesh_terms: D000203:Activities of Daily Living / Q000523:psychology; D000328:Adult; D000368:Aged; D001294:Attitude to Health; D002755:Choice Behavior; D004032:Diet / Q000009:adverse effects / Q000191:economics / Q000523:psychology; D004034:Diet Surveys; D004522:Educational Status; D005260:Female; D005518:Food Preferences / Q000523:psychology; D054624:Health Status Disparities; D006801:Humans; D008297:Male; D008875:Middle Aged; D008960:Models, Psychological; D009426:Netherlands; D018673:Nutrition Policy; D010349:Patient Compliance / Q000523:psychology; D010549:Personal Satisfaction; D011446:Prospective Studies; D011582:Psychological Theory; D012959:Socioeconomic Factors; D055815:Young Adult
keywords: Maslow's hierarchy of needs