title: Gender and the double burden of economic and social disadvantages on healthy eating: cross-sectional study of older adults in the EPIC-Norfolk cohort.
abstract: BACKGROUND
  Multiple economic factors and social relationships determine dietary behaviours, but the inter-relations between determinants is unknown. Whether women and men differ in the vulnerability to, and impact of, combined disadvantages is also unclear. We examined associations between diverse combinations of economic resources and social relationships, and healthy eating in British older women and men.
  
  
  METHODS
  Our sample comprised 9,580 over-50s (47 % of over-50 respondents) in the EPIC-Norfolk cohort study. We examined six economic factors (education, social class, home-ownership, money for needs, frequency of insufficient money for food/clothing, paying bills) and three social relationships (marital status, living arrangement and friend contact), independently and in combination, in relation to fruit variety and vegetable variety. We analysed gender-specific associations using multivariable linear regression with interaction terms.
  
  
  RESULTS
  Lower social class, lower education, and difficulty paying bills were associated with lower fruit and vegetable variety in both genders, independent of social relationships. All social relationships were independently associated with fruit variety in men and with vegetable variety in both genders. Substantially lower variety was found for all combinations of low economic resources and lack of social relationship than for either measure alone, with men faring worse in the majority of combined disadvantages. For example, the difference in vegetable variety for men reporting low social class and non-married was much greater (β -4.1, [-4.8, -3.4]), than the independent association of low social class (β -1.5, [-1.8,-1.2]), or non-married (β -1.8, [-2.3,-1.3]). Variety was also lower among men with high economic resources but non-married or lone-living.
  
  
  CONCLUSIONS
  A double burden of low economic resources and lack of social relationships suggested they are unique joint determinants, particularly in older men, and that public health efforts to improve healthy eating would offer most benefit to older adults with intersecting economic and social disadvantages.
authors.affiliation: UK Clinical Research Collaboration Centre for Diet and Activity Research (CEDAR), MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, UK. annalijn@gmail.com.
authors.forename: Annalijn I
authors.initials: AI
authors.lastname: Conklin
authors.affiliation: Medical Research Council Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK. nita.forouhi@mrc-epid.cam.ac.uk.
authors.forename: Nita G
authors.initials: NG
authors.lastname: Forouhi
authors.affiliation: Strangeways Research Laboratory and Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK. ps404@cam.ac.uk.
authors.forename: Paul
authors.initials: P
authors.lastname: Surtees
authors.affiliation: UK Clinical Research Collaboration Centre for Diet and Activity Research (CEDAR), MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, UK. nick.wareham@mrc-epid.cam.ac.uk.|Medical Research Council Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK. nick.wareham@mrc-epid.cam.ac.uk.
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Wareham
authors.affiliation: UK Clinical Research Collaboration Centre for Diet and Activity Research (CEDAR), MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, UK. pm491@medschl.cam.ac.uk.
authors.forename: Pablo
authors.initials: P
authors.lastname: Monsivais
mesh_terms: D000368:Aged; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D004032:Diet / Q000191:economics / Q000706:statistics & numerical data*; D004034:Diet Surveys; D005260:Female; D005638:Fruit; D005783:Gender Identity; D015438:Health Behavior; D006801:Humans; D008297:Male; D008875:Middle Aged; D012111:Residence Characteristics / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D014675:Vegetables