Abstract

Background: Food habits and their socio-economic differences in Russia have rarely been compared to those in western countries. Our aim was to determine socio-economic differences and their changes in the consumption of vegetables, fruit and berries in two neighbouring areas: the district of Pitkäranta in the Republic of Karelia, Russia, and North Karelia, Finland. Methods: Cross-sectional risk factor surveys in Pitkäranta, in 1992, 1997, 2002 and 2007 (1144 men, 1528 women) and in North Karelia, in 1992, 1997 and 2002 (2049 men, 2316 women), were carried out. Data collected with a self-administered questionnaire were analysed with logistic regression. Results: The consumption of fruit and vegetables was more common in North Karelia than in Pitkäranta, but increased markedly in Pitkäranta from 1992 to 2007. In Pitkäranta, women, and in North Karelia both men and women with higher education ate fresh vegetables more often than those with a lower education. In both areas, daily consumption of fruit tended to be more common among subjects with a higher education. In Pitkäranta, there were virtually no differences by employment status. In North Karelia, vegetable consumption was less common among the unemployed than the employed subjects. Only minor socio-economic differences in berry consumption were observed. The educational differences in vegetable consumption seemed to widen in Pitkäranta and narrow in North Karelia. Conclusion: A converging trend was observed, with the Russian consumption levels and socio-economic differences starting to approach those observed in Finland. This may be partly explained by the improvements in availability and affordability of fruit and vegetables in Pitkäranta.

Introduction

Frequent consumption of fruit and vegetables is recommended in practically all dietary guidelines in order to maintain a balanced diet and to prevent obesity and chronic diseases. Socio-economic and gender differences in the consumption of fruit and vegetables have been studied widely in Western Europe. Women and persons with a higher socio-economic position eat fruit and vegetables more often, especially in northern and western parts of Europe including Finland and the Baltic countries, while in southern Europe the associations are less clear or even the reverse.1–6 In northern Europe, the geographic conditions for growing fruit and vegetables are less favourable than in the southern parts of Europe and the prices of fruit and vegetables have been higher than those in the south.6

Large parts of Russia belong geographically and in terms of climate and agricultural conditions to the northern European area. In Russia, results from limited regions suggest that the overall consumption of fruit and vegetables has been extremely low.7 To our knowledge, socio-economic differences in fruit and vegetable consumption in Russia have not thus far been examined. Socio-economic differences in mortality,8–10 self-reported health11,12 and alcohol use13 have been observed. Socio-economic variation in smoking has also been observed but the results have been conflicting.14,15 Thus, the possible socio-economic differences in health behaviours, especially in food habits, remain unclear.

In Russia, the availability and prices of foods are more important motives for food choice than health. In a recent study among Russian consumers, health ranked only on sixth place compared with, e.g., Great Britain, where health has been the second most important motive, only preceded by sensory appeal.16,17 The collapse of the Soviet Union in 1991 was followed by vast changes in Russian society, resulting in an uncertain food supply. In addition, as a consequence of a rise in prices and a decline in real income, the food share of expenditures has risen markedly since 1991.11

The prevalence of cardiovascular diseases and the mortality of working-age men are exceptionally high in Russia.18 In Finland, coronary heart disease mortality was among the highest in the world in the 1960s, especially among men in eastern Finland, in the province of North Karelia.19 From 1973 to 2001, it decreased by 72% among 35–64-year-old North Karelian men20 in connection with a health promotion campaign called the North Karelia Project.21 Dietary changes such as increasing the consumption of fruit and vegetables were an important element in the project. Therefore, North Karelia in Finland and the Republic of Karelia in Russia are an interesting case for comparative public health research.

In this paper, we compare vegetable, fruit and berry consumption in the Republic of Karelia in north-western Russia and its neighbouring area North Karelia in Finland, during 1992–2007. The study period encompasses the transition of Russia from a centrally planned economy towards a market economy. Our aim is to examine differences in the consumption of fresh vegetables, fruit and berries in Pitkäranta in the Republic of Karelia, Russia, and in North Karelia, Finland, by education and employment status. We will also examine whether the consumption has diminished or increased in different educational and employment status groups in Pitkäranta and in North Karelia. Results from previous studies give grounds to expect clearer socio-economic variation in Finnish North Karelia than in Russian Karelia.

Methods

Study sites and population

The Republic of Karelia in Russia and North Karelia in Finland are neighbouring areas with 296 km of common border. They partly shared a common history until the end of the Second World War, when parts of formerly Finnish Karelia including our study site, the district of Pitkäranta, were annexed to the Soviet Union. The Republic of Karelia is a part of the Russian Federation. In the district of Pitkäranta, there are some 28 000 inhabitants, half living in the city of Pitkäranta.22 North Karelia is the most eastern province of Finland, with 168 000 inhabitants. Finland is a more affluent country than Russia with, e.g., a 10-fold household final consumption expenditure in 2005.23

The data were collected by cross-sectional risk factor surveys in 1992, 1997, 2002 and 2007. All surveys were conducted during the spring. The two study areas, the district of Pitkäranta in the Republic of Karelia, Russia, and North Karelia in Finland, were identical each year. The samples were stratified with each 10-year age group having an equal number of men and women (stratified random sample). The survey methodology has been described in more detail earlier.24 The age range of subjects in this study was 25–64 years. The basic characteristics of the subjects are presented in table 1.

Table 1

Characteristics of the study data

 Pitkäranta North Karelia 
 Men Women Men Women 
 n = 1144 n = 1528 n = 2049 n = 2316 
Study year, n (response rate, %) 
    1992 380 (77) 455 (92) 673 (68) 803 (81) 
    1997 309 (64) 440 (88) 712 (71) 751 (75) 
    2002 263 (56) 342 (71) 664 (67) 762 (77) 
    2007 192 (45) 291 (65) – – 
Age (%)     
 1992     
        25–34 24 25 21 22 
        35–44 25 26 25 24 
        45–54 24 24 26 26 
        55–64 28 25 27 27 
 1997     
        25–34 22 26 21 23 
        35–44 25 25 24 25 
        45–54 25 25 26 26 
        55–64 28 24 29 25 
 2002     
        25–34 24 21 21 24 
        35–44 26 25 25 26 
        45–54 25 29 26 24 
        55–64 25 26 29 26 
 2007     
        25–34 16 18 – – 
        35–44 23 22 – – 
        45–54 29 30 – – 
        55–64 32 31 – – 
Education (%)     
 1992     
        Low 25 35 31 38 
        Intermediate 42 32 33 27 
        High 33 33 36 35 
 1997     
        Low 17 30 25 35 
        Intermediate 46 34 36 34 
        High 36 36 39 31 
 2002     
        Low 17 32 21 36 
        Intermediate 50 32 37 30 
        High 33 35 42 34 
 2007     
        Low 15 27 – – 
        Intermediate 50 35 – – 
        High 35 37 – – 
Mean years of education 
    1992 10.3 10.7 10.3 10.8 
    1997 11.0 11.5 11.0 11.7 
    2002 11.3 11.8 11.7 12.7 
    2007 11.7 12.1 – – 
Employment status (%) 
 1992     
        Employed 85 75 73 67 
        Unemployed 
        Other 13 24 22 28 
 1997     
        Employed 65 70 62 60 
        Unemployed 11 15 14 
        Other 24 24 23 27 
 2002     
        Employed 65 60 69 66 
        Unemployed 12 13 
        Other 23 36 19 25 
 2007     
        Employed 75 66 – – 
        Unemployed – – 
        Other 21 29 – – 
Daily consumption of fresh vegetables (%) 
    1992 10 11 54 71 
    1997 11 18 48 72 
    2002 15 25 44 69 
    2007 24 35 – – 
Daily consumption of fruit (%) 
    1992 61 82 
    1997 18 53 72 
    2002 16 32 43 66 
    2007 31 50 – – 
Consumption of berries at least a couple of times per week (%) 
    1992 14 17 48 69 
    1997 12 39 59 
    2002 17 38 58 
    2007 15 22 – – 
 Pitkäranta North Karelia 
 Men Women Men Women 
 n = 1144 n = 1528 n = 2049 n = 2316 
Study year, n (response rate, %) 
    1992 380 (77) 455 (92) 673 (68) 803 (81) 
    1997 309 (64) 440 (88) 712 (71) 751 (75) 
    2002 263 (56) 342 (71) 664 (67) 762 (77) 
    2007 192 (45) 291 (65) – – 
Age (%)     
 1992     
        25–34 24 25 21 22 
        35–44 25 26 25 24 
        45–54 24 24 26 26 
        55–64 28 25 27 27 
 1997     
        25–34 22 26 21 23 
        35–44 25 25 24 25 
        45–54 25 25 26 26 
        55–64 28 24 29 25 
 2002     
        25–34 24 21 21 24 
        35–44 26 25 25 26 
        45–54 25 29 26 24 
        55–64 25 26 29 26 
 2007     
        25–34 16 18 – – 
        35–44 23 22 – – 
        45–54 29 30 – – 
        55–64 32 31 – – 
Education (%)     
 1992     
        Low 25 35 31 38 
        Intermediate 42 32 33 27 
        High 33 33 36 35 
 1997     
        Low 17 30 25 35 
        Intermediate 46 34 36 34 
        High 36 36 39 31 
 2002     
        Low 17 32 21 36 
        Intermediate 50 32 37 30 
        High 33 35 42 34 
 2007     
        Low 15 27 – – 
        Intermediate 50 35 – – 
        High 35 37 – – 
Mean years of education 
    1992 10.3 10.7 10.3 10.8 
    1997 11.0 11.5 11.0 11.7 
    2002 11.3 11.8 11.7 12.7 
    2007 11.7 12.1 – – 
Employment status (%) 
 1992     
        Employed 85 75 73 67 
        Unemployed 
        Other 13 24 22 28 
 1997     
        Employed 65 70 62 60 
        Unemployed 11 15 14 
        Other 24 24 23 27 
 2002     
        Employed 65 60 69 66 
        Unemployed 12 13 
        Other 23 36 19 25 
 2007     
        Employed 75 66 – – 
        Unemployed – – 
        Other 21 29 – – 
Daily consumption of fresh vegetables (%) 
    1992 10 11 54 71 
    1997 11 18 48 72 
    2002 15 25 44 69 
    2007 24 35 – – 
Daily consumption of fruit (%) 
    1992 61 82 
    1997 18 53 72 
    2002 16 32 43 66 
    2007 31 50 – – 
Consumption of berries at least a couple of times per week (%) 
    1992 14 17 48 69 
    1997 12 39 59 
    2002 17 38 58 
    2007 15 22 – – 

Dash indicates that data for North Karelia in 2007 were excluded because the food frequency questions were not comparable with other study years

Measurements

Data from self-administered questionnaires were used. In addition to questions on health behaviours and use of health services, the questionnaire included a simple food frequency section. In the Finnish questionnaire, the food frequency section was changed in 2007 and the answers were not comparable with the earlier studies. Thus, we decided to omit the data for 2007 from North Karelia from the analyses.

Education and employment status were chosen to indicate the socio-economic position. Education was measured as the total number of years of education. The years of education were divided into three tertiles within each 10-year birth cohort in the two areas, separately for men and women. Based on a question on occupation and employment, a variable indicating the employment status was constructed: (1) employed, (2) unemployed and (3) other. The third category included pensioners, housewives, students and persons on long-term sick leave. More details on the socio-economic measures can be found in our upcoming publication (Paalanen L et al., submitted for publication).

In the food frequency section, the subjects were asked to report on their food consumption during the preceding half-year period in 1992, and since 1997 the question was changed to concern the entire preceding year (12 months). The food frequency questions did not measure consumption quantitatively. The food list was preceded by the following question: ‘How often did you consume following foods during the preceding 12 months’. There were six frequency options: (1) less than once a month or never, (2) a couple of times per month, (3) once a week, (4) a couple of times per week, (5) almost every day and (6) once a day or more often. Three dichotomous outcome variables were formed for the analyses: (i) daily consumption of fresh vegetables (yes/no), (ii) daily consumption of fruit (yes/no) and (iii) consumption of fresh or frozen berries at least a couple of times per week (yes/no). Daily consumption included daily and almost daily consumption (options 5 and 6). Consumption of fresh or frozen berries at least a couple of times per week included options 4, 5 and 6. For berries the variable was dichotomized differently from fruit and vegetables because daily consumption of berries was very uncommon.

Statistical analyses

The data from Pitkäranta and North Karelia were analysed separately. Logistic regression analysis was used to examine differences in the consumption of selected foods by educational level and employment status separately for each study year. All analyses were performed separately for men and women, with age adjustment using age as a continuous variable. The age-adjusted odds ratios and 95% confidence intervals are presented in tables 2 and 3 and Supplementary table S1. In addition to age adjustment, the results according to the level of education were adjusted for employment status and vice versa (full model). Since the adjustment had only a minor effect, the results of the full model are only commented on in the text.

Table 2

Daily consumption of fresh vegetables by educational level and employment status in Pitkäranta, 1992–2007, and North Karelia, 1992–2002

 1992 1997 2002 2007 Time trend indexa 
 OR CI (95%) OR CI (95%) OR CI (95%) OR CI (95%) OR CI (95%) 
Pitkäranta, men     1.46 (1.25–1.70)b 
Education      
    High 1.54 (1.17–2.02) 
    Intermediate 1.10 (0.47–2.57) 0.73 (0.32–1.68) 0.81 (0.38–1.76) 0.99 (0.46–2.13) 1.51 (1.18–1.94) 
    Low 1.71 (0.68–4.31) 1.02 (0.37–2.82) 1.03 (0.36–2.93) 0.86 (0.29–2.56) 1.25 (0.88–1.77) 
Employment status      
    Employed 1.51 (1.26–1.81) 
    Unemployed No daily consumers 1.01 (0.28–3.66) 0.70 (0.20–2.48) 0.38 (0.04–3.20) 1.28 (0.48–3.43) 
    Othersc 2.00 (0.74–5.45) 1.29 (0.50–3.32) 2.18 (0.93–5.14) 0.72 (0.29–1.80) 1.27 (0.91–1.76) 
Pitkäranta, women     1.59 (1.41–1.79)b 
Education      
    High 1.65 (1.37–1.99) 
    Intermediate 0.86 (0.43–1.68) 0.81 (0.46-1.41) 0.51 (0.28-0.93) 0.67 (0.38-1.19) 1.52 (1.24–1.86) 
    Low 0.49 (0.23–1.03) 0.43 (0.22-0.84) 0.42 (0.23-0.78) 0.38 (0.20-0.74) 1.55 (1.22–1.99) 
Employment status      
    Employed 1.58 (1.37–1.81) 
    Unemployed 1.74 (0.19–16.01) 0.41 (0.09–1.80) 0.48 (0.10–2.20) 0.59 (0.16–2.25) 1.38 (0.62–3.08) 
    Othersc 0.50 (0.21–1.18) 1.04 (0.55–2.00) 0.88 (0.50–1.56) 0.59 (0.33–1.08) 1.68 (1.33–2.12) 
North Karelia, men     0.82 (0.73–0.91)b 
Education      
    High d 0.76 (0.63–0.93) 
    Intermediate 0.40 (0.27–0.60) 0.44 (0.30–0.64) 0.43 (0.30–0.64)  0.78 (0.64–0.96) 
    Low 0.30 (0.20–0.47) 0.40 (0.26–0.61) 0.41 (0.25–0.67)  0.84 (0.66–1.07) 
Employment status      
    Employed d 0.84 (0.74–0.96) 
    Unemployed 0.21 (0.10–0.48) 0.58 (0.37–0.89) 0.20 (0.11–0.37)  0.68 (0.44–1.05) 
    Othersc 0.70 (0.46–1.06) 0.91 (0.61–1.36) 0.80 (0.51–1.23)  0.83 (0.65–1.06) 
North Karelia, women     0.95 (0.85–1.06)b 
Education      
    High d 0.89 (0.71–1.12) 
    Intermediate 0.61 (0.39–0.95) 0.50 (0.32–0.80) 0.53 (0.35–0.80)  0.81 (0.66–1.00) 
    Low 0.26 (0.17–0.38) 0.26 (0.17–0.40) 0.38 (0.25–0.56)  1.09 (0.92–1.29) 
Employment status      
    Employed d 0.90 (0.78–1.03) 
    Unemployed 0.47 (0.24–0.94) 0.54 (0.34–0.85) 0.56 (0.33–0.94)  0.96 (0.64–1.43) 
    Othersc 0.46 (0.32–0.65) 0.60 (0.41–0.88) 0.57 (0.39–0.81)  1.05 (0.86–1.29) 
 1992 1997 2002 2007 Time trend indexa 
 OR CI (95%) OR CI (95%) OR CI (95%) OR CI (95%) OR CI (95%) 
Pitkäranta, men     1.46 (1.25–1.70)b 
Education      
    High 1.54 (1.17–2.02) 
    Intermediate 1.10 (0.47–2.57) 0.73 (0.32–1.68) 0.81 (0.38–1.76) 0.99 (0.46–2.13) 1.51 (1.18–1.94) 
    Low 1.71 (0.68–4.31) 1.02 (0.37–2.82) 1.03 (0.36–2.93) 0.86 (0.29–2.56) 1.25 (0.88–1.77) 
Employment status      
    Employed 1.51 (1.26–1.81) 
    Unemployed No daily consumers 1.01 (0.28–3.66) 0.70 (0.20–2.48) 0.38 (0.04–3.20) 1.28 (0.48–3.43) 
    Othersc 2.00 (0.74–5.45) 1.29 (0.50–3.32) 2.18 (0.93–5.14) 0.72 (0.29–1.80) 1.27 (0.91–1.76) 
Pitkäranta, women     1.59 (1.41–1.79)b 
Education      
    High 1.65 (1.37–1.99) 
    Intermediate 0.86 (0.43–1.68) 0.81 (0.46-1.41) 0.51 (0.28-0.93) 0.67 (0.38-1.19) 1.52 (1.24–1.86) 
    Low 0.49 (0.23–1.03) 0.43 (0.22-0.84) 0.42 (0.23-0.78) 0.38 (0.20-0.74) 1.55 (1.22–1.99) 
Employment status      
    Employed 1.58 (1.37–1.81) 
    Unemployed 1.74 (0.19–16.01) 0.41 (0.09–1.80) 0.48 (0.10–2.20) 0.59 (0.16–2.25) 1.38 (0.62–3.08) 
    Othersc 0.50 (0.21–1.18) 1.04 (0.55–2.00) 0.88 (0.50–1.56) 0.59 (0.33–1.08) 1.68 (1.33–2.12) 
North Karelia, men     0.82 (0.73–0.91)b 
Education      
    High d 0.76 (0.63–0.93) 
    Intermediate 0.40 (0.27–0.60) 0.44 (0.30–0.64) 0.43 (0.30–0.64)  0.78 (0.64–0.96) 
    Low 0.30 (0.20–0.47) 0.40 (0.26–0.61) 0.41 (0.25–0.67)  0.84 (0.66–1.07) 
Employment status      
    Employed d 0.84 (0.74–0.96) 
    Unemployed 0.21 (0.10–0.48) 0.58 (0.37–0.89) 0.20 (0.11–0.37)  0.68 (0.44–1.05) 
    Othersc 0.70 (0.46–1.06) 0.91 (0.61–1.36) 0.80 (0.51–1.23)  0.83 (0.65–1.06) 
North Karelia, women     0.95 (0.85–1.06)b 
Education      
    High d 0.89 (0.71–1.12) 
    Intermediate 0.61 (0.39–0.95) 0.50 (0.32–0.80) 0.53 (0.35–0.80)  0.81 (0.66–1.00) 
    Low 0.26 (0.17–0.38) 0.26 (0.17–0.40) 0.38 (0.25–0.56)  1.09 (0.92–1.29) 
Employment status      
    Employed d 0.90 (0.78–1.03) 
    Unemployed 0.47 (0.24–0.94) 0.54 (0.34–0.85) 0.56 (0.33–0.94)  0.96 (0.64–1.43) 
    Othersc 0.46 (0.32–0.65) 0.60 (0.41–0.88) 0.57 (0.39–0.81)  1.05 (0.86–1.29) 

Age-adjusted odds ratios (OR) and 95% confidence intervals (CI). Statistically significant figures are written in bold.

a: Time trend index for each socio-economic group was calculated using study year as a continuous explanatory variable. Figures indicating statistically significant change within the specific subgroup are written in bold

b: Total time trend index among all subjects of the same gender in the specific area

c: Category ‘others’ includes pensioners, housewives, students and persons on a long-term sick leave

d: Data for 2007 in North Karelia were omitted from the analyses

To check whether the effect of education and employment status on selected food habits varied depending on study year, the terms for interaction between study year and educational level or employment status were tested simultaneously adjusting for age. We also calculated gender-specific, age-adjusted time trend indices for the study year as a continuous variable and then similar trends within each educational and employment status category. The continuous study year variable was coded with values 1–4 (in North Karelia 1–3).

The analyses were carried out with the Stata statistical software package, version 9.2 (StataCorp College Station, TX, USA).

Results

Overall consumption and trends

The unadjusted prevalences in the selected food habits during 1992–2007 are presented in table 1 and figure 1. In Pitkäranta, the overall consumption of vegetables, fruit and berries was very low. There was a marked increase in the proportion of daily vegetable and fruit consumers among both men and women from 1992 to 2007. The consumption of vegetables, fruit and berries was much more common and more stable in North Karelia than in Pitkäranta (table 1, figure 1). The consumption was more common among women than among men (table 1, figure 1).

Figure 1

Daily consumption of fresh vegetables and fruit and consumption of fresh or frozen berries at least a couple of times per week by educational level in Pitkäranta, 1992–2007, and North Karelia, 1992–2002

Figure 1

Daily consumption of fresh vegetables and fruit and consumption of fresh or frozen berries at least a couple of times per week by educational level in Pitkäranta, 1992–2007, and North Karelia, 1992–2002

Daily consumption of fresh vegetables

There were no significant differences in daily consumption of fresh vegetables by education among men in Pitkäranta (table 2, figure 1). From 1997, daily consumption of fresh vegetables was less common among women with a lower education in Pitkäranta. In North Karelia, both men and women in the intermediate and the lowest education tertile consumed fresh vegetables less often compared to the highest education tertile. In Pitkäranta, the employment status had no significant association with daily consumption of fresh vegetables, whereas the unemployed in North Karelia consumed vegetables less often than the employed. Among women in North Karelia, vegetable consumption was less common also in the group ‘others’ that included, e.g., pensioners, housewives and students than among the employed women. When the figures by employment status were adjusted for education, the difference between the employed and unemployed women in North Karelia was no longer significant (data not shown).

The time trend indices showed that among both men and women in Pitkäranta, consumption of fresh vegetables increased significantly during the study period in all education groups except men in the lowest education tertile. The magnitude of the increase was similar in all education groups. In North Karelia, consumption of fresh vegetables seemed to decline among men. The decline was statistically significant in the highest and intermediate education tertiles. In Pitkäranta, the increase in daily vegetable consumption was also significant among the employed but not among the unemployed. In North Karelia, only minor changes within the employment status groups were observed. No significant interaction terms for the interaction of education and study year or employment status and study year were found in either area (data not shown). Thus, the effects of education and employment status on daily consumption of fresh vegetables appeared stable over the study period also on the grounds of the interactions.

Daily consumption of fruit

In Pitkäranta, men in the intermediate education tertile ate fruit less often than men in the highest education tertile in 2007 (table 3, figure 1). Before 2007 the educational differences did not reach statistical significance. Among women, significant educational differences were found in 1997, 2002 and 2007 with less common fruit consumption in the lower education groups. In North Karelia, the consumption of fruit was less common in the lower educational groups in 1992 and 1997 but not in 2002 among men, whereas among women the educational differences were most obvious in 2002. No significant differences by employment status were found in Pitkäranta. Among women in North Karelia daily consumption of fruit was less common in the group ‘others’ in 1997 and 2002 and among the unemployed in 1997. After adjustment for employment status, the consumption of fruit was significantly less common among men in the intermediate education tertile in Pitkäranta also in 2002 (data not shown). After adjustment for education, the consumption of fruit was no longer significantly less common in the group ‘others’ among North Karelian women in 1997.

Table 3

Daily consumption of fruit by educational level and employment status in Pitkäranta, 1992–2007, and North Karelia, 1992–2002

 1992 1997 2002 2007 Time trend indexa 
 OR CI (95%) OR CI (95%) OR CI (95%) OR CI (95%) OR CI (95%) 
Pitkäranta, men     2.62 (2.15–3.19)b 
Education      
    High 3.05 (2.21–4.20) 
    Intermediate 0.58 (0.11–3.04) 0.90 (0.37–2.19) 0.48 (0.22–1.01) 0.32 (0.15–0.66) 2.05 (1.51–2.78) 
    Low 1.66 (0.13–22.11) No daily consumers 0.48 (0.17–1.35) 0.37 (0.13–1.06) 3.71 (1.89–7.29) 
Employment status      
    Employed 2.44 (1.97–3.01
    Unemployed No daily consumers 0.27 (0.03–2.07) 0.55 (0.15–1.92) 0.33 (0.04–2.74) 3.61 (0.82–15.89) 
    Othersc No daily consumers 0.28 (0.06–1.37) 1.00 (0.43–2.33) 1.16 (0.49–2.75) 3.79 (2.20–6.53) 
Pitkäranta, women     2.61 (2.29–2.97)b 
Education      
    High 2.65 (2.15–3.27) 
    Intermediate 0.58 (0.17–2.03) 0.81 (0.47–1.42) 0.97 (0.57–1.66) 0.56 (0.33–0.98) 2.36 (1.90–2.94) 
    Low 0.66 (0.20–2.14) 0.31 (0.16–0.64) 0.43 (0.24–0.77) 0.58 (0.33–1.05) 2.94 (2.22–3.90) 
Employment status      
    Employed 2.64 (2.26–3.09) 
    Unemployed No daily consumers 0.41 (0.12–1.43) 0.97 (0.32–2.96) 0.72 (0.24–2.20) 2.57 (1.24–5.33) 
    Othersc 0.80 (0.20–3.18) 0.98 (0.49–1.99) 0.70 (0.41–1.20) 0.65 (0.37–1.14) 2.62 (2.00–3.44) 
North Karelia, men     0.69 (0.62–0.77)b 
Education      
    High d 0.63 (0.52–0.76) 
    Intermediate 0.88 (0.59–1.31) 0.59 (0.41–0.86) 0.83 (0.56–1.21)  0.63 (0.51–0.76) 
    Low 0.65 (0.43–0.98) 0.68 (0.44–1.04) 1.10 (0.69–1.77)  0.92 (0.73–1.17) 
Employment status      
    Employed d 0.70 (0.61–0.79) 
    Unemployed 0.62 (0.31–1.24) 0.76 (0.49–1.16) 0.78 (0.48–1.28)  0.80 (0.54–1.17) 
    Othersc 1.27 (0.83–1.94) 0.88 (0.59–1.33) 0.81 (0.52–1.26)  0.66 (0.51–0.84) 
North Karelia, women     0.68 (0.60–0.76)b 
Education      
    High d 0.72 (0.58–0.89) 
    Intermediate 0.83 (0.50–1.35) 0.88 (0.58–1.32) 0.63 (0.43–0.94)  0.61 (0.49–0.76) 
    Low 0.54 (0.35–0.82) 0.72 (0.49–1.08) 0.51 (0.35–0.75)  0.69 (0.58–0.83) 
Employment status      
    Employed d 0.73 (0.63–0.85) 
    Unemployed 1.16 (0.47–2.85) 0.54 (0.34–0.86) 0.60 (0.36–1.02)  0.60 (0.39–0.93) 
    Othersc 0.87 (0.58–1.31) 0.68 (0.47–1.00) 0.46 (0.32–0.67)  0.58 (0.47–0.73) 
 1992 1997 2002 2007 Time trend indexa 
 OR CI (95%) OR CI (95%) OR CI (95%) OR CI (95%) OR CI (95%) 
Pitkäranta, men     2.62 (2.15–3.19)b 
Education      
    High 3.05 (2.21–4.20) 
    Intermediate 0.58 (0.11–3.04) 0.90 (0.37–2.19) 0.48 (0.22–1.01) 0.32 (0.15–0.66) 2.05 (1.51–2.78) 
    Low 1.66 (0.13–22.11) No daily consumers 0.48 (0.17–1.35) 0.37 (0.13–1.06) 3.71 (1.89–7.29) 
Employment status      
    Employed 2.44 (1.97–3.01
    Unemployed No daily consumers 0.27 (0.03–2.07) 0.55 (0.15–1.92) 0.33 (0.04–2.74) 3.61 (0.82–15.89) 
    Othersc No daily consumers 0.28 (0.06–1.37) 1.00 (0.43–2.33) 1.16 (0.49–2.75) 3.79 (2.20–6.53) 
Pitkäranta, women     2.61 (2.29–2.97)b 
Education      
    High 2.65 (2.15–3.27) 
    Intermediate 0.58 (0.17–2.03) 0.81 (0.47–1.42) 0.97 (0.57–1.66) 0.56 (0.33–0.98) 2.36 (1.90–2.94) 
    Low 0.66 (0.20–2.14) 0.31 (0.16–0.64) 0.43 (0.24–0.77) 0.58 (0.33–1.05) 2.94 (2.22–3.90) 
Employment status      
    Employed 2.64 (2.26–3.09) 
    Unemployed No daily consumers 0.41 (0.12–1.43) 0.97 (0.32–2.96) 0.72 (0.24–2.20) 2.57 (1.24–5.33) 
    Othersc 0.80 (0.20–3.18) 0.98 (0.49–1.99) 0.70 (0.41–1.20) 0.65 (0.37–1.14) 2.62 (2.00–3.44) 
North Karelia, men     0.69 (0.62–0.77)b 
Education      
    High d 0.63 (0.52–0.76) 
    Intermediate 0.88 (0.59–1.31) 0.59 (0.41–0.86) 0.83 (0.56–1.21)  0.63 (0.51–0.76) 
    Low 0.65 (0.43–0.98) 0.68 (0.44–1.04) 1.10 (0.69–1.77)  0.92 (0.73–1.17) 
Employment status      
    Employed d 0.70 (0.61–0.79) 
    Unemployed 0.62 (0.31–1.24) 0.76 (0.49–1.16) 0.78 (0.48–1.28)  0.80 (0.54–1.17) 
    Othersc 1.27 (0.83–1.94) 0.88 (0.59–1.33) 0.81 (0.52–1.26)  0.66 (0.51–0.84) 
North Karelia, women     0.68 (0.60–0.76)b 
Education      
    High d 0.72 (0.58–0.89) 
    Intermediate 0.83 (0.50–1.35) 0.88 (0.58–1.32) 0.63 (0.43–0.94)  0.61 (0.49–0.76) 
    Low 0.54 (0.35–0.82) 0.72 (0.49–1.08) 0.51 (0.35–0.75)  0.69 (0.58–0.83) 
Employment status      
    Employed d 0.73 (0.63–0.85) 
    Unemployed 1.16 (0.47–2.85) 0.54 (0.34–0.86) 0.60 (0.36–1.02)  0.60 (0.39–0.93) 
    Othersc 0.87 (0.58–1.31) 0.68 (0.47–1.00) 0.46 (0.32–0.67)  0.58 (0.47–0.73) 

Age-adjusted odds ratios (OR) and 95% confidence intervals (CI). Statistically significant figures are written in bold.

a: Time trend index for each socio-economic group was calculated using study year as a continuous explanatory variable. Figures indicating statistically significant change within the specific subgroup are written in bold

b: Total time trend index among all subjects of the same gender in the specific area

c: Category ‘others’ includes pensioners, housewives, students and persons on a long-term sick leave

d: Data for 2007 in North Karelia were omitted from the analyses

The time trend index revealed a marked increase in daily fruit consumption in all other education and employment status groups except among the unemployed men in Pitkäranta. The increase was of the same magnitude in all subgroups. In North Karelia, respectively, the decline in fruit consumption was systematic with few exceptions. The interaction terms for education and study year and employment status and study year were statistically non-significant, which confirmed that the effects of education and employment status were stable over the study period also in the case of daily fruit consumption (data not shown).

Consumption of berries at least a couple of times per week

Education was not clearly associated with the consumption of berries (Supplementary table S1, figure 1). However, women in the lowest education tertile in Pitkäranta in 1992, and both men and women in the intermediate tertile in North Karelia in 2002 ate berries less often compared to the highest education tertile. In addition, the consumption was less common among unemployed North Karelian men in 2002 and more common among North Karelian women in the group ‘others’ in 1997 compared to the employed subjects. Adjustment for employment status attenuated the differences between intermediate and high education tertiles in North Karelia in 2002. After adjustment for education, the consumption of berries was less common among the unemployed than the employed women in North Karelia in 2002.

There were only minor changes in the consumption of berries in Pitkäranta. Among men in Pitkäranta, the consumption decreased in the lowest education tertile and increased among the unemployed. The time trend index differed significantly between the employed and unemployed men. The interaction term for employment status and study year (P = 0.05) confirmed that relative differences by educational level changed during the study period. However, the group ‘unemployed’ was overall small in Pitkäranta, and in 1992, there were no unemployed subjects who would have reported consumption of berries at least a couple of times per week. Among employed women in Pitkäranta, consumption of berries increased during the study period. In North Karelia, consumption of berries decreased among both men and women and within most education and employment status groups.

Discussion

Daily consumption of fruit and fresh vegetables was remarkably low in Pitkäranta in the Republic of Karelia, Russia. In North Karelia, Finland, vegetable and fruit consumption was much more common. In Pitkäranta, vegetable and fruit consumption increased markedly from 1992 to 2007. In North Karelia, a slight decrease was observed from 1992 to 2002. It can perhaps be seen as a levelling off after a long preceding rising trend.25 As expected, the differences by education and employment status were more obvious in North Karelia than in Pitkäranta. Education seemed to be a more important socio-economic determinant than employment status. In Pitkäranta, virtually no socio-economic differences were found in the early 1990s but during the study period, socio-economic differences started to emerge. Meanwhile in North Karelia, the socio-economic differences seemed to narrow. Thus, the two areas seemed to have a converging trend in vegetable and fruit consumption patterns.

Vast changes occurred in both study areas during the study period. The Soviet Union collapsed in 1991, and during 1992–2007 Russia moved from a centrally planned economy towards a market economy. The chaotic societal and economic circumstances of the early 1990s in Russia had major impacts on the everyday life and health of the population. These were reflected, for example, in increased unemployment, poverty and alcohol consumption.12,26–28 As a consequence, Russia encountered a severe population health crisis during and immediately following the collapse of the Soviet Union.27,29 In 1998, Russia faced another economic crisis, followed by a period of recovery at the turn of the millennium. In Finland, the economy plummeted into recession in the early 1990s, which led to an exceptionally high unemployment rate.30 The recession did not lead to a health crisis in Finland, but it did lead to a widening of the socio-economic differences in, for example, smoking.30 One of the consequences of the unstable circumstances in Russia was that the selection of foods in the groceries became minimal in the early 1990s. For example, there were virtually no fruit available in springtime and thus, it was not simply a matter of a personal choice to select healthy food. The selection of foods has widened in the years following the collapse of the Soviet Union with the transition to a market economy. Thus, the consumption of fruit and vegetables no more depends only on availability. However, according to a recent study, the availability and pricing of foods, rather than health, are still more important factors for food choice among Russian consumers.16 In Finland, a good assortment of fresh fruit and vegetables has been available in the groceries around the year for several decades. Thus, it is not surprising that differences by socio-economic position existed in the early 1990s in North Karelia in favour of more educated and employed subjects. According to earlier studies, given the possibility, people in higher socio-economic groups are the first ones to adopt new healthier food habits.31

The consumption of berries was surprisingly low in both areas considering the continued tradition of picking berries from forests and growing berries in one’s own garden. However, the question only included fresh and frozen berries and not jams or other preserves, which have traditionally been prepared at home. Compared to fruit and vegetables, socio-economic differences were less obvious in berry consumption; practically no statistically significant differences were found in Pitkäranta. It could be hypothesized that persons with economic problems, such as the unemployed, might pick berries instead of buying expensive fruit and vegetables for their families. However, this does not seem to be the case in either Pitkäranta or North Karelia. On the contrary, at least in North Karelia, the consumption of berries seems to be more common in the higher socio-economic groups. In addition, especially in Pitkäranta, people may pick berries in order to sell them instead of using them in their own households.

The possibility of comparing an area from Russia with a geographically close but historically and politically very different area gives us a rare glimpse into the development and convergence of food habits at a time of rapid societal change. In fact, we do not know any other data where health behaviour in Russia could be followed and compared with a western country for 10–15 years. However, because of methodological limitations, we could only use data up until 2002 for North Karelia. Other studies from Finland give grounds to expect that the overall consumption trends did not change dramatically between 2002 and 2007.32

In the questionnaires, food consumption during the preceding 6 months (in 1992) or the preceding year (in 1997, 2002 and 2007) was enquired about. We do not think that the change in the format of the question causes major problems, as we believe that the subjects may have thought more of the current consumption patterns. The surveys were conducted during spring in both areas, and the prevalence of vegetable, fruit and berry consumption might have been higher if the studies had been conducted in the summer or autumn, since earlier studies on fruit and vegetables have shown that their consumption depends on the time of the year.33,34 However, since the time of the year was the same in each study round in our study, the results are comparable with each other.

We also have biologic marker data from the two areas, which can be used to validate our findings. In Pitkäranta, very low plasma ascorbic acid (i.e. vitamin C) levels were measured in 1992 and 1997,35,36 which is compatible with low vegetable and fruit consumption. In North Karelia, the plasma ascorbic acid levels were much higher. The trends in plasma ascorbic acid levels since 1997 and their possible socio-economic differences remain to be explored in further studies.

Conclusions

The different socio-economic trends in Pitkäranta and North Karelia demonstrate the role of availability and affordability in the socio-economic variation in food habits. In Pitkäranta, Russia, the availability and affordability of fruit and vegetables improved markedly between 1992 and 2007 whereas in North Karelia, Finland, they were relatively good already in the early 1990s. With increasing availability and affordability, the overall consumption of fruit and vegetables increased in Pitkäranta, and the highest educational groups were the first to take the opportunity to purchase them. In North Karelia, the increase in consumption seemed to level off with a parallel decrease in educational differences. It can be expected that without specific political measures, socio-economic differences in food habits and related risk factors will continue to increase in Russia as long as the consumption of fruit and vegetables increases. The future economic and health policies in Russia should pay attention both to the whole population and to the lower socio-economic groups.

Supplementary Data

Supplementary data are available at EURPUB online.

Funding

Doctoral Programs in Public Health and the Ministry of Social Affairs and Health in Finland.

Conflicts of interest: None declared.

Key points

  • Earlier studies from Russia on socio-economic differences in food habits are scarce.

  • We used unique data to compare socio-economic differences and their 15-year trends in vegetable, fruit and berry consumption between two neighbouring areas, the district of Pitkäranta in the Republic of Karelia, Russia, and North Karelia, Finland, immediately after the collapse of the Soviet Union in 1991.

  • Socio-economic differences in vegetable and fruit consumption started to emerge in Pitkäranta during the study period in accordance with improved availability and affordability. In North Karelia, clear socio-economic differences existed already in the early 1990s.

  • In Russia, the affordability of fruit and vegetables should be further improved to increase their consumption in lower socio-economic groups.

References

1
Irala-Estévez
JD
Groth
M
Johansson
L
, et al.  . 
A systematic review of socio-economic differences in food habits in Europe: consumption of fruit and vegetables
Eur J Clin Nutr
 , 
2000
, vol. 
54
 (pg. 
706
-
14
)
2
Billson
H
Pryer
JA
Nichols
R
Variation in fruit and vegetable consumption among adults in Britain. An analysis from the dietary and nutritional survey of British adults
Eur J Clin Nutr
 , 
1999
, vol. 
53
 (pg. 
946
-
52
)
3
Roos
E
Talala
K
Laaksonen
M
, et al.  . 
Trends of socioeconomic differences in daily vegetable consumption, 1979–2002
Eur J Clin Nutr
 , 
2008
, vol. 
62
 (pg. 
823
-
33
)
4
Prättälä
R
Paalanen
L
Grinberga
D
, et al.  . 
Gender differences in the consumption of meat, fruit and vegetables are similar in Finland and the Baltic countries
Eur J Public Health
 , 
2007
, vol. 
17
 (pg. 
520
-
5
)
5
Roos
G
Johansson
L
Kasmel
A
, et al.  . 
Disparities in vegetable and fruit consumption: European cases from the north to the south
Public Health Nutr
 , 
2001
, vol. 
4
 (pg. 
35
-
43
)
6
Prättälä
R
Hakala
S
Roskam
AJ
, et al.  . 
Association between educational level and vegetable use in nine European countries
Public Health Nutr
 , 
2009
, vol. 
30
 (pg. 
1
-
9
)
7
Laatikainen
T
Vlasoff
T
Korpelainen
V
, et al.  . 
Health behaviour in Pitkaranta—results of the health behaviour surveys in the Pitkaranta district in the Republic of Karelia, Russia in 1998, 2000 and 2004. Joensuu: Pohjois-Karjalan kansanterveyden keskus
 
Hyvätuuli Oy; 2006
8
Malyutina
S
Bobak
M
Simonova
G
, et al.  . 
Education, marital status, and total and cardiovascular mortality in Novosibirsk, Russia: a prospective cohort study
Ann Epidemiol
 , 
2004
, vol. 
14
 (pg. 
244
-
9
)
9
Plavinski
SL
Plavinskaya
SI
Klimov
AN
Social factors and increase in mortality in Russia in the 1990s: prospective cohort study
Br Med J
 , 
2003
, vol. 
326
 (pg. 
1240
-
2
)
10
Murphy
M
Bobak
M
Nicholson
A
, et al.  . 
The widening gap in mortality by educational level in the Russian Federation, 1980–2001
Am J Public Health
 , 
2006
, vol. 
96
 (pg. 
1293
-
9
)
11
Bobak
M
Pikhart
H
Hertzman
C
, et al.  . 
Socioeconomic factors, perceived control and self-reported health in Russia. A cross-sectional survey
Soc Sci Med
 , 
1998
, vol. 
47
 (pg. 
269
-
79
)
12
Carlson
P
Educational differences in self-rated health during the Russian transition. Evidence from Taganrog 1993–1994
Soc Sci Med
 , 
2000
, vol. 
51
 (pg. 
1363
-
74
)
13
Jukkala
T
Mäkinen
IH
Kislitsyna
O
, et al.  . 
Economic strain, social relations, gender, and binge drinking in Moscow
Soc Sci Med
 , 
2008
, vol. 
66
 (pg. 
663
-
74
)
14
McKee
M
Bobak
M
Rose
R
, et al.  . 
Patterns of smoking in Russia
Tob Control
 , 
1998
, vol. 
7
 (pg. 
22
-
6
)
15
Carlson
P
Risk behaviours and self rated health in Russia 1998
J Epidemiol Community Health
 , 
2001
, vol. 
55
 (pg. 
806
-
17
)
16
Honkanen
P
Frewer
L
Russian consumers’ motives for food choice
Appetite
 , 
2009
, vol. 
52
 (pg. 
363
-
71
)
17
Steptoe
A
Pollard
TM
Wardle
J
Development of a measure of the motives underlying the selection of food: the food choice questionnaire
Appetite
 , 
1995
, vol. 
25
 (pg. 
267
-
84
)
18
McKee
M
Shkolnikov
V
Understanding the toll of premature death among men in eastern Europe
Br Med J
 , 
2001
, vol. 
323
 (pg. 
1051
-
5
)
19
Keys
A
Seven countries: a multivariate analysis of death and coronary heart disease
1980
Cambridge
Harvard University Press
20
Jousilahti
P
Cardiovascular disease mortality trends in Finland
Suom Laakaril
 , 
2003
, vol. 
58
 (pg. 
2969
-
71
)
21
Puska
P
Tuomilehto
J
Nissinen
A
Vartiainen
E
The North Karelia Project. 20-year results and experiences
 , 
1995
Helsinki
The National Public Health Institute (KTL)
22
Republic of Karelia
The official site of the Administrative Bodies
(14 July 2005, date last accessed) 
23
Nationmaster Statistics
Database on the Internet
(3 December 2009, date last accessed) 
24
Laatikainen
T
Alho
H
Vartiainen
E
, et al.  . 
Self-reported alcohol consumption and association to carbohydrate-deficient transferrin and gamma-glutamyltransferase in a random sample of the general population in the Republic of Karelia, Russia and in North Karelia, Finland
Alcohol Alcohol
 , 
2002
, vol. 
37
 (pg. 
282
-
8
)
25
Berg
MA
Karjalainen
V
Puska
P
Suomalaisen aikuisväestön terveyskäyttäytyminen, kevät 1992 (Health behaviour among Finnish adult population, Spring 1992)
Helsinki
National Public Health Institute, Publications of the National Public Health Institute B5/1993
26
Palosuo
H
Health and well-being in Moscow and Helsinki [dissertation]
2003
Saarijärvi
University of Helsinki
27
Cockerham
WC
Health and social change in Russia and Eastern Europe
1999
New York
Routledge
28
Zaridze
D
Maximovitch
D
Lazarev
, et al.  . 
Alcohol poisoning is a main determinant of recent mortality trends in Russia: evidence from a detailed analysis of mortality statistics and autopsies
Int J Epidemiol
 , 
2009
, vol. 
38
 (pg. 
143
-
53
)
29
Shkolnikov
V
Mesle
F
Vallin
J
Health crisis in Russia: I. Recent trends in life expectancy and causes of death from 1970 to 1993
Population
 , 
1996
, vol. 
8
 (pg. 
123
-
54
)
30
Palosuo
H
Koskinen
S
Lahelma
E
, et al.  . 
Health inequalities in Finland. Trends in socioeconomic health differences 1980–2005
2009
Helsinki
Ministry of Social Affairs and Health
31
Roos
E
Prättälä
R
Lahelma
E
, et al.  . 
Modern and healthy: socioeconomic differences in the quality of diet
Eur J Clin Nutr
 , 
1996
, vol. 
50
 (pg. 
753
-
60
)
32
Helakorpi
S
Prättälä
R
Uutela
A
Kansanterveyslaitos. Suomalaisen aikuisväestön terveyskäyttäytyminen ja terveys: kevät 2007 (Health behaviour and health among the Finnish adult population: Spring 2007)
2008
(1 January 2010, date last accessed)
Helsinki
National Public Health Institute
 
33
Smolkova
B
Dusinska
M
Raslova
K
, et al.  . 
Seasonal changes in markers of oxidative damage to lipids and DNA; correlations with seasonal variation in diet
Mutat Res
 , 
2004
, vol. 
551
 (pg. 
135
-
44
)
34
Locke
E
Coronado
GD
Thompson
B
Kuniyuki
A
Seasonal variation in fruit and vegetable consumption in a rural agricultural community
J Am Diet Assoc
 , 
2009
, vol. 
109
 (pg. 
45
-
51
)
35
Matilainen
T
Vartiainen
E
Puska
P
, et al.  . 
Plasma ascorbic acid concentrations in the Republic of Karelia, Russia and in North Karelia, Finland
Eur J Clin Nutr
 , 
1996
, vol. 
50
 (pg. 
115
-
20
)
36
Pussinen
PJ
Laatikainen
T
Alfthan
G
, et al.  . 
Periodontitis is associated with a low concentration of vitamin C in plasma
Clin Diagn Lab Immunol
 , 
2003
, vol. 
10
 (pg. 
897
-
902
)

Supplementary data

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