title: Neighbourhood socioeconomic disadvantage and fruit and vegetable consumption: a seven countries comparison.
abstract: BACKGROUND
  Low fruit and vegetable consumption is a risk factor for poor health. Studies have shown consumption varies across neighbourhoods, with lower intakes in disadvantaged neighbourhoods. However, findings are inconsistent, suggesting that socio-spatial inequities in diet could be context-specific, highlighting a need for international comparisons across contexts. This study examined variations in fruit and vegetable consumption among adults from neighbourhoods of varying socioeconomic status (SES) across seven countries (Australia, Canada, Netherlands, New Zealand, Portugal, Scotland, US).
  
  
  METHODS
  Data from seven existing studies, identified through literature searches and knowledge of co-authors, which collected measures of both neighbourhood-level SES and fruit and vegetable consumption were used. Logistic regression was used to examine associations between neighbourhood-level SES and binary fruit and vegetable consumption separately, adjusting for neighbourhood clustering and age, gender and education. As much as possible, variables were treated in a consistent manner in the analysis for each study to allow the identification of patterns of association within study and to examine differences in the associations across studies.
  
  
  RESULTS
  Adjusted analyses showed evidence of an association between neighbourhood-level SES and fruit consumption in Canada, New Zealand and Scotland, with increased odds of greater fruit intake in higher SES neighbourhoods. In Australia, Canada, New Zealand and Portugal, those residing in higher SES neighbourhoods had increased odds of greater vegetable intake. The other studies showed no evidence of a difference by neighbourhood-level SES.
  
  
  CONCLUSIONS
  Acknowledging discrepancies across studies in terms of sampling, measures, and definitions of neighbourhoods, this opportunistic study, which treated data in a consistent manner, suggests that associations between diet and neighbourhood-level socioeconomic status vary across countries. Neighbourhood socioeconomic disadvantage may differentially impact on access to resources in which produce is available in different countries. Neighbourhood environments have the potential to influence behaviour and further research is required to examine the context in which these associations arise.
authors.affiliation: Centre for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, Melbourne, VIC, 3125, Australia. kylie.ball@deakin.edu.au.
authors.forename: Kylie
authors.initials: K
authors.lastname: Ball
authors.affiliation: Centre for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, Melbourne, VIC, 3125, Australia. karen.lamb@deakin.edu.au.
authors.forename: Karen E
authors.initials: KE
authors.lastname: Lamb
authors.affiliation: Centre of Studies on Geography and Spatial Planning (CEGOT), University of Coimbra, Coimbra, Portugal. claudiampcosta1@gmail.com.
authors.forename: Claudia
authors.initials: C
authors.lastname: Costa
authors.affiliation: The Research Center of the University of Montreal Hospital Centre (Centre de Recherche du Centre hospitalier de l'Université de Montréal - CRCHUM) & The Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, Canada. nicoleta@ualberta.ca.
authors.forename: Nicoleta
authors.initials: N
authors.lastname: Cutumisu
authors.affiliation: Medical Research Council Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK. anne.ellaway@glasgow.ac.uk.
authors.forename: Anne
authors.initials: A
authors.lastname: Ellaway
authors.affiliation: Erasmus University Medical Centre, Rotterdam, Netherlands. c.kamphuis@erasmusmc.nl.
authors.forename: Carlijn B M
authors.initials: CB
authors.lastname: Kamphuis
authors.affiliation: University of Michigan, Ann Arbor, MI, USA. gmentz@umich.edu.
authors.forename: Graciela
authors.initials: G
authors.lastname: Mentz
authors.affiliation: Centre for Research on Environment, Society & Health, School of GeoSciences, University of Edinburgh, Edinburgh, UK. jamie.pearce@ed.ac.uk.
authors.forename: Jamie
authors.initials: J
authors.lastname: Pearce
authors.affiliation: Centre of Studies on Geography and Spatial Planning (CEGOT), University of Coimbra, Coimbra, Portugal. paulasantana.coimbra@gmail.com.|Department of Geography, Faculty of Humanities, University of Coimbra, Coimbra, Portugal. paulasantana.coimbra@gmail.com.
authors.forename: Paula
authors.initials: P
authors.lastname: Santana
authors.affiliation: Centre for Health Economics, University of York, York, United Kingdom. rita.santos@york.ac.uk.
authors.forename: Rita
authors.initials: R
authors.lastname: Santos
authors.affiliation: University of Michigan, Ann Arbor, MI, USA. amy@schulz.com.
authors.forename: Amy J
authors.initials: AJ
authors.lastname: Schulz
authors.affiliation: University of Alberta, Edmonton, Canada. jc.spence@ualberta.ca.
authors.forename: John C
authors.initials: JC
authors.lastname: Spence
authors.affiliation: Centre for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, Melbourne, VIC, 3125, Australia. lukar.thornton@deakin.edu.au.
authors.forename: Lukar E
authors.initials: LE
authors.lastname: Thornton
authors.affiliation: Erasmus University Medical Centre, Rotterdam, Netherlands. f.vanlenthe@erasmusmc.nl.
authors.forename: Frank J
authors.initials: FJ
authors.lastname: van Lenthe
authors.affiliation: University of Illinois, Chicago, IL, USA. szenk@uic.edu.
authors.forename: Shannon N
authors.initials: SN
authors.lastname: Zenk
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001294:Attitude to Health; D001315:Australia; D002170:Canada; D005247:Feeding Behavior; D005260:Female; D005638:Fruit; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D009520:New Zealand; D011174:Portugal; D012111:Residence Characteristics; D012307:Risk Factors; D012606:Scotland; D012931:Social Environment; D012959:Socioeconomic Factors; D014481:United States; D014675:Vegetables; D055815:Young Adult