Abstract
In order to address the paucity of evidence on the association between childhood eating habits and urbanization, this cross-sectional study describes urban–rural differences in frequency of fruit, vegetable, and soft drink consumption in 123,100 children aged 6–9 years from 19 countries participating in the fourth round (2015–2017) of the WHO European Childhood Obesity Surveillance Initiative (COSI). Children's parents/caregivers completed food-frequency questionnaires. A multivariate multilevel logistic regression analysis was performed and revealed wide variability among countries and within macroregions for all indicators. The percentage of children attending rural schools ranged from 3% in Turkey to 70% in Turkmenistan. The prevalence of less healthy eating habits was high, with between 30–80% and 30–90% children not eating fruit or vegetables daily, respectively, and up to 45% consuming soft drinks on >3 days a week. For less than one third of the countries, children attending rural schools had higher odds (OR-range: 1.1–2.1) for not eating fruit or vegetables daily or consuming soft drinks >3 days a week compared to children attending urban schools. For the remainder of the countries no significant associations were observed. Both population-based interventions and policy strategies are necessary to improve access to healthy foods and increase healthy eating behaviors among children.
| Original language | English |
|---|---|
| Article number | e13207 |
| Journal | Obesity Reviews |
| Volume | 22 |
| Issue number | S6 |
| Early online date | 7 Jul 2021 |
| DOIs | |
| Publication status | Published - 30 Nov 2021 |
Acknowledgements
We gratefully acknowledge all participating, children, their parents, and the schoolteachers and principals for kindly volunteering to participate in the study. We also thank the examiners and regional and local supervisors/coordinators who collected the data in each country. We also gratefully acknowledge support from Liza Villas and Gerben Rienk for making the WHO European Childhood Obesity Surveillance Initiative (COSI) project possible. Additionally, we acknowledge the leadership of the principal investigators from Kyrgyzstan (Gulmira Aitmurzaeva), Romania (Constanta Huidimac Petrescu), Norway (Else Karin Grøholt), Spain (Mª), and Turkey (Nazan Yardim). Ángeles Dal Re.Funding
The authors gratefully acknowledge support from a grant from the Russian Government in the context of the WHO European Office for the Prevention and Control of NCDs.
Keywords
- children
- fruit
- rural
- soft drinks
- urban
- vegetables
ASJC Scopus subject areas
- Endocrinology, Diabetes and Metabolism
- Public Health, Environmental and Occupational Health
Access to Document
- Paper_urban_and_rural_differences_eating_habits_COSI_v4_editors.PDF
This is the peer reviewed version of the following article: Heinen, MM, Bel-Serrat, S, Kelleher, CC, et al. Urban and rural differences in frequency of fruit, vegetable, and soft drink consumption among 6–9-year-old children from 19 countries from the WHO European region. Obesity Reviews. 2021; 22( S6):e13207. , which has been published in final form at https://doi.org/10.1111/obr.13207 . This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions. This article may not be enhanced, enriched or otherwise transformed into a derivative work, without express permission from Wiley or by statutory rights under applicable legislation. Copyright notices must not be removed, obscured or modified.