Mediation of psychosocial determinants in the relation between socio-economic status and adolescents' diet quality.
OBJECTIVE
To examine the underlying reasons for the positive relation between socio-economic status (SES) and the diet quality of adolescents.


METHODS
In 2081 adolescents (12.5-17.5 years) of the European HELENA study, a continuous variable on diet quality via 2-day 24-h recalls was available. SES was reflected by parental education, parental occupation and family affluence. Mediation by several psychosocial determinants was tested: self-efficacy, availability at school and home, social support, barriers, benefits, awareness and some self-reported influencers (parents, school, taste, health, friends, food readily available, easy preparation, hunger, price and habits). Multiple mediation analyses were adjusted for age, sex and country.


RESULTS
The availability of soft drinks and fruit at home, social support, parental influence, barriers, price influence, taste influence, health influence and food being readily available were significant mediators. The multiple mediation indirect effect accounted for 23-64% of the total effect. Both occupation and education and both maternal and paternal factors could be explained by the mediation. The unavailability of soft drinks was the strongest mediator (17-44% of the total effect).


CONCLUSIONS
Up to 64% of the positive relation between SES and the diet quality in adolescence could be explained by several healthy eating determinants. Focusing on these factors in low-SES populations can minimize social inequalities in diet and health by improving the diet of these specific adolescents.
Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185-4K3, 9000, Ghent, Belgium. Nathalie.michels@ugent.be.
Nathalie
http://orcid.org/0000-0002-3069-7254
N
Michels
Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185-4K3, 9000, Ghent, Belgium.
Lisa
L
Vynckier
GENUD (Growth, Exercise, NUtrition and Development) Research Group, Faculty of Health Sciences, University of Zaragoza, , Edificio del SAI, C/Pedro Cerbuna s/n, 50009, Zaragoza, Spain.
Luis A
LA
Moreno
Centre d'Investigation Clinique CH&U Inserm, Bd Pr Leclercq, Hôpital Cardiologique, Lille Cedex, France.
Laurent
L
Beghin
Department of Physiology, Faculty of Medicine, Granada University, Granada, Spain.
Alex
A
de la O
School of Education, Health and Social Sciences, Dalarna University, Falun, Sweden.
Maria
M
Forsner
Department of Health and Human Performance, Facultad de Ciencias de la Actividad Física y del Deporte, Universidad Politécnica de Madrid, Madrid, Spain.
Marcela
M
Gonzalez-Gross
Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185-4K3, 9000, Ghent, Belgium.|Nutrition and Metabolism Section, International Agency for Research on Cancer, Lyon, France.
Inge
I
Huybrechts
Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185-4K3, 9000, Ghent, Belgium.
Isabel
I
Iguacel
School of Medicine, University of Crete, Crete, Greece.
Antonio
A
Kafatos
Research Institute of Child Nutrition, Rheinische Friedrich-Wilhelms-Universität Bonn, Dortmund, Germany.
Mathilde
M
Kersting
INRAN (National Research Institute on Food and Nutrition), Via Ardeatina, 546I00176, Roma, Italy.
Catherine
C
Leclercq
Department of Nutrition and Dietetics, Harokopio University, Athens, Greece.
Yannis
Y
Manios
Department of Metabolism and Nutrition, ICTAN Institute Frı´o Spanish National Research Council C/ Jose´ Antonio Novais, Madrid, 28000, Spain.
Ascension
A
Marcos
Department of Pediatrics, University of Pécs, Pécs, Hungary.
Denes
D
Molnar
Department of BioScience and Nutrition, Karolinska institutet, Stockholm, Sweden.
Michael
M
Sjöström
Department of Pediatrics, Division of Clinical Nutrition, Medical University of Vienna, Vienna, Austria.
Kurt
K
Widhalm
Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185-4K3, 9000, Ghent, Belgium.
Stefaan
S
De Henauw
D000293:Adolescent; D000294:Adolescent Behavior / Q000208:ethnology; D017195:Adolescent Nutritional Physiological Phenomena / Q000208:ethnology; D003430:Cross-Sectional Studies; D000072001:Diet, Healthy / Q000191:economics / Q000208:ethnology / Q000523:psychology; D004522:Educational Status; D005060:Europe; D005260:Female; D005518:Food Preferences / Q000208:ethnology; D007722:Health Knowledge, Attitudes, Practice / Q000208:ethnology; D006801:Humans; D008297:Male; D008960:Models, Psychological; D016487:Parenting / Q000208:ethnology; D010290:Parents / Q000193:education; D010349:Patient Compliance / Q000208:ethnology / Q000523:psychology; D000067074:Peer Influence; D000072858:Psychosocial Support Systems; D057566:Self Report; D012959:Socioeconomic Factors
Adolescents; Diet quality; Socio-economic class; Soft drink availability