Social inequality in adolescents' healthy food intake: the interplay between economic, social and cultural capital

Background: Current explanations of health inequalities in adolescents focus on behavourial and economic determinants and rarely include more meaningful forms of economic, cultural, and social capital. The aim of the study was to investigate how the interplay between capitals constitutes social inequalities in adolescent healthy food intake. Methods: Data were collected in the 2013/14 Flemish Health Behavior among School-aged Children (HBSC) survey, which is part of the international WHO HBSC survey. The total sample included 7266 adolescents aged 12-18. A comprehensive set of 58 capital indicators was used to measure economic, cultural and social capital and a healthy food index was computed from a 17-item food frequency questionnaire (FFQ) to assess the consumption frequency of healthy food within the overall food intake. Results: The different forms of capital were unequally distributed in accordance with the subdivisions within the education system. Only half of the capital indicators positively related to healthy food intake, and instead 17 interactions were found that both increased or reduced inequalities. Cultural capital was a crucial component for explaining inequalities such that social gradients in healthy food intake increased when adolescents participated in elite cultural practices (P < 0.05), and were consequently reduced when adolescents reported to have a high number of books at home (P < 0.05). Conclusion: A combination of selected resources in the form of economic, cultural and social capital may both increase or reduce healthy food intake inequalities in adolescents. Policy action needs to take into account the unequal distribution of these resources within the education system.