Table 4.
Studies examining the association between SES and fruits and vegetables consumption.
| SN | Authors | Methodology description | Findings | Key strengths and limitations | Quality score | |||||
|---|---|---|---|---|---|---|---|---|---|---|
| Study design | Sample size (n) | Continent/country | Age range | SES measure | Method of analysis | |||||
| 1 | Mikki et al. (2010) | Cross-sectional survey | 2,952 | Palestine | 13–15 years | Parental education | The multivariate linear regression model | Adolescents with high parental education consumed fruits and vegetables more frequently (6.3 times per week) than those with low parental education. | Healthy eating habits are more prone in highly educated families which can influence their children’s healthy dietary choices. One potential constraint of this study is the utilization of self-reported responses, which has the potential to impact both the validity and reliability of the findings. | 8 |
| 2 | Moore and Littlecott (2015) | Cross-sectional | 9,194 | Wales | 11–16 years | SES | Mixed-effects logistic regression models | Children and adolescents with low SES had a lower likelihood (OR: 1.15, 95% CI: 1.10–1.20) of consuming fruits and vegetables compared to those from high SES. | Food insecurity can result in less frequent consumption of fruits and vegetables. However, this cross-sectional study lacks to established causal association between high SES and the consumption of fruits and vegetables. | 8 |
| 3 | Yannakoulia et al. (2016) | Cross-sectional, National representative | 11,717 | Greece | 3–18 years | SES | Classification–regression tree analysis (CART) model | Children and adolescents from low SES consumed fewer fruits (31.2 and 25.3%, respectively) and vegetables (56.7 and 55.5%, respectively) than those from high SES. | Limited financial resources can make it difficult to afford fresh fruits and vegetables regularly. However, a low response rate might distort the findings | 8 |
| 4 | Richter et al. (2009a) | Cross-national survey | 97,721 | Europe (n = 30), Asia (n = 1), North America (n = 2) | 13–15 years | SES | The multilevel logistic regression model | Adolescents with low SES had lower odds of consuming fruits and vegetables (OR boys: 0.61, 95% CI: 0.54–0.70; OR girls: 0.78, 95% CI: 0.73–0.84) than those with high SES. | Affordable food sources limit access to these nutritious options. However, self-reported adolescent behavioral patterns can make it difficult to estimate the inclusive results. | 8 |
| 5 | Richter et al. (2009) | Cross-national survey | 86,667 | Europe (n = 26) North America (n = 2) | 11–15 years | SES | Logistic regression | Children and adolescents from various regions, including Southern, Northern, Western, Eastern, Central Europe, Northern America (USA and Canada), and Asia (Israel), had a lower likelihood of consuming vegetables if they were from low SES compared to high SES | SES disparities exist in many regions that can limit their ability to access and afford fresh vegetables. However, methodological constraints limit findings. | 8 |
| 6 | Svastisalee et al. (2012) | Cross-sectional | 6,034 | Denmark | 11–15 years | Parental occupation | The multilevel logistic regression model | Children and adolescents from higher parental social class had a higher likelihood of consuming fruits (OR: 1.46, 95% CI: 1.24–1.71) and vegetables (OR: 1.86, 95% CI: 1.58–2.19) compared to those from lower social class | Higher social classes may be part of social circles that emphasize fruits and vegetables. Due to the nature of the data, this study is unable to draw a causality between SES and consumption of fruit and vegetables. | 8 |
| 7 | Vereecke et al. (2005) | Cross-national | 114,558 | 28 European countries | 11–15 years | SES, parental occupation | Multiple regression model | Children and adolescents from high parental SES had a higher likelihood of daily fruit consumption (OR: 1.530, 95% CI: 1.479–1.581) compared to those from low SES. Similarly, adolescents from high parental occupation levels had a higher likelihood of daily fruit consumption (OR: 1.186, 95% CI: 1.148–1.227) compared to their peers. | Healthy lifestyle prioritization contributes to daily fruit consumption. However, due to the poor classification of data measurement draws a poor conclusion. | 6 |
| 8 | Zaborskis et al. (2021) | Cross-national | 192,755 | 42 countries including 40 countries from Europe, Canada, and Israel | 11–15 years | SES | Logistic regression model and structural equation model | Adolescents with low parental SES were less likely to consume daily fruits (OR: 0.51; 95% CI: 0.49–0.53), vegetables (OR: 0.58; 95% CI: 0.56–0.60), and sweets (OR: 0.94; 95% CI: 0.90–0.97) than those with higher parental SES. | Access to affordable food and nutritional knowledge incorporated into diets. However, the findings are concerned with potential bias. | 7 |
| 9 | Voráčová et al. (2016) | Cross-sectional | 10,831 | Czech republic | 11–15 years | SES | Logistic regression | Children and adolescents from higher parental SES backgrounds had higher odds of daily fruit (OR: 1.67, 95% CI: 1.34–2.08) and vegetable consumption (OR: 1.54, 95% CI: 1.22–2.00) compared to those from lower SES. | Food accessibility seems to increase the consumption of fruits and vegetables. However, eating habits as reported may have been influenced by social desirability | 8 |
| 10 | de Buhr and Tannen (2020) | Cross-sectional | 4,294 | German | 6–13 years | SES | Spearman’s Rho correlations | Children from higher parental SES consumed more vegetables and salad (r: 0.100, 95% CI: 0.047–0.153) and fruits (r: 0.086, 95% CI: 0.032–0.139) than those from lower SES. | Financial resources, nutritional knowledge, and healthy lifestyle prioritization contribute to increased consumption of healthy food. However, it does not explain whether SES influences dietary choices or if dietary choices influence SES | 8 |
| 11 | Johansen et al. (2006) | Cross-sectional | 3,458 | Denmark | 14–16 years | Maternal occupation | GEE logistic regression | Adolescents with high maternal occupation significantly consumed more fruits and vegetables (OR: 1.65, 95% CI: 1.15–2.36) compared to their peers. | High-occupation may cultivate a health-conscious environment that encourages the consumption of fruits and vegetables. However, the study failed to establish a causal association between SES and healthy food behavior. | 6 |
| 12 | Nardone et al. (2020) | Cross-sectional | 58,976 | Italy | 11–15 years | Parental income and parental education | Logistic regression | Children and adolescents with high parental education were more likely to consume fruits and vegetables (OR: 0.54, 95% CI: 0.48–0.61), as were those with high parental income (OR: 0.70, 95% CI: 0.64–0.77) compared to their counterparts with lower education and income. | Health-conscious behavior may prioritize providing nutritious foods. The poor study setting did not provide a valid conclusion. | 6 |
| 13 | Al Sabbah et al. (2007) | Cross-sectional | 8,885 | Palestine | 12–18 years | Maternal education | Logistic regression | Adolescents with high maternal education were more likely to consume more fruits (OR: 1.35, 95% CI: 1.19–1.53) and vegetables (OR: 1.10, 95% CI: 0.98–1.24) compared to those with low maternal education. | Nutritional information associated with consuming fruits and vegetables. Nevertheless, self-reported measurements might result in either an overestimation or underestimation of the findings. | 6 |
| 14 | Zaborskis et al. (2012) | Cross-sectional | 33,230 | Lithuania | 11–15 years | Parental income | Binary logistic regression | Adolescents with high parental income were more likely to consume fruits daily (OR: 2.15, 95% CI: 1.86–2.49) and vegetables (OR: 1.12, 95% CI: 0.97–1.28) compared to those with low parental income. | Families with higher incomes often have better access to fresh fruits and vegetables on a daily basis. However, it is hard to make causality inferences due to the study design. | 8 |