Perceived barriers to healthy eating and adherence to dietary guidelines: Nationwide study.

People report many barriers that prevent them from achieving a healthy diet. Whether perceived barriers are associated with dietary behavior remains unclear. To assess the association between barriers to healthy eating and adherence to the Swiss dietary guidelines. Cross-sectional data from the Swiss Health Survey 2012 (N = 15,450; 53% women). Barriers included price, daily habits, taste, gluttony, lack of time, lack of willpower, limited options in restaurants, in supermarkets, no social support, and social opposition. The associations between barriers and adherence to Swiss dietary guidelines were assessed using multivariable logistic regression. Daily habits (odds ratio; 95% confidence interval: 0.91; 0.85-0.98) and taste (0.85; 0.79-0.91) were associated with lower adherence to the guidelines for fruits, while price (1.13; 1.06-1.21) and limited options in restaurants (1.33; 1.23-1.45) and in supermarkets (1.18; 1.03-1.35) were associated with higher adherence. Taste was associated with lower adherence to the guidelines for vegetables (0.72; 0.66-0.78), while price (1.20; 1.11-1.30), gluttony (1.17; 1.04-1.31), social group opposition (1.48; 1.18-1.85) and limited options in restaurants (1.56; 1.42-1.72) and in supermarkets (1.25; 1.07-1.47) were associated with higher adherence. Daily habits (0.82; 0.75-0.90), time (0.86; 0.78-0.94), lack of willpower (0.78; 0.70-0.87), and gluttony (0.86; 0.76-0.98) were associated with lower adherence to the guidelines for fish, whereas price (1.09; 1.01-1.19), and limited options in restaurants (1.26; 1.14-1.39) and supermarkets (1.40; 1.20-1.63) were associated with higher adherence. Daily habits (0.89; 0.82-0.97), taste (0.66; 0.61-0.72), lack of willpower (0.84; 0.76-0.92) and gluttony (0.66; 0.58-0.75) were associated with lower adherence to the guidelines for meat. Time (0.88; 0.78-0.99) was associated with lower adherence to the guidelines for dairy, while gluttony (1.26; 1.09-1.46) was associated with higher adherence. Daily habits was associated with lower adherence (0.91; 0.85-0.97) to the guidelines for liquids, while limited options in restaurants was associated with higher adherence (1.12; 1.03-1.22). In the Swiss adult population, several self-reported barriers to healthy eating appear to hinder adherence to the dietary guidelines, while other commonly reported barriers are linked to higher adherence

Independent association between socioeconomic indicators and macro- and micro-nutrient intake in Switzerland.

Socioeconomic differences in diet are rarely assessed with more than one indicator. We aimed to assess differences in macro- and micro-nutrient intake in both sexes according to education, income, and occupation. We used data from validated food frequency questionnaire measured dietary intake in 5087 participants (2157 women) from yearly adult population-based cross-sectional surveys conducted from 2005 to 2012 in the canton of Geneva, Switzerland. We used two ANOVA models: age-adjusted and multivariable adjusted simultaneously for all three socioeconomic indicators. Low-education men consumed more calcium but less vitamin D than high-education men; low-income men consumed less total and animal protein (80.9±0.9 vs 84.0±0.6 g/d; 55.6±1.0 vs 59.5±0.7 g/d) and more total carbohydrates and sugars (246±2 vs 235±2 g/d; 108±2 vs 103±1 g/d) than high-income men. Occupation and diet showed no association. Low-education women consumed less vegetable protein (20.7±0.2 vs 21.6±0.2 g/d), fibre (15.7±0.3 vs 16.8±0.2 g/d), and carotene (4222±158 vs 4870±128 μg/d) than high-education women; low-income women consumed more total carbohydrates (206±2 vs 197±1 g/d) and less monounsaturated fat (27.7±0.4 vs 29.3±0.3 g/d) than high-income women. Finally, low-occupation women consumed more total energy (1792±27 vs 1714±15 kcal/d) and total carbohydrates (206±2 vs 200±1 g/d), but less saturated fat (23.0±0.3 vs 24.4±0.2 g/d), calcium (935±17 vs 997±10 mg/d) and vitamin D (2.5±0.1 vs 2.9±0.1 μg/d), than high-occupation women. In Switzerland, the influence of socioeconomic factors on nutrient intake differs by sex; income and education, but not occupation, drive differences among men; among women, all three indicators seem to play a role. Interventions to reduce inequalities should consider the influence of education, income, and occupation in diet to be most effective

Interventions promoting healthy eating as a tool for reducing social inequalities in diet in low- and middle-income countries: a systematic review.

Diet is a major risk factor for non-communicable diseases (NCDs) and is also strongly patterned by socioeconomic factors. Whether interventions promoting healthy eating reduce social inequalities in diet in low- and middle-income countries (LMICs) remains uncertain. This paper aims to summarize current evidence on interventions promoting healthy eating in LMICs, and to establish whether they reduce social inequalities in diet. Systematic review of cross-sectional or quasi-experimental studies (pre- and post-assessment of interventions) in Pubmed, Scielo and Google Scholar databases, including adults in LMICs, assessing at least one outcome of healthy eating and showing results stratified by socioeconomic status. Seven intervention studies including healthy eating promotion, conducted in seven LMICs (Brazil, Chile, Colombia, Iran, Panama, Trinidad and Tobago, and Tunisia), met our inclusion criteria. To promote healthy eating, all interventions used nutrition education and three of them combined nutrition education with improved acces to foods or social support. Interventions targeted mostly women and varied widely regarding communication tools and duration of the nutrition education sessions. Most interventions used printed material, media use or face-to-face training and lasted from 6 weeks to 5 years. Four interventions targeted disadvantaged populations, and three targeted the entire population. In three out of four interventions targeting disadvantaged populations, healthy eating outcomes were improved suggesting they were likely to reduce social inequalities in diet. All interventions directed to the entire population showed improved healthy eating outcomes in all social strata, and were considered as having no impact on social inequalities in diet. In LMICs, agentic interventions promoting healthy eating reduced social inequalities in diet when specifically targeting disadvantaged populations. Further research should assess the impact on social inequalities in diet of a combination of agentic and structural approaches in interventions promoting healthy eating

Parental willingness to have children vaccinated against COVID-19 in Geneva, Switzerland: a cross-sectional population-based study.

We aimed to examine factors associated with parental willingness to vaccinate their children against COVID-19. We surveyed adults included in a digital longitudinal cohort study composed of participants in previous SARS-CoV-2 serosurveys conducted in Geneva, Switzerland. In February 2022, an online questionnaire collected information on COVID-19 vaccination acceptance, parental willingness to vaccinate their children aged ≥5 years and reasons for vaccination preference. We used multivariable logistic regression to assess the demographic, socioeconomic and health-related factors associated with being vaccinated and with parental intention to vaccinate their children. We included 1,383 participants (56.8% women; 69.3% aged 35-49 years). Parental willingness to vaccinate their children increased markedly with the child's age: 84.0%, 60.9% and 21.2%, respectively, for parents of adolescents aged 16-17 years, 12-15 years and 5-12 years. For all child age groups, unvaccinated parents more frequently indicated not intending to vaccinate their children than vaccinated parents. Refusal to vaccine children was associated with having a secondary education (1.73; 1.18-2.47) relative to a tertiary education and with middle (1.75; 1.18-2.60) and low (1.96; 1.20-3.22) household income relative to high income. Refusal to vaccine their children was also associated with only having children aged 12-15 years (3.08; 1.61-5.91), aged 5-11 years (19.77; 10.27-38.05), or in multiple age groups (6.05; 3.22-11.37), relative to only having children aged 16-17 years. Willingness to vaccinate children was high for parents of adolescents aged 16-17 years but decreased significantly with decreasing child age. Unvaccinated, socioeconomically disadvantaged parents and those with younger children were less likely to be willing to vaccinate their children. These results are important for vaccination programs and developing communication strategies to reach vaccine-hesitant groups, both in the context of COVID-19 and in the prevention of other diseases and future pandemics

The Contribution of Diet Quality to Socioeconomic Inequalities in Obesity: A Population-based Study of Swiss Adults.

Socioeconomically disadvantaged people are disproportionally more likely to develop obesity and obesity-related diseases. However, it remains unclear to what extent diet quality contributes to socioeconomic inequalities in obesity. We aimed to assess the role of diet quality in the association between socioeconomic status (SES) and obesity. Data originated from the national nutrition survey, a cross-sectional sample of the adult Swiss population (N = 1860). We used education and income as proxies for SES; calculated the Alternate Healthy Eating Index (AHEI) as a measure of diet quality; and used body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), and waist-to-height ratio (WHtR) as obesity markers. We applied counterfactual mediation modelling to generate odds ratios, 95% confidence intervals, and the proportion mediated by diet quality. Individuals with less than a tertiary education were two to three times more likely to be obese, regardless of the marker (OR (95% CI): 3.36 (2.01, 5.66) using BMI; 2.44 (1.58, 3.75) using WC; 2.48 (1.63, 3.78) using WHR; and 2.04 (1.43, 2.96) using WHtR). The proportion of the association between educational level and obesity that was mediated by diet quality was 22.1% using BMI, 26.6% using WC, 31.4% using WHtR, and 35.8% using WHR. Similar findings were observed for income. Our findings suggest that diet quality substantially contributes to socioeconomic inequalities in obesity while it does not fully explain them. Focusing efforts on improving the diet quality of disadvantaged groups could help reduce social inequalities in obesity

The contribution of health behaviors to socioeconomic inequalities in health: A systematic review.

Unhealthy behaviors and their social patterning have been frequently proposed as factors mediating socioeconomic differences in health. However, a clear quantification of the contribution of health behaviors to the socioeconomic gradient in health is lacking. This study systematically reviews the role of health behaviors in explaining socioeconomic inequalities in health. Published studies were identified by a systematic review of PubMed, Embase and Web-of-Science. Four health behaviors were considered: smoking, alcohol consumption, physical activity and diet. We restricted health outcomes to cardiometabolic disorders and mortality. To allow comparison between studies, the contribution of health behaviors, or the part of the socioeconomic gradient in health that is explained by health behaviors, was recalculated in all studies according to the absolute scale difference method. We identified 114 articles on socioeconomic position, health behaviors and cardiometabolic disorders or mortality from electronic databases and articles reference lists. Lower socioeconomic position was associated with an increased risk of all-cause mortality and cardiometabolic disorders, this gradient was explained by health behaviors to varying degrees (minimum contribution -43%; maximum contribution 261%). Health behaviors explained a larger proportion of the SEP-health gradient in studies conducted in North America and Northern Europe, in studies examining all-cause mortality and cardiovascular disease, among men, in younger individuals, and in longitudinal studies, when compared to other settings. Of the four behaviors examined, smoking contributed the most to social inequalities in health, with a median contribution of 19%. Health behaviors contribute to the socioeconomic gradient in cardiometabolic disease and mortality, but this contribution varies according to population and study characteristics. Nevertheless, our results should encourage the implementation of interventions targeting health behaviors, as they may reduce socioeconomic inequalities in health and increase population health

A scoping review of foot screening in adults with diabetes mellitus across Canada

Objectives Regular foot screening by a knowledgeable health provider is the cornerstone of ulcer and amputation prevention in people with diabetes. However, information on foot screening practices among Canadians with diabetes remains sparse. Therefore, we sought to synthesize available data on the frequency and approach to diabetic foot screening across Canada. Methods We conducted a scoping review by searching MEDLINE and Embase databases, alongside a grey literature search, for both English- and French-language reports. Data on patients’ demographics, setting as well as the frequency and approach to foot screening were abstracted. Title and abstract screening, full-text review and data abstraction were conducted in duplicate, with discrepancies resolved by a third reviewer. Results The search yielded 21 reports including information on diabetic foot screening practices in Canada. In a consolidated study sample of 13,388 Canadians with diabetes, 7,277 (53%) reported receiving a foot examination by a health-care provider at least once in the past year. The majority of reports did not provide information on the demographics of patients being screened or details on the approach to foot screening. No report mentioned the use of a triage algorithm applied to the results of foot screening. Conclusions In this work, we identified the limited frequency and uncertain quality of diabetic foot screening across Canada. Further research should focus on better understanding disparities and barriers to regular diabetic foot screening. Résumé Objectifs Le dépistage systématique du pied par un professionnel de la santé compétent est le pilier de la prévention de l’ulcère et de l’amputation chez les personnes diabétiques. Toutefois, l’information sur les pratiques de dépistage du pied chez les Canadiens diabétiques demeure fragmentaire. Par conséquent, nous avons cherché à faire la synthèse des données disponibles sur la fréquence et l’approche en matière de dépistage du pied diabétique au Canada. Méthodes Nous avons consulté les bases de données MEDLINE et Embase, ainsi que la littérature grise, en anglais et en français, pour réaliser l’étude de portée. Nous avons extrait les données démographiques sur les patients, le contexte ainsi que la fréquence et l’approche en matière de dépistage du pied. La vérification des titres et des résumés, l’examen du texte intégral et l’extraction des données ont été effectués en double par 2 membres indépendants, et les divergences, résolues par un 3e examinateur. Résultats La recherche a permis d’obtenir 21 rapports dans lesquels figurait l’information sur les pratiques de dépistage du pied diabétique au Canada. Dans l’échantillon consolidé d’une étude auprès de 13 388 Canadiens diabétiques, 7277 (53 %) ont signalé avoir eu un examen du pied par un professionnel de la santé au moins une fois au cours de la dernière année. La majorité des rapports n’ont fourni aucune information sur les données démographiques des patients qui avaient eu un dépistage ou des détails sur l’approche du dépistage du pied. Aucun rapport n’a mentionné l’utilisation d’un algorithme de triage appliqué aux résultats du dépistage du pied. Conclusions Dans ces travaux, nous avons relevé la fréquence limitée et la qualité incertaine du dépistage du pied diabétique au Canada. Des recherches plus approfondies devraient porter sur la meilleure compréhension des disparités et des obstacles en matière de dépistage systématique du pied diabétique

Interactive impact of ethnic distance and cultural familiarity on the perceived effects of free trade agreements

Past research on free trade agreements (FTAs) mostly uses an economic perspective to assess their impact on the level of trade and investments between nations. As a result, there is a distinct paucity of research on the perceptions of employees and managers in organizations affected by FTAs, towards the likely outcomes of those FTAs. We address this gap by using the context of recently signed China-Australia free trade agreement (ChAFTA) to develop a multidimensional scale for the perceived advantages and disadvantages of FTAs. Drawing on social identity theory and the similarly-attraction paradigm we also show direct and interactive effects of perceived ethnic distance (between home and partner country) and cultural familiarity (with the FTA partner country) on these perceived outcomes of FTAs. Our findings highlight the need to look beyond the economic perspective and consider a much broader range of perceived outcomes of FTAs