How important is the neighbourhood food environment in influencing fruit and vegetable intakes? An Australian perspective
While a considerable body of research has examined the influence of personal factors (e.g. knowledge, attitudes, beliefs, preferences) and social factors (e.g. social support by family and peers) on Fruit and Vegetable (F&V) intake, less work has focused on factors in the local neighbourhood environment (e.g. access, availability, cost) that might impact on consumption. This is despite the fact that the environment is a potentially strong determinant of eating behaviours.
We have conducted a number of population studies in Victoria, Australia, that have examined the association of environmental factors with F&V consumption among women and children. This paper will present findings from the HEAPS (“Health, Eating and Play Study”) (800 children), the SESAW study (“Socioeconomic and neighbourhood inequalities in women’s physical activity, diet and obesity”) (1,500 women; in HEAPS and SESAW study participants were selected from neighbourhoods across the socioeconomic spectrum), and the READI study (“Resilience for Eating and Activity Despite Inequality”) (4,300 women living in disadvantaged neighbourhoods). Each study gathered sociodemographic, behavioural and other data on individual and social variables, and used Geographic Information Systems to objectively assess each participant’s neighbourhood food environment. In the SESAW study we also gathered information on the availability and price of F&V in stores.
The HEAP Study
Analyses of the HEAPS data on children showed that the more fast food outlets and convenience stores there were close to home, the lower was the likelihood of consuming fruit two or more times per day. There was also an inverse relation between density of convenience stores and the likelihood of consuming vegetables three or more times per day. The likelihood of consuming vegetables three or more times per day was greater the further away children lived from a supermarket or a fast food outlet.
The READI Study
In the READI study we examined whether poorer access to major supermarkets, smaller supermarkets and F&V stores in local neighbourhoods was associated with lower intakes of F&V. Six variables were used to assess access. None of our measures of access were associated with vegetable intake, and only one (greater distance to the nearest F&V store) was associated with lower fruit consumption.
The SESAW Study
In the SESAW study we examined the role of individual, social and neighbourhood factors as mediators of the relationship between SocioEconomic Status (SES) and F&V consumption. We found that while a number of the individual and social variables partly explained SES differences in consumption, store density did not mediate the relation between SES and F&V intakes.
In the SESAW study we also considered whether differences in intake across socioeconomically diverse neighbourhoods could be explained by the availability and price of F&V in those neighbourhoods, or by store opening hours. Fruit intake did not vary by neighbourhood, while vegetable intake was lower among women living in disadvantaged neighbourhoods. However the availability and price of vegetables and store opening hours did not explain neighbourhood differences in vegetable intake.
The complexity of understanding the role of neighbourhood food environments as a determinant of F&V consumption
So what we’re starting to see in the published data, is the kind of relations we might expect to exist based on what we believe about the environment, are just not being borne out in the objective data. These findings highlight the complexity of understanding the role of neighbourhood food environments as a determinant of F&V consumption. Further, findings that we might see from one country will not, probably, apply in another country because of these contextual factors. The cultures are different, the environments are different, the way that people think about food, the way they eat food, are different. And we have to bear that in mind when we are trying to take the findings from one country, and try to apply them to our own.
Future research, and policies and programs aimed at understanding and influencing the food environment, need to consider a broader range of contextual factors that impact on food choice and to better understand the ways in which individuals interact with their local environments. We need to create a better evidence base, understand what it is about the environment that is important, and what is not important. If we’ve got limited dollars to invest in influencing the environment, we have to invest wisely.