Background/Aims: Cooking and home food preparation have increasingly been considered as a public health opportunity in the face of augmented rates of overweight and obesity in the developed, high-income countries . “Domestic cooking”, used interchangeably with “home cooking”, refers to actions required for preparing hot or cold foods at home, including combining, mixing and often heating ingredients , which is typically associated with women despite the shifting developed country demographics . Domestic cooking was shown to be positively associated with higher diet quality and positive health outcomes among adults in certain studies [4, 3]; whereas other ones reported either no association or suggest that longer meal preparation time to be associated with higher energy intake and obesity among women [5, 6]. Since domestic cooking’s complexity that is attributable to geographical and demographical variations between studies affects diet and health inconsistently, more research is needed to assess the effect of domestic cooking on women’s BMI [7, 8]. Also, the complex interactions between determinants and health-related outcomes of domestic cooking is also relatively understudied due to methodological challenges . Furthermore, determinants of domestic cooking have been understudied for the context ofdeveloping countries as well. Therefore, the aim of this study was to evaluate the effect of domestic cooking on women’s BMI and then elucidate the factors that determine women’s involvement in domestic cooking for the context of Turkey. Methods: Study Design and Data Source The data source for the present study came from publicly available Turkey Demographic and Health Survey 2013 (TDHS-2013) dataset. TDHS-2013 was conducted by Hacettepe University Institute of Population Studies with the contributions of Turkish Ministries of Development and Health . TDHS-2013 was a nationally representative, cross-sectional household survey, in which the respondents are selected from urban and rural areas of major five regions of the country through weighted, multi-stage, stratified cluster sampling. Information was collected from women of reproductive age (15-49 years) via individual face-to-face questionnaires. Data on various sociodemographic and socio-economic indicators, fertility, maternal and child heath, reproductive health, and women’s status along with the anthropometric measures of women and children were collected. Further details of the study design and methods of the TDHS-2013 have been described previously . For the present study, secondary data analysis on women’s data was performed to evaluate the effect of domestic cooking on women’s BMI and then elucidate the factors that determine women’s involvement in domestic cooking for the context of Turkey through the nationally representative TDHS-2013 Survey. For the current analysis pregnant participants and those with missing information on domestic cooking were excluded. In total 8204 participants’ data were used and women were grouped into two categories as either “involved with domestic cooking” if they reported to primarily cook either themselves only or with others in the household or “not involved with cooking” if cooking was done by others. The difference in BMI ((weight(kg)/(height(m))²) depending on cooking involvement was analyzed with CSGLM procedure. Then, the factors that impact the odds of being involved in cooking were assessed with bivariate logistic regression analysis. Estimates were adjusted for education (DHS categories of 1. No education/primary incomplete, 2. First level primary, 3. Second level primary, 4. Highschool and higher) household wealth level (DHS categories of Wealth Index; 1. Very poor, 2. Poor, 3. Normal, 4. Rich, 5. Very rich), smoking (categories of 1. No smoking, 2. Irregular smoking, 3. Regular smoking), alcohol intake (categories of 1. No intake, 2. Irregular intake, 3. Regular intake), physical activity (categories of 1. None, 2. Irregular, 3. Regular), marital status (categories of 1. Married, 2. Single), age (in years), and parity (total children ever born). All the analyses were conducted using the complex sample procedures of the SPSS software version 21 (IBM Corp., 2013, Armonk, NY, USA). TDHS-2013 study was conducted according to the guidelines laid down in the Declaration of Helsinki and all procedures (data collection and the questionnaires) involving research study participants were approved by the Hacettepe University’s Ethics Committee. Informed consent was obtained from all study participants at first contact. Since this study analyzed the publicly available TDHS-2013 data with no personally identifiable information, no further institutional review board approval was required. Results: In total 8204 participants’ data were used and 70.8% of women in the TDHS sample were reported to be primarily involved in cooking. Those who were involved in cooking had significantly higher BMI than women who were not involved (28.09 vs. 23.55, p<0.001). Wealth status explained the highest odds of being involved in cooking for low household wealth women (eß=2.236; p<0.0001) compared with high household wealth counterparts (Table 1) after adjusting for education, physical activity, marital status, smoking, alcohol intake, age, parity, and BMI. Additionally, holding all the covariates constant, being involved with cooking was associated with odds of having 2% higher BMI level (p=0.016) as opposed to being single ((eß=0.040; p<0.001) compared with married women (Table 1). Conclusions: For the context of Turkey, higher participation of meal preparation and cooking appears to be associated with having higher BMI for women; low household wealth level and being married explaining the level of involvement the most. Despite having similar percentage of women being involved with cooking in Turkey compared to many high income countries (around 70%), there was a decreasing trend of cooking with increasing levels of wealth, which was different from developed countries where cooking could be perceived as a luxury requiring more time, money, and skills . These differences of social determinants of cooking in Turkey could be used to enhance public health nutrition interventions and/or programs (nutrition assistance programs, healthy cooking guidance) to cook healthfully and promote cooking among people of different levels of income.
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