The Southampton Women's Survey (SWS) has shown that women with lower educational attainment are less likely to eat a healthy diet than women with higher educational attainment(Reference Robinson, Crozier, Borland, Hammond, Barker and Inskip1). The SWS has also found that women who are on benefits or felt they are under financial strain are more likely to be diagnosed with depression(Reference Dunn, Inskip, Kendrick, Oestmann, Barnett, Godfrey and Cooper2) and have lower folate levels – a marker of a poor diet(Reference Kendrick, Dunn, Robinson, Oestmann, Godfrey, Cooper and Inskip3). Focus group discussions with women of lower educational attainment have revealed that they may eat unhealthy diets because they are constrained by limited financial resources and lack of control over their lives in general and their food choices in particular(Reference Barker, Lawrence, Skinner, Haslam, Robinson, Inskip, Margetts, Barker and Cooper4). A sense of control is important for healthy psychological functioning and has been shown to predict well-being(Reference Lachman and Weaver5). The SWS team of psychologists, epidemiologists and nutritionists therefore wished to assess the impact of food insecurity and well-being on the diets of women with lower educational attainment.
A cross-sectional questionnaire survey of 212 women (mean age 27 years) of lower educational attainment (GCSE only or below) attending baby and toddler sessions at SureStart children's centres in Southampton was undertaken. Diet was measured by a twenty-item FFQ(Reference Crozier, Inskip, Barker, Lawrence, Cooper and Robinson6), food insecurity was measured using the household food security scale(Reference Blumberg, Bialostosky, Hamilton and Briefel7) and well-being was assessed by the WHO-5 well-being index(Reference Bonsignore, Barkow, Jessen and Heun8). Data on level of education attained were also collected.
Principal components analysis was used to calculate a single diet score for each woman(Reference Robinson, Crozier, Borland, Hammond, Barker and Inskip1). Women with high scores ate diets that complied with healthy eating guidelines from the Department of Health and other agencies (e.g. Food Standards Agency(9), which was termed a prudent dietary pattern. No relationship was found between food insecurity and quality of diet or well-being and quality of diet. However, there was a significant correlation between food insecurity and well-being (r−0.22, P=0.002), such that the more food insecure the women were, the lower their sense of well-being.
Unlike previous research, the present study did not find food insecurity or well-being to be related to quality of diet in this population. The findings indicate that eating a poor quality diet may not simply be a matter of having insufficient money for food. However, the relationship between food insecurity and well-being suggests that having insufficient money for food may be stressful, thus reducing feelings of well-being. Other psychosocial factors are currently being explored to determine whether they explain why women of lower educational attainment eat poorer diets than women of higher educational attainment.
