Appetite 92 (2015) 43–50

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Appetite
j o u r n a l h o m e p a g e : w w w. e l s e v i e r. c o m / l o c a t e / a p p e t

Research report

The social distribution of dietary patterns. Traditional, modern and

healthy eating among women in a Latin American city ☆
Ietza Bojorquez a,*, Claudia Unikel b, Irene Cortez a, Diego Cerecero a
a El Colegio de la Frontera Norte, Carretera Escénica Tijuana Ensenada Km. 18.5, San Antonio del Mar, Tijuana, B.C. 22560, Mexico
b
Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Calzada Mexico Xochimilco #101, Tlalpan, Huipulco, 14370 Ciudad de Mexico, D.F., Mexico

A R T I C L E I N F O A B S T R A C T

Article history: Popkin’s nutrition transition model proposes that after the change from the traditional to the modern
Received 26 February 2015 dietary pattern, another change toward “healthy eating” could occur. As health-related practices are as-
Received in revised form 2 May 2015 sociated with social position, with higher socioeconomic groups generally being the first to adopt public
Accepted 5 May 2015
health recommendations, a gradient of traditional–modern–healthy dietary patterns should be ob-
Available online 11 May 2015
served between groups. The objectives of this article were: 1) to describe the dietary patterns of a
representative sample of adult women; 2) to assess whether dietary patterns differentiate in tradition-
Keywords:
al, modern and healthy; and 3) to evaluate the association of social position and dietary patterns. We
Dietary patterns
Health-related practices conducted a survey in Tijuana, a Mexican city at the Mexico–United States (US) border. Women 18–65
Nutrition transition years old (n = 2345) responded to a food frequency questionnaire, and questions about socioeconomic
Social epidemiology and demographic factors. We extracted dietary patterns through factor analysis, and employed indica-
Health inequalities tors of economic and cultural capital, life course stage and migration to define social position. We evaluated
the association of social position and dietary patterns with linear regression models. Three patterns were
identified: “tortillas,” “hamburgers” and “vegetables.” Women in a middle position of economic and cul-
tural capital scored higher in the “hamburgers” pattern, and women in upper positions scored higher in
the “vegetables” pattern. Economic and cultural capitals and migration interacted, so that for women
lower in economic capital, having lived in the US was associated with higher scores in the “hamburg-
ers” pattern.
© 2015 Published by Elsevier Ltd.

Introduction
Throughout history, changes in processes of food production, dis-
tribution and trade have been accompanied by modifications in
dietary patterns. In recent times, industrialization and globalized
markets have led to a nutrition transition (Popkin, 1993), where a
diet based on grains and starchy food gave way to the modern food
pattern including a high consumption of saturated fats, sugars, pro-
cessed food and those of animal origin. Another component of this
transition is globalization, where local products are replaced by food
from all parts of the world, and nontraditional, brand name food
and fast food replaces the local diet (Belasco, 2008; Hawkes, 2006).
These changes, apparent in high as well as middle and low-income
countries, can occur rapidly with urbanization or migration, and
within the same country different patterns may coexist (Popkin,
☆ Acknowledgements: The research project on which this article is based was fi-
nanced by Consejo Nacional de Ciencia y Tecnología (CONACYT), grant no. SEP/
CONACYT/Basic Science-153536.
* Corresponding author.
E-mail address: ietzabojorquez@gmail.com (I. Bojorquez).
1993; Popkin, Adair, & Ng, 2012; Rivera, Pedraza, Martorell, & Gil,
2014). While the nutrition transition is a well-established phenom-
enon, another component of Popkin’s model has been less studied.
In his 1993 publication relating demographic and economic trans-
formations to patterns of food consumption the author also proposed
that another change may arise, where the intention of preventing
disease would increase consumption of foods considered as healthy.
Since the modern diet is associated with an increment in the risk
of noncommunicable diseases (Ezzati & Riboli, 2013; World Health
Organization, 2011), understanding the factors associated with its
adoption, and with the possible transition to a healthier diet,
becomes an important public health objective.
Health-related practices are carried out in specific socio-
historic contexts, which provide their conditions of possibility and
are distributed differentially across social groups (Cockerham, 2013;
Williams, 1995). In general, those higher in social position are the
first to access innovations in health, as well as to adopt public health
recommendations for a healthy lifestyle. Differential practices, in
turn, result in a social gradient of risk and protective factors which
mostly favors the better-off (Cockerham, 2005; Link & Phelan, 1996;
Rubin, Clouston, & Link, 2014; Rubin, Colen, & Link, 2010). As
happens with other health-related practices, dietary habits should

http://dx.doi.org/10.1016/j.appet.2015.05.003
0195-6663/© 2015 Published by Elsevier Ltd.
44 I. Bojorquez et al./Appetite 92 (2015) 43–50
be expected to differ between social groups. Supporting this notion,
an association between higher economic and educational levels and
dietary consumption following nutritional guidelines has been found
(Arruda et al., 2014; Lenz et al., 2009; Mullie, Clarys, Hulens, &
Vansant, 2010; Rezazadeh, Rashidkhani, & Omidvar, 2010). In middle
income countries, which in the past few decades have undergone
an accelerated nutrition transition, the change has been uneven, with
malnutrition and obesity coexisting (Popkin et al., 2012; Rivera et al.,
2014). In these countries, some studies show that people with better
social position consume less of the traditional local foods, and more
of the modern, globalized ones (Arruda et al., 2014; Oseguera, 2003).
However, the association between eating habits and social posi-
tion is still unclear, as studies of the social distribution of dietary
patterns have mainly been conducted in high-income countries.
Using data from a survey of women’s health-related practices
in an urban, Latin American context, the objective of this article was
to explore the socially differentiated distribution of dietary pat-
terns. Our specific aims were:1) to describe the dietary patterns of
a representative sample of adult women; 2) to assess whether dietary
patterns differentiate in traditional, modern and healthy; and 3) to
evaluate the association of social position and dietary patterns. For
the purposes of this article, we defined “traditional” as a diet low
in processed, industrialized and global food, and composed mainly
of traditional food and local products. We defined “modern” as the
consumption of globalized, processed, high caloric content food.
Finally, we defined “healthy” as food recommended by current
dietary guidelines, including fresh fruit and vegetables, high-fiber
content and less fat and sugar. Below, we detail the elements of social
position that were considered for the analysis, and our hypoth-
eses regarding each of them.
Economic and cultural capital
Pierre Bordieu’s work (Bourdieu, 1984) provides a framework for
understanding the relationship between social position and health-
related practices (Abel & Frohlich, 2012; Williams, 1995). According
to Bourdieu, as a result of differential access to resources, as well
as socially constructed predispositions, members of a social class
tend to share common practices. Resources, in the form of “capi-
tals,” define class membership, as members of a social class share
a common position in the space defined by their possession.
Bourdieu distinguishes between social capital, consisting of re-
sources accessible through belonging to social groups; economic
capital, composed of assets and monetary resources; and cultural
capital, which includes both knowledge and the credentials (degrees)
that validate knowledge. The different types of capital can poten-
tiate each other or interact in various ways, conditioning
differentiated practices (Abel & Frohlich, 2012). Economic and cul-
tural capital are components of social position which would
independently be expected to be associated with the adoption of
healthier practices (Cockerham, 2005; Link & Phelan, 1996), but their
combined effect in this regard could also be synergistic (Abel &
Frohlich, 2012).
In this article, we assessed the association of economic and cul-
tural capital and dietary patterns. Our hypotheses were that a
gradient would be observed where women with lower capital would
consume the traditional pattern, women in an intermediate level
would consume the modern pattern, and those with more capital
would consume the healthy pattern. We also hypothesized there
would be a synergistic interaction between economic and cultural
capital in this relationship.
Life course
Life course refers to stages through which the individual passes
along life, defined not just by age, but also by the social and cul-
tural context (Hunt, 2005). The transitions from one stage to another
may be accompanied by changes in dietary practices (Devine, 2005).
Studies show in general that the consumption of industrialized and
fast food reaches its highest point in adolescence and young adult-
hood, and decreases afterwards (Barquera et al., 2008; Paeratakul,
Ferdinand, Champagne, Ryan, & Bray, 2003). In contrast, the con-
sumption of fruits, vegetables and other “healthy foods” increases
with age (Bezerra et al., 2014; Lenz et al., 2009; Rezazadeh et al.,
2010). Other elements of the life course, in addition to age, can affect
diet, among them are pregnancy (Olson, 2005), family structure and
the position of women in it (Devine, Connors, Bisognia, & Sobal, 1998;
Devine & Olson, 1991), health status and employment (Brown, Smith,
& Kromm, 2012; Elstgeest, Mishra, & Dobson, 2012).
According to the above, our hypotheses were that younger women
and those in positions of less family responsibility would tend to
consume the traditional food pattern, while older women and/or
those with more family responsibility would preferably consume
the healthy pattern.
Migration
Migration from less developed countries and regions, to the more
developed, is generally associated with changes akin to those of the
nutrition transition (Holmboe-Ottesen & Wandel, 2012; Popkin &
Gordon-Larsen, 2004). However, there are differences according to
the conditions in which migration occurs. Migrants in better social
position take advantage of the food possibilities at the destination
site, and usually they have already been exposed to the modern diet
at their places of origin ( Bojorquez et al, 2014; Perez-Cueto, Verbeke,
Lachat, & Remaut-De Winter, 2009). Migrants with less resources
may experience a rapid nutrition transition (Holmboe-Ottesen &
Wandel, 2012) or food insecurity (Bojorquez et al., 2014; Reyes, Nazar,
Estrada, & Mundo, 2007), and those from rural areas, when they
arrive to urban areas, may maintain a traditional pattern (Bowen
et al., 2011).
The city where this research was conducted, Tijuana, is located
in Northern Mexico, a region with the lowest consumption of fruits
and vegetables, and the greatest of food of animal origin in the
country (Ponce et al., 2014). Tijuana also has one of the highest rates
of internal migration in Mexico, and it is a city of passing for mi-
grants heading to the US. More than 40 million annual border
crossings (del Castillo, Peschard-Sverdrup, & Fuentes, 2007) account
for the intense relationship between the city and the neighboring
state of California, US, and some of Tijuana’s inhabitants live es-
sentially transborder lives with daily activities on both sides of the
border. In this way, Tijuana can be described as an in-between place
in a Mexico–US gradient of customs (Valenzuela, 2003).
Given the above, our hypotheses were that internal migrant women
(born in Southern Mexico) would tend to consume the traditional dietary
pattern, while women born in Tijuana, as well as those with a closer
relation to the US (having lived in that country or crossing the border
frequently), would tend to consume the modern pattern. Based on pre-
vious qualitative data which showed that the association between
migration and diet varied according to the social context (Bojorquez
et al, 2014), we explored interactions between indicators of econom-
ic and cultural capital, and migration.
Methods
Sample design and selection
In 2014, we conducted a representative survey of adult women
in Tijuana. The probability sample design started with selection of
Basic Geographic Statistical Areas (AGEB), stratified by level of dep-
rivation (low/middle/high). From each AGEB, blocks were randomly
selected, and all households in each block were visited. When more
 I. Bojorquez et al./Appetite 92 (2015) 43–50
than one eligible woman lived in the household, the respondent was
selected randomly. Eligibility criteria were 1) being 18 years of age
or older; and 2) accepting to participate in the survey after a process
of informed consent. All procedures were approved by the Ethics
Committee of El Colegio de la Frontera Norte (approval # 017–23-
10–11). Participants responded to a questionnaire, and their weight
and height were recorded with Tanita BF-683W scales, and SECA
213 portable stadiometers by previously trained personnel.
Dietary pattern assessment
The survey included a 41-item food frequency questionnaire
(FFQ), based on descriptions of dietary practices from in-depth in-
terviews in a previous, qualitative phase of the project, and developed
for the survey’s purposes. Rather than evaluating the nutrient com-
position of diet, the objective of the FFQ was to explore socially and
culturally diverse dietary patterns, and included food items char-
acteristic of Northern and Southern Mexico, and others representative
of a globalized diet. The questionnaire asked about frequency of con-
sumption of each item during the last seven days, with the following
response options: does not know that food/did not consume that
food/1–3 times/4–5 times/6–7 times or more. For the analysis, the
options does not know/did not consume were collapsed into a single
category.
Following the recommendation of Imamura and Jacques (2011),
two different methods were employed to obtain dietary patterns
from responses to the FFQ, and their results were compared to eval-
uate their similarity. The first method was exploratory factor analysis
(with principal factor extraction and varimax rotation). The result-
ing factors were compared with the classification from K-means
cluster analysis with two, three and four clusters. In all of these, the
results distinguished between a dietary pattern high in fruits, veg-
etables, whole grains and other “healthy” foods, and a pattern high
in fast food, sugary breakfast cereals and other “unhealthy” ele-
ments. In solutions with three factors or three clusters a pattern of
generalized low consumption of all items appeared, in which the
higher relative consumption corresponded to maize tortillas, beans
and rice. Following the criteria of keeping factors with eigenval-
ues ≥ 1, we kept the three-factor solution for subsequent analysis.
The factors were named according to the food or drink with the
highest factor loading on them. The Kaiser–Meyer–Olkin value for
the FFQ was 0.84, and Bartlett’s sphericity test had a p < .001 value,
indicating that factor analysis was appropriate for the data.
Economic and cultural capital
An index of economic capital was computed as the first com-
ponent in a principal components analysis of responses to 14
questions about goods and services in the household (such as elec-
tricity, water heater, landline, internet access and domestic service),
with a higher score corresponding to more economic capital. Years
of education were used as indicators of cultural capital.
Life course
Life course in adulthood is usually divided into young adult-
hood (up to 29 years), adulthood (30–40 years) and middle age (41–
65 years). However, the transition from adolescence to adulthood
is not only defined by age but also by events such as marriage or
first pregnancy. Therefore, a variable was constructed with four
stages: “young adult” (18 to 29 year old, not head of family nor
spouse of the head of family), “young head of family” (18 to 29 years
old, head of family or spouse of the head of family), “adult” (30 to
40 years old), and “middle-aged” (41–65 years old). Other vari-
ables considered were age, children (no children/≥1 child 0–5 years
old/only children >5 years old), and occupation (employed/student/
45
homemaker/other, with “other” including those who were not
working or in search for work, and those retired, not working for
health-related reasons, and unemployed).
Migration
We included indicators of internal and international migra-
tion, as well as of contact with the US. Variables included were place
of birth (Tijuana/US/Northern Mexico/Southern Mexico), having ever
lived in the US (no/yes), frequency of border crossings to that country
(never/<1 per month/≥1 per month), and more frequent place for
food shopping (supermarket/farmers’ market/convenience store/
small local shop/any place in the US).
Analysis
We explored the distribution of factor scores according to indi-
cators of social position through bivariate analysis and graphics.
Subsequently, three linear regression models were adjusted, with
the predicted score on each factor as dependent variables. The in-
dependent variables were introduced according to theoretical criteria.
Following our hypotheses, we tested for interactions between the
indicators of economic and cultural capital, as well as between in-
dicators of economic and cultural capital and indicators of migration
and contact with the US, keeping in the model interactions with
p < .05. In all of these analyses, the sample design was taken into
account, with adjustment of the variance by Taylor’s linearized series
using the Stata 13.1 svy module.
Results
A total of 2500 women were selected for the survey, and 2345
(93.8%) answered the questionnaire (weighted n = 490,695), of which
2268 (96.7% of the sample) had complete responses in the FFQ.
Table 1 shows the items in the FFQ with higher loadings in each
dietary pattern. The first one (“hamburgers”) grouped modern items,
such as fast food, breakfast cereal and latte coffee, and also high
calorie traditional Mexican items like burritos and Mexican candies.
The items in factor 2 (“vegetables”) can be considered part of a
healthy pattern, as most of them are recommended by dietary guide-
lines. Interestingly, latte coffee also had a high loading in this factor.
Factor 3 (“tortillas”) grouped traditional Mexican foods, like maize
tortillas and beans, but also modern foods, such as cold cuts or break-
fast cereal. Yogurt had a high, but negative, loading in this factor.
Table 2 shows mean scores in dietary patterns, by characteris-
tics of participants. Women with higher economic capital and more
years of education consumed more food from the “vegetables”
pattern, and less from “tortillas.” The latter variable showed an in-
verted U association with the “hamburgers” pattern, with the peak
of consumption in those with 10–12 years of education. Young adults
and students, and participants born in Tijuana, had the higher scores
in “hamburgers,” and the lower in “tortillas.” Those born in the US,
those who had ever lived in the US, and those who crossed the in-
ternational border more often had higher scores in “vegetables,”
while those from Southern Mexico had higher scores in “tortillas.”
According to the multivariate regression models (Table 3), eco-
nomic capital and years of education increased consumption of
“vegetables,” but the effect of years of education was more marked
for those born in Tijuana or the US (Fig. 1). A three-way interac-
tion was observed, in which economic capital increased consumption
of “hamburgers” for those with lower education who had never lived
in the US, but decreased its consumption for those of higher edu-
cation or who had lived in the US (Fig. 2a). Alternatively, the
interaction term could be interpreted as economic and cultural
capital modifying the effect of having ever lived in the US (Fig. 2b).
More years of education were associated with less consumption of
46 I. Bojorquez et al./Appetite 92 (2015) 43–50

Table 1
Items with higher factor loadings.a

Factor 1 Factor 2 Factor 3

Item Factor score Item Factor score Item Factor score

Hamburgers and pizza 0.55 Vegetables 0.60 Maize tortilla 0.54

Burritosb 0.51 Fresh fruit 0.57 Rice (with oil) 0.50
Commercial snacks 0.47 Fresh fruit juice 0.54 Beans (no oil) 0.50
Wheat tortilla 0.46 Wholegrain breakfast cereal 0.48 Eggs 0.43
Latte or cappuccino coffee 0.42 Wholegrain bread 0.46 Cold cuts 0.36
Processed fruit juice 0.42 Fresh fish 0.44 Beans (with oil) 0.35
Donuts and pastries 0.40 Rice (no oil) 0.39 Milk 0.30
Breakfast cereal 0.40 Latte/cappuccino 0.35 Breakfast cereal 0.29
Mexican candies 0.34 Organic food 0.34 Yogurt (no sugar) −0.28
Peanut butter 0.33 Milk 0.33 White bread 0.28
a Factor analysis, principal factor method with Varimax rotation, n = 2268.
b Burritos: Northern Mexican wrap.

“tortillas,” but the effect was more pronounced for those with more
economic capital.
As for life course, older women had lower scores in the “ham-
burgers” pattern, higher scores in “vegetables,” and a quadratic
association was observed for “tortillas.” Even adjusting for age, young
heads of family consumed less “hamburgers” than young women
who were not heads of family. Number of children and occupa-
tion were associated only with the “tortillas” pattern, with higher
scores for those with children, and higher scores for students and
women in the “other” category as compared with women in paid
employment.
In addition to the interactions between indicators of migration
and contact with the US, and indicators of economic and cultural
capital mentioned above (Fig. 2a and b), women born in Southern
Mexico consumed less “hamburgers” and more “tortillas.” More fre-
quent border crossing was associated with higher score in
“vegetables” and lower score in “tortillas,” as was buying food mainly
in the US.
Discussion
In this article, we explored whether the dietary habits of a sample
of adult women corresponded to traditional, modern and healthy
patterns. Two of the patterns identified represent a globalized diet,
including items available and consumed in many other countries.
The “hamburgers” pattern is akin to that described as part of the

Table 2
Scores in dietary patterns, by social and demographic characteristics.a

Variable Score in “Hamburgers” Score in “Vegetables” Score in “Tortillas”

(mean, CI95%) (mean, CI95%) (mean, CI95%)

Quintile of economic capitalb

1 −0.08 (−0.19,0.02) −0.38 (−0.49,−0.27) 0.23 (0.13,0.33)
2 −0.02 (−0.09,0.05) −0.17 (−0.26,−0.07) 0.28 (0.15,0.41)
3 −0.02 (−0.13,0.09) −0.05 (−0.16,0.06) 0.09 (−0.05,0.23)
4 0.00 (−0.11,0.11) 0.03 (−0.10,0.15) −0.07 (−0.18,0.05)
5 0.01 (−0.07,0.08) 0.43 (0.28,0.57) −0.37 (−0.50,−0.25)
Years of education
0–6 −0.26 (−0.33,−0.19) −0.19 (−0.30,−0.08) 0.25 (0.16,0.34)
7–9 0.02 (−0.06,0.09) −0.12 (−0.20,−0.04) 0.19 (0.08,0.30)
10–12 0.12 (0.03,0.21) 0.06 (−0.06,0.17) −0.24 (−0.33,−0.15)
≥13 0.00 (−0.09,0.09) 0.61 (0.45,0.77) −0.50 (−0.63,−0.38)
Life stage
Young adult 0.41 (0.29,0.52) −0.12 (−0.25,0.01) −0.24 (−0.42,−0.06)
Young household head 0.06 (−0.01,0.13) −0.12 (−0.24,−0.00) 0.10 (−0.01,0.20)
Adult −0.06 (−0.15,0.04) 0.09 (−0.04,0.23) 0.02 (−0.08,0.13)
Middle aged −0.23 (−0.30,−0.16) 0.13 (0.04,0.22) 0.02 (−0.09,0.14)
Occupation
Employed −0.05 (−0.12,0.02) 0.07 (−0.06,0.20) −0.04 (−0.14,0.05)
Student 0.47 (0.33,0.61) −0.06 (−0.27,0.16) −0.38 (−0.54,−0.22)
Homemaker −0.05 (−0.11,0.01) −0.01 (−0.09,0.07) 0.03 (−0.08,0.15)
Other −0.04 (−0.19,0.11) 0.03 (−0.13,0.19) 0.24 (0.08,0.39)
Place of birth
Tijuana 0.17 (0.09,0.25) 0.03 (−0.13,0.18) −0.18 (−0.28,−0.07)
USc 0.18 (−0.26,0.62) 0.34 (0.00,0.67) −0.46 (−0.91,−0.01)
Northern Mexico −0.07 (−0.14,0.00) 0.02 (−0.08,0.11) 0.05 (−0.07,0.17)
Southern Mexico −0.18 (−0.25,−0.12) 0.01 (−0.08,0.10) 0.17 (0.07,0.27)
Ever lived in the US
No −0.03 (−0.08,0.03) −0.01 (−0.10,0.09) 0.00 (−0.09,0.10)
Yes 0.01 (−0.12,0.13) 0.21 (0.06,0.37) −0.15 (−0.31,0.01)
Border crossing
Never −0.01 (−0.08,0.05) −0.19 (−0.26,−0.12) 0.20 (0.11,0.30)
<1/month −0.14 (−0.25,−0.02) 0.27 (0.14,0.41) −0.16 (−0.25,−0.07)
≥1/month 0.09 (−0.05,0.24) 0.51 (0.35,0.68) −0.51 (−0.64,−0.38)
a Unweighted n = 2232 (varies due to missing data for some variables). Values in the table are weighted.
b
Higher = more economic capital.
c US: United States.
 I. Bojorquez et al./Appetite 92 (2015) 43–50 47

Table 3
Linear regression models. Dependent variable: score in dietary patterns.a

Variable Model 1 Model 2 “Vegetables” Model 3

“Hamburgers” “Tortillas”

β (CI 95%)b β (CI 95%) β (CI 95%)

c
Index of economic capital 0.07 (0.02,0.12) 0.11 (0.07,0.14) 0.02 (−0.05,0.09)
Index squared n.i.d 0.01 (0.00,0.02) n.i.
Years of education 0.00 (−0.01,0.01) 0.07 (0.05,0.09) −0.03 (−0.05,−0.02)
Age (years) −0.02 (−.03,−0.01) 0.02 (0.01,0.03) 0.04 (0.01,0.08)
Age squared n.i. n.i. −0.00 (−0.00,−0.00)
Life stage: Young adult Ref. Ref. Ref.
Young head of family −0.26 (−0.44,−0.07) 0.03 (−0.10,0.15) 0.07 (−0.10,0.24)
Adult −0.14 (−0.35,0.06) 0.03 (−0.12,0.18) −0.11 (−0.37,0.15)
Middle aged 0.05 (−0.21,0.31) −0.23 (−0.48,0.02) −0.13 (−0.47,0.21)
Children: No children Ref. Ref. Ref.
≥1 child 0–5 years. −0.05 (−0.24,0.14) −0.07 (−0.19,0.05) 0.20 (0.10,0.30)
All children >5 years −0.02 (−0.18,0.14) −0.05 (−0.18,0.09) 0.24 (0.13,0.35)
Occupation: Employed Ref. Ref. Ref.
Student 0.14 (−0.08,0.36) −0.14 (−0.37,0.08) 0.18 (0.01,0.36)
Homemaker 0.06 (−0.03,0.14) −0.00 (−0.07,0.07) 0.05 (−0.03,0.14)
Other 0.01 (−0.15,0.17) −0.00 (−0.14,0.13) 0.30 (0.15,0.46)
Place of birth: Tijuana Ref. Ref. Ref.
USd −0.21 (−0.62,0.21) −0.24 (−0.98,0.50) −0.03 (−0.41,0.36)
Northern Mexico −0.02 (−0.13,0.09) 0.47 (0.19,0.76) 0.06 (−0.03,0.14)
Southern Mexico −0.13 (−0.23,−0.03) 0.63 (0.39,0.86) 0.10 (0.00,0.19)
Ever lived in the US −0.06 (−0.43,0.30) 0.03 (−0.10,0.16) −0.01 (−0.15,0.13)
Border crossing: Never Ref. Ref. Ref.
<1/month −0.06 (−0.17,0.05) 0.22 (0.10,0.34) −0.19 (−0.28,−0.10)
≥1/month 0.05 (−0.12,0.21) 0.35 (0.22,0.48) −0.41 (−0.56,−0.26)
Food shopping: Supermarket Ref. Ref. Ref.
Farmers’ market 0.19 (0.05,0.33) −0.07 (−0.24,0.10) −0.12 (−0.25,0.01)
Grocery store 0.14 (−0.20,0.48) −0.20 (−0.52,0.11) −0.35 (−0.81,0.10)
Small shop 0.28 (−0.02,0.58) 0.20 (−0.37,0.77) 0.34 (−0.52,1.19)
US 0.16 (−0.19,0.51) 0.44 (0.13,0.75) −0.39 (−0.59,−0.19)
Economic capital × Years of education −0.01 (−0.01,−0.00) n.i. −0.01 (−0.01,−0.00)
Economic capital × Ever lived in US 0.06 (−0.06,0.18) n.i. n.i.
Years of education × Ever lived in US 0.03 (−0.02,0.07) n.i. n.i.
Economic capital × Years of education × Ever lived in US −0.02 (−0.03,−0.00) n.i. n.i.
Place of birth × Years of education
Tijuana n.i. Ref. n.i.
US 0.02 (−0.05,0.10)
Northern Mexico −0.05 (−0.07,−0.02)
Southern Mexico −0.05 (−0.08,−0.02)
a Unweighted n = 2000. Model adjusted for complex sample design. Model 1: R2 = 0.118, p < .0001. Model 2: R2 = 0.204, p < .0001. Model 3: R2 = 0.198, p < .0001. Each model

adjusted by all variables and interactions shown.

b
CI95% = 95% confidence interval. Numbers in bold show statistically significant coefficients.
c
Higher score = more economic capital.
d n.i.: not included in the model because interaction p > .05. US: United States.

modern nutrition transition; the “vegetables” pattern, on the other

Fig. 1. Interaction between years of education and place of birth, effect on con-
sumption of the “vegetables” pattern.
hand, includes food recommended as healthy by nutritional guide-
lines. The distinction between “unhealthy” and “healthy” patterns
has been identified in other studies (Alves, Olinto, Costa, Bairros,
& Balbinotti, 2006; Walthouwer, Oenema, Soetens, Lechner, & de
Vries, 2014). The “tortillas” pattern, which is similar to patterns pre-
viously identified in Mexican and Mexican-origin samples (Flores
et al., 2010; Sofianou, Fung, & Tucker, 2011), may be interpreted in
different ways. On the one hand, as in Flores et al. (2010), it may
be considered as traditional as it includes items which have been
staples of the Mexican diet since pre-Columbian times. On the other
hand, it may be thought of as a less expensive consumption pattern
(Valero-Gil & Valero, 2008). Reinforcing this second interpreta-
tion, the pattern included foods that are not traditional, but relatively
inexpensive, such as sausage or white bread. Flores et al.’s analy-
sis also included a high proportion of calories from rice, pasta, and
sugar added to coffee or tea, all of them foods that provide energy
at low cost.
Regarding the association of social position and dietary pat-
terns, the expected gradient was observed between economic and
48 I. Bojorquez et al./Appetite 92 (2015) 43–50
a b
Fig. 2. Interactions between economic capital, years of education and having ever lived in the United States (US), effect on consumption of the “hamburgers” pattern. (a)
Modification of the effect of economic capital, by years of education and having ever lived in the US. (b) Modification of the effect of having ever lived in the US, by eco-
nomic capital and years of education.
cultural capital, and the traditional, modern and healthy patterns.
Overall, the observed associations suggest that economic capital pro-
motes the consumption of a more globalized diet, and when
accompanied by greater cultural capital this diet is geared toward
a healthier pattern. This finding can be interpreted in light of
Bourdieu’s (1984) notion that choices are influenced by social po-
sition, which in turn is defined not just by the total amount of capital,
but by the specific combination of types of capital. In this sense,
we suggest that economic capital is needed in order to purchase
relatively more expensive food, but the shift of food preference
toward “vegetables” requires the addition of cultural capital.
As for life course, age was associated with increased consump-
tion of the “vegetables” pattern, and being head of family was
associated with a lesser consumption of the “hamburgers” pattern.
This probably reflects the greater concern of middle-aged women
to follow a preventive diet for chronic diseases, as well as changes
in women’s position in the household during the life course (Devine,
2005; Devine & Olson, 1991). Interestingly, occupation had a sig-
nificant effect only in the consumption of the “tortillas” pattern,
higher among students and women who did not work, as com-
pared with women in paid employment. This result might indicate
the lower income of these two groups; however, this is a finding
worth investigating further.
In relation to migration, the expected relationship was ob-
served between being native to southern Mexico and increased
consumption of a traditional pattern. An unexpected effect was ob-
served in which women who crossed to the US more frequently
tended to consume the “vegetables” pattern. However, for women
with less economic and cultural capital, having lived in the US was
associated with higher consumption of the “hamburgers” pattern.
While research on migration and diet tends to see migration as a
single phenomenon, migrants are not a homogeneous group, and
contact with the US can mean different things for persons in dif-
ferent social positions. It is possible that in the context of our study,
frequency of border crossing was a further indicator of capital, as
having more economic and cultural capital would facilitate obtain-
ing a US visa, purchasing food priced in an expensive foreign
currency, and taking advantage of the abundant organic and healthy
food offering of California. Women in lower social positions, on the
other hand, were more similar to the typical findings of migration
and diet studies, in that those who had lived in the US were more
likely to consume the modern dietary pattern than their counter-
parts who had never lived in that country.
Considering dietary patterns as historically and socially situated
actions, we propose that the adoption of the modern pattern may be
explained by access to global foods, and by the prestige associated to
modern foods, just as in previous centuries European food was valued
over indigenous foods (Oseguera, 2003). The consumption of a healthy
pattern can in turn be explained by the combination of capitals. Eco-
nomic capital allows access to relatively expensive “healthy” foods, such
as fruits and vegetables (Ponce et al., 2014; Valero-Gil & Valero, 2008)
and organic food. Cultural capital, in turn, reinforces taste (in the sense
of Bourdieu) for these “distinctive” foods. Meanwhile, position in the
life course facilitates or hinders certain practices, as in the case of in-
creased consumption of the post-transitional pattern by younger
women. Finally, dietary patterns of women born in Tijuana tended less
to the consumption of traditional foods, fruits and vegetables, in rela-
tion to women from Southern Mexico, which could be explained by
an increased contact with the cultural patterns of the US society.
However, for women in higher social position contact with the US might
indicate membership in the global upper class, with its associated pref-
erence for healthy food (Hawkes, 2006), explaining their consumption
of the “vegetables” pattern.
Our results are in accordance with previous research suggest-
ing that those in higher social positions tend to adopt health
innovations and recommended practices (Link & Phelan, 1996; Rubin
et al., 2010, 2014). According to Hawkes (2006), the globalization
of food production and consumption bring forth two processes: con-
vergence and adaptation/divergence. In convergence, diet is
homogenized globally to the modern pattern. In adaptation, niche
consumption practices emerge. The net result of these two pro-
cesses is that people with lower income show the pattern of
convergence, since the foods that are part of it are cheaper and more
accessible. Instead, people with more resources can access a wide
variety of foods, including those specially addressed to the health-
conscious market. The difference by social group in convergence/
divergence has foreseeable consequences for health, and is a case
of the phenomenon of fundamental causality (Link, Northridge,
Phelan, & Ganz, 1998), in which social differences exert their effect
on health through various means, and with results in different
areas, but always resulting in better health for the upper classes.
The adoption of a healthier diet by women with greater economic
 I. Bojorquez et al./Appetite 92 (2015) 43–50
and cultural capital in our study is just one of the many ways in
which this difference is manifested.
Our results highlight the complex interplay of elements of social
position in the production of health-related practices. In this regard,
interactions between the variables employed as indicators of social
position also point to the limitations of traditional epidemiologic
analysis. The “risk factor epidemiology” which emphasizes the es-
timation of individual effects should be replaced by more complex
frameworks, if the social determination of health is to be under-
stood (Krieger et al., 2010).
A limitation of our study is the cross-sectional design. Other
authors have shown dietary patterns to be relatively unstable
(Walthouwer et al., 2014), and affected by the transitions in the life
course (Devine, 2005), issues that cannot be addressed with this
study design. The cross-sectional nature of our data also means our
results regarding migration and dietary pattern should be inter-
preted with caution. Furthermore, the use of an FFQ developed for
the study limits the generalizability of our results. On the other hand,
the use of a limited number of indicators of the theoretical con-
cepts of economic and cultural capital, life course, and migration
implies that the observed associations might have been different
if other indicators had been employed. One important indicator that
we were unable to analyze is household income, which could have
rendered different results than our indicator of economic capital.
Similarly, some interactions might be partially dependent on the
indicators used. It is possible that with more accurate measure-
ments of our theoretical constructs, the effects of social position could
have been more clearly distinguished in the main effects of vari-
ables, in which case interactions would lose significance. Because
of all the above, the results must be interpreted with caution.
The objective of this paper was to assess if the dietary patterns
of a sample of adult women showed a gradient of traditional–
modern–healthy, paralleling the gradient in social position. From
the results, our main conclusion is that such a gradient was evident
in the distribution of dietary patterns, with women in lower posi-
tions consuming the traditional (or less expensive) pattern, women
in the middle consuming more of the modern pattern, and women
in higher positions consuming more of the healthy pattern. In this
cross-sectional study, it is not possible to evaluate if these differ-
ences are part of the change that the nutrition transition model
(Popkin, 1993) predicted would occur with time, a subject worth
of future study.
Most public health interventions aimed at modifying diet are
based on health behavior models centered on the individual. In
general, such models relegate to second place the social and cul-
tural environment in which people function, the embeddedness of
their actions in social relations, and the symbolic elements of actions
(Baum & Fisher, 2014; Cohn, 2014). Interventions that consider those
aspects and modify the social environment can be more success-
ful in promoting widespread change (Baum & Fisher, 2014).
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