BackgroundThe aims of this study are 1) to investigate the association between maternal educational level and healthy eating behaviour of 11-year-old children (fruit, vegetables and breakfast consumption), and 2) to examine whether factors in the home food environment (parental intake of fruit, vegetables and breakfast; rules about fruit and vegetables and home availability of fruit and vegetables) mediate these associations.MethodsData were obtained from the Dutch INPACT study. In total, 1318 parent–child dyads were included in this study. Multilevel regression models were used to investigate whether factors of the home food environment mediated the association between maternal educational level and children’s healthy eating behaviour.ResultsChildren of mothers with a high educational level consumed more pieces of fruit per day (B = 0.13, 95% CI: 0.04-0.22), more grams of vegetables per day (B = 23.81, 95% CI = 14.93-32.69) and were more likely to have breakfast on a daily basis (OR = 2.97, 95% CI: 1.38-6.39) than children of mothers with a low educational level. Home availability, food consumption rules and parental consumption mediated the association between maternal education level and children’s fruit and vegetable consumption. Parental breakfast consumption mediated the association between maternal education level and children’s breakfast consumption.ConclusionsFactors in the home food environment play an important role in the explanation of socio-economic disparities in children’s healthy eating behaviour and may be promising targets for interventions.
In the present study, we examined the association between maternal education and unhealthy eating behaviour (the consumption of snack and sugar-sweetened beverages (SSB)) and explored environmental factors that might mediate this association in 11-year-old children. These environmental factors include home availability of snacks and SSB, parental rules about snack and SSB consumption, parental intake of snacks and SSB, peer sensitivity and children's snack-purchasing behaviour. Data were obtained from the fourth wave of the INPACT (IVO Nutrition and Physical Activity Child cohorT) study (2011), in which 1318 parent-child dyads completed a questionnaire. Data were analysed using multivariate regression models. Children of mothers with an intermediate educational level were found to consume more snacks than those of mothers with a high educational level (B ¼ 1·22, P¼ 0·02). This association was not mediated by environmental factors. Children of mothers with a low educational level were found to consume more SSB than those of mothers with a high educational level (B ¼ 0·63, P, 0·01). The association between maternal educational level and children's SSB consumption was found to be mediated by parental intake of snacks and SSB and home availability of SSB. The home environment seems to be a promising setting for interventions on reducing socio-economic inequalities in children's SSB consumption.
Background Despite high vaccination coverage, there have recently been epidemics of vaccine preventable diseases in the Netherlands, largely confined to an orthodox protestant minority with religious objections to vaccination. The orthodox protestant minority consists of various denominations with either low, intermediate or high vaccination coverage. All orthodox protestant denominations leave the final decision to vaccinate or not up to their individual members. Methods To gain insight into how orthodox protestant parents decide on vaccination, what arguments they use, and the consequences of their decisions, we conducted an in-depth interview study of both vaccinating and non-vaccinating orthodox protestant parents selected via purposeful sampling. The interviews were thematically coded by two analysts using the software program Atlas.ti. The initial coding results were reviewed, discussed, and refined by the analysts until consensus was reached. Emerging concepts were assessed for consistency using the constant comparative method from grounded theory. Results After 27 interviews, data saturation was reached. Based on characteristics of the decision-making process (tradition vs. deliberation) and outcome (vaccinate or not), 4 subgroups of parents could be distinguished: traditionally non-vaccinating parents, deliberately non-vaccinating parents, deliberately vaccinating parents, and traditionally vaccinating parents. Except for the traditionally vaccinating parents, all used predominantly religious arguments to justify their vaccination decisions. Also with the exception of the traditionally vaccinating parents, all reported facing fears that they had made the wrong decision. This fear was most tangible among the deliberately vaccinating parents who thought they might be punished immediately by God for vaccinating their children and interpreted any side effects as a sign to stop vaccinating. Conclusions Policy makers and health care professionals should stimulate orthodox protestant parents to make a deliberate vaccination choice but also realize that a deliberate choice does not necessarily mean a choice to vaccinate.
The integration of both sub-studies, with their own specific strengths and weaknesses, added to our insight in the vaccination coverage in this minority. Based on these results, we recommend to focus prevention and control of vaccine-preventable diseases on the orthodox Protestant subgroups with intermediate and low vaccination coverage.
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