Urban–rural differences in adolescent eating behaviour: a multilevel cross-sectional study of 15-year-olds in Scotland

Abstract

Objective: Improving the diet of the Scottish population has been a government focus in recent years. Population health is known to vary between geographies; therefore alongside trends and socio-economic inequalities in eating behaviour, geographic differences should also be monitored. Design: Eating behaviour data from the 2010 Scotland Health Behaviour in School-aged Children survey were modelled using multilevel linear and logistic modelling. Setting: Data were collected in schools across urban and rural Scotland. Subjects: Schoolchildren aged 15 years. Results: Adolescents living in remote rural Scotland had the highest consumption frequency of vegetables (on average consumed on 6?68 d/week) and the lowest consumption frequency of sweets and crisps (on 4?27 and 3?02 d/week, respectively). However, it was not in the major four cities of Scotland (Glasgow, Edinburgh, Dundee and Aberdeen) but in the geography described by the classification 'other urban' areas (large towns of between 10 000 and 125 000 residents) that adolescents had the poorest diet. Deprivation and rurality were independently associated with food consumption for all but fruit consumption. Sharing a family meal, dieting behaviour, food poverty and breakfast consumption did not differ by rurality. Variance at the school level was significant for fruit and vegetable consumption frequencies and for irregular breakfast consumption, regardless of rurality. Conclusions: Young people from rural areas have a healthier diet than those living in urban areas. The eating behaviours examined did not explain these differences. Future research should investigate why urban-rural differences exist for consumption frequencies of 'healthy' and 'unhealthy' foods. Keywords Urban-rural Eating behaviour Adolescent ScotlandThe Scottish Government, in accordance with international guidelines such as the WHO Global Strategy on Diet, Physical Activity and Health (1) and the WHO 2008-2013 Action Plan for the Global Strategy for the Prevention and Control of Noncommunicable Diseases (2) , has in recent years prioritised improving the diet of the Scottish population by increasing healthy eating and reducing unhealthy eating (3)(4)(5) . As with many health outcomes, however, some members of the population fare better than others. Within Scotland, gender and age differences have been shown in eating behaviour, with fruit and vegetable consumption more prevalent among girls and younger children, and sweets, chips and crisps consumption less prevalent (6) . Socio-economic inequalities in health have also been shown for many adolescent outcomes in Scotland and have widened over time for both adult (7,8) and adolescent health measures (9,10) . A recent study of adolescent eating behaviour showed that socio-economic inequalities in adolescent eating habits exist in Scotland, with those from higher social class reporting a more favourable diet (11) . Scotland has a population of approximately 5 250 000 with a land mass of 78 772 km 2 , resulting in a relatively low average...

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