Association of socio-economic environment and women’s empowerment with daily fruit and vegetable intake in Latin American cities: a multilevel study
Abstract Background In Latin America, a low proportion of the population meets the recommended fruit and vegetable (F&V) intake. The region is highly urbanized, with significant socioeconomic inequalities. The objective of this study was to analyze the association of the socio-economic environme...
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2025-07-01
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| author | Giovanna Valentino Amy H. Auchincloss Natalia Tumas Nancy López-Olmedo Ana Ortigoza Mariana Carvalho de Menezes Mónica Mazariegos Carolina Nazzal |
| author_facet | Giovanna Valentino Amy H. Auchincloss Natalia Tumas Nancy López-Olmedo Ana Ortigoza Mariana Carvalho de Menezes Mónica Mazariegos Carolina Nazzal |
| author_sort | Giovanna Valentino |
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| description | Abstract Background In Latin America, a low proportion of the population meets the recommended fruit and vegetable (F&V) intake. The region is highly urbanized, with significant socioeconomic inequalities. The objective of this study was to analyze the association of the socio-economic environment (GDP per capita, living conditions) and women's empowerment (WE) with daily F&V intake in adults from Latin American cities, and whether these associations vary by individual education. Methods Cross-sectional study using secondary data from the SALURBAL project (Urban Health in Latin America), which compiled data from health surveys, censuses, and other surveys from cities with ≥ 100,000 inhabitants in 11 Latin American countries. The sample included 91,977 adults from 234 cities in 8 countries with self-reported F&V intake data. The outcome was daily F&V intake, defined as consuming F&V 7 days a week. City-level exposures included GDP per capita (tertiles), living conditions score (overcrowding, piped water, and education access; Z-scores), and WE score (labor force participation and early marriage; Z-scores). We estimated prevalence ratios (PR) for the association between each exposure and daily F&V intake using gender-stratified two-level Poisson models with random intercepts for cities adjusted by city and individual-level covariates. Interaction terms were included to evaluate effect-modification by individual education. Results Participants from cities in the upper GDP tertiles (T2 and T3) showed a ~ 7% higher prevalence of daily F&V intake among men (T2 PR = 1.08, 95% CI: 1.00–1.15; T3 PR = 1.06, 95% CI: 0.99–1.14) and women (T2 PR = 1.07, 95% CI: 1.01–1.13; T3 PR = 1.06, 95% CI: 0.99–1.12). A one standard deviation increase in WE and living conditions scores was associated with a ~ 10% higher prevalence of daily F&V intake in men (WE PR = 1.10, 95% CI: 1.02–1.19; living conditions PR = 1.10, 95% CI: 1.04–1.16) and women (WE PR = 1.11, 95% CI: 1.04–1.17; living conditions PR = 1.10, 95% CI: 1.05–1.15). Individual education levels significantly modified these associations (p < 0.05), which were stronger among those with lower educational attainment. Conclusions City GDP per capita, living conditions and WE were directly associated with fruit and vegetable daily intake, particularly among individuals with lower education levels in Latin America. |
| format | Article |
| id | doaj-art-4b5af3fc9a374baa96fa31b484d76ee1 |
| institution | Kabale University |
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| publishDate | 2025-07-01 |
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| spelling | doaj-art-4b5af3fc9a374baa96fa31b484d76ee12025-08-20T04:01:43ZengBMCBMC Public Health1471-24582025-07-0125111110.1186/s12889-025-22973-0Association of socio-economic environment and women’s empowerment with daily fruit and vegetable intake in Latin American cities: a multilevel studyGiovanna Valentino0Amy H. Auchincloss1Natalia Tumas2Nancy López-Olmedo3Ana Ortigoza4Mariana Carvalho de Menezes5Mónica Mazariegos6Carolina Nazzal7Programa de Doctorado, Facultad de Medicina, Escuela de Salud Pública, Universidad de ChileDepartment of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel UniversityCenter of Research and Studies on Culture and Society, National and Technical Research Council and National University of Córdoba (CIECS, CONICET and UNC)Center for Population Health Research, National Institute of Public HealthUrban Health Collaborative, Dornsife School of Public Health, Drexel UniversityDepartment of Nutrition, Federal University of Minas GeraisINCAP Research Center for the Prevention of Chronic Diseases (CIIPEC), Institute of Nutrition of Central America and Panama (INCAP)Escuela de Salud Pública, Facultad de Medicina, Universidad de ChileAbstract Background In Latin America, a low proportion of the population meets the recommended fruit and vegetable (F&V) intake. The region is highly urbanized, with significant socioeconomic inequalities. The objective of this study was to analyze the association of the socio-economic environment (GDP per capita, living conditions) and women's empowerment (WE) with daily F&V intake in adults from Latin American cities, and whether these associations vary by individual education. Methods Cross-sectional study using secondary data from the SALURBAL project (Urban Health in Latin America), which compiled data from health surveys, censuses, and other surveys from cities with ≥ 100,000 inhabitants in 11 Latin American countries. The sample included 91,977 adults from 234 cities in 8 countries with self-reported F&V intake data. The outcome was daily F&V intake, defined as consuming F&V 7 days a week. City-level exposures included GDP per capita (tertiles), living conditions score (overcrowding, piped water, and education access; Z-scores), and WE score (labor force participation and early marriage; Z-scores). We estimated prevalence ratios (PR) for the association between each exposure and daily F&V intake using gender-stratified two-level Poisson models with random intercepts for cities adjusted by city and individual-level covariates. Interaction terms were included to evaluate effect-modification by individual education. Results Participants from cities in the upper GDP tertiles (T2 and T3) showed a ~ 7% higher prevalence of daily F&V intake among men (T2 PR = 1.08, 95% CI: 1.00–1.15; T3 PR = 1.06, 95% CI: 0.99–1.14) and women (T2 PR = 1.07, 95% CI: 1.01–1.13; T3 PR = 1.06, 95% CI: 0.99–1.12). A one standard deviation increase in WE and living conditions scores was associated with a ~ 10% higher prevalence of daily F&V intake in men (WE PR = 1.10, 95% CI: 1.02–1.19; living conditions PR = 1.10, 95% CI: 1.04–1.16) and women (WE PR = 1.11, 95% CI: 1.04–1.17; living conditions PR = 1.10, 95% CI: 1.05–1.15). Individual education levels significantly modified these associations (p < 0.05), which were stronger among those with lower educational attainment. Conclusions City GDP per capita, living conditions and WE were directly associated with fruit and vegetable daily intake, particularly among individuals with lower education levels in Latin America.https://doi.org/10.1186/s12889-025-22973-0Middle-income countriesSocial determinants of healthWomen’s empowermentDiet qualitySocioeconomic developmentGross domestic income |
| spellingShingle | Giovanna Valentino Amy H. Auchincloss Natalia Tumas Nancy López-Olmedo Ana Ortigoza Mariana Carvalho de Menezes Mónica Mazariegos Carolina Nazzal Association of socio-economic environment and women’s empowerment with daily fruit and vegetable intake in Latin American cities: a multilevel study BMC Public Health Middle-income countries Social determinants of health Women’s empowerment Diet quality Socioeconomic development Gross domestic income |
| title | Association of socio-economic environment and women’s empowerment with daily fruit and vegetable intake in Latin American cities: a multilevel study |
| title_full | Association of socio-economic environment and women’s empowerment with daily fruit and vegetable intake in Latin American cities: a multilevel study |
| title_fullStr | Association of socio-economic environment and women’s empowerment with daily fruit and vegetable intake in Latin American cities: a multilevel study |
| title_full_unstemmed | Association of socio-economic environment and women’s empowerment with daily fruit and vegetable intake in Latin American cities: a multilevel study |
| title_short | Association of socio-economic environment and women’s empowerment with daily fruit and vegetable intake in Latin American cities: a multilevel study |
| title_sort | association of socio economic environment and women s empowerment with daily fruit and vegetable intake in latin american cities a multilevel study |
| topic | Middle-income countries Social determinants of health Women’s empowerment Diet quality Socioeconomic development Gross domestic income |
| url | https://doi.org/10.1186/s12889-025-22973-0 |
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