Dietary quality, behavioural factors and cardiovascular health : an econometric analysis of structural relationships with the data of the National Health and Nutrition Examination Survey 2005-2006, USA
Cardiovascular diseases (CVDs) are leading causes of death globally and are responsible for huge costs of health care systems. One important risk factor of CVDs is adverse health behaviour such as physical inactivity, smoking, harmful alcohol consumption, unbalanced diet and obesity. Since interrelations between human choices and health outcomes are complex and depend on numerous economic, social, and environmental factors, there is a need for economic and interdisciplinary studies to investigate the underlying relationships and to suggest possible avenues for health policy. This dissertation analyses interdependencies between individual health-related behaviour, personal characteristics and cardiovascular health with a special focus on dietary quality due to its determinative role. The theoretical framework is provided by household production theory. The thesis includes several empirical analyses based on the representative U.S. National Health and Nutrition Examination Survey (NHANES) of 2005-2006, which provides comprehensive data on health and the nutritional status of the American population.First, the dietary quality of U.S. adults is assessed employing a number of methods. Results indicate a large discrepancy between the perceived dietary quality and the actual nutritional status of adults. The analysis of fruits and vegetables (F&V) consumption incorporated the cluster-analysis technique and identified specific intake patterns among the study population, which are related to the preparation methods of consumed produce. The results indicate that the way Americans prepare and consume initially healthy F&V may reduce their nutritional value and have a negative impact on the overall diet. It is suggested to put more emphasis on this aspect of the public health policy. Next, structural-equation modelling is used to test the hypothesised model of cardiovascular health. This approach allowed to model health as a latent variable represented by several observed indicators and, thus, to improve its measurement properties. Health inputs are specified as endogenous variables that may affect health as well as each other. The results indicate a multidimensionality of cardiovascular health, which is more adequately represented by a two-factor latent variable model. Further findings include a positive impact of F&V and negative effects of alcohol intake and sedentary leisure time activities on health. The model also suggests that education and income rather have an indirect impact on health, transmitted through their positive influence on behavioural patterns beneficial to health, e.g., less smoking, a more active use of leisure time and more regular professional medical care. Education and income affect diet only indirectly, too, by increasing nutrition knowledge of a person. A positive indirect impact of income on weight is because individuals, who are more affluent, use their leisure time more actively. This seems to be even more important than choosing a healthier diet.
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