Associations between neighbourhood and household environmental variables and fruit consumption: exploration of mediation by individual cognitions and habit strength in the GLOBE study

The association of dimensions of fruit and vegetable access in the retail food environment with consumption; a systematic review

The consumption of fruit and vegetables (F&V) is important for human health to protect against non-communicable disease and micronutrient deficiency. Increasing consumption of F&V may also benefit planetary health if these foods are substituted for foods with higher environmental footprints such as red meat or dairy. The retail food environment (RFE) is an influential junction between the food system and individual diets as it drives access to F&V through external (physical access) and personal (availability, affordability, acceptability) domains. We performed a systematic search of six literature databases (January 2021) for studies assessing access to F&V in the RFE and its association with F&V consumption in adults in high- and upper-middle income countries. 36 studies were identified and categorised by dimensions of food access – accessibility, affordability, acceptability, availability and accommodation. More than half of the studies (n = 20) were based in the USA. F&V accessibility was the most commonly reported dimension (n = 29); no study reported on accommodation. 6 studies were rated to be high quality. A positive association of increased availability of F&V options in the RFE with intake was identified in 9 of 15 studies. Associations in both acceptability and accessibility dimensions were inconsistent. No association was observed between F&V affordability and consumption although available data were limited. Many challenges exist to building a robust evidence base within food environment research including conceptual, definitional and methodological heterogeneity and measurement standardisation. Future food policies should consider multi-dimensional interventions to promote access to F&V in the RFE across all domains.

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First systematic review of dimensions of access in the retail food environment (RFE) and fruit and vegetable (F&V) intake.

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This review suggests potential importance of having access to available healthy options in the RFE for F&V intake.

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The absence of an association of F&V affordability with consumption is likely due to limited and mixed data availability.

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F&V accessibility and acceptability require development as dimensions of access for clearer links to be made.

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The retail food environment is complex but likely predictor of F&V consumption.

Association between food availability and young people's fruits and vegetables consumption: understanding the mediation role of the theory of planned behaviour

OBJECTIVE

To evaluate the relationship between fruits and vegetables (F&V) availability at home and young people's F&V consumption behaviour, and how the theory of planned behaviour (TPB) constructs could potentially mediate the relationship.

DESIGN

Cross-sectional face-to-face survey questionnaire to assess the TPB constructs and home food availability assessed using open inventories method. F&V availability was categorised into low and high levels based on median split.

SETTING

Singapore.

PARTICIPANTS

Two hundred and ten households (each consisting one parent-child pair) recruited via stratified cluster sampling with child participants ranging from 9 to 16 years of age.

RESULTS

Mediation analyses were conducted using structural equation modelling. The relationship between home F&V availability and F&V consumption behaviour did not have a significant direct association, but there were significant indirect effects through the routes of perceived behavioural control (PBC) and intention as well as attitude and intention. Specifically, higher level of F&V availability at home was related to more positive PBC and attitude towards F&V, and subsequently greater intention to consume F&V and higher consumption of F&V.

CONCLUSIONS

Parents should make F&V more readily available at home as increased exposure to F&V could be related to enhanced liking, sense of control and intention to consume F&V and facilitate children's healthy diet.

Supermarket access, transport mode and BMI: the potential for urban design and planning policy across socio-economic areas

OBJECTIVE

To investigate dietary intake, BMI and supermarket access at varying geographic scales and transport modes across areas of socio-economic disadvantage, and to evaluate the implementation of an urban planning policy that provides guidance on spatial access to supermarkets.

DESIGN

Cross-sectional study used generalised estimating equations to investigate associations between supermarket density and proximity, vegetable and fruit intake and BMI at five geographic scales representing distances people travel to purchase food by varying transport modes. A stratified analysis by area-level disadvantage was conducted to detect optimal distances to supermarkets across socio-economic areas. Spatial distribution of supermarket and transport access was analysed using a geographic information system.

SETTING

Melbourne, Australia.

SUBJECTS

Adults (n 3128) from twelve local government areas (LGA) across Melbourne.

RESULTS

Supermarket access was protective of BMI for participants in high disadvantaged areas within 800 m (P=0·040) and 1000 m (P=0·032) road network buffers around the household but not for participants in less disadvantaged areas. In urban growth area LGA, only 26 % of dwellings were within 1 km of a supermarket, far less than 80-90 % of dwellings suggested in the local urban planning policy. Low public transport access compounded disadvantage.

CONCLUSIONS

Rapid urbanisation is a global health challenge linked to increases in dietary risk factors and BMI. Our findings highlight the importance of identifying the most appropriate geographic scale to inform urban planning policy for optimal health outcomes across socio-economic strata. Urban planning policy implementation in disadvantaged areas within cities has potential for reducing health inequities.

The theory of planned behaviour and discrete food choices: a systematic review and meta-analysis

The combination of economic and social costs associated with non-communicable diseases provide a compelling argument for developing strategies that can influence modifiable risk factors, such as discrete food choices. Models of behaviour, such as the Theory of Planned Behaviour (TPB) provide conceptual order that allows program designers and policy makers to identify the substantive elements that drive behaviour and design effective interventions. The primary aim of the current review was to examine the association between TPB variables and discrete food choice behaviours. A systematic literature search was conducted to identify relevant studies. Calculation of the pooled mean effect size (r(+)) was conducted using inverse-variance weighted, random effects meta-analysis. Heterogeneity across studies was assessed using the Q- and I(2)-statistics. Meta-regression was used to test the impact of moderator variables: type of food choice behaviour; participants' age and gender. A total of 42 journal articles and four unpublished dissertations met the inclusion criteria. TPB variables were found to have medium to large associations with both intention and behaviour. Attitudes had the strongest association with intention (r(+)  = 0.54) followed by perceived behavioural control (PBC, r(+)  = 0.42) and subjective norm (SN, r(+)  = 0.37). The association between intention and behaviour was r(+)  = 0.45 and between PBC and behaviour was r(+)  = 0.27. Moderator analyses revealed the complex nature of dietary behaviour and the factors that underpin individual food choices. Significantly higher PBC-behaviour associations were found for choosing health compromising compared to health promoting foods. Significantly higher intention-behaviour and PBC-behaviour associations were found for choosing health promoting foods compared to avoiding health compromising foods. Participant characteristics were also found to moderate associations within the model. Higher intention-behaviour associations were found for older, compared to younger age groups. The variability in the association of the TPB with different food choice behaviours uncovered by the moderator analyses strongly suggest that researchers should carefully consider the nature of the behaviour being exhibited prior to selecting a theory.

Correlates of dietary behavior in adults: an umbrella review

CONTEXT

Multiple studies have been conducted on correlates of dietary behavior in adults, but a clear overview is currently lacking.

OBJECTIVE

An umbrella review, or review-of-reviews, was conducted to summarize and synthesize the scientific evidence on correlates and determinants of dietary behavior in adults.

DATA SOURCES

Eligible systematic reviews were identified in four databases: PubMed, PsycINFO, The Cochrane Library, and Web of Science. Only reviews published between January 1990 and May 2014 were included.

STUDY SELECTION

Systematic reviews of observable food and dietary behavior that describe potential behavioral determinants of dietary behavior in adults were included. After independent selection of potentially relevant reviews by two authors, a total of 14 reviews were considered eligible.

DATA EXTRACTION

For data extraction, the importance of determinants, the strength of the evidence, and the methodological quality of the eligible reviews were evaluated. Multiple observers conducted the data extraction independently.

DATA SYNTHESIS

Social-cognitive determinants and environmental determinants (mainly the social-cultural environment) were included most often in the available reviews. Sedentary behavior and habit strength were consistently identified as important correlates of dietary behavior. Other correlates and potential determinants of dietary behavior, such as motivational regulation, shift work, and the political environment, have been studied in relatively few studies, but results are promising.

CONCLUSIONS

The multitude of studies conducted on correlates of dietary behavior provides mixed, but sometimes quite convincing, evidence. However, because of the generally weak research design of the studies covered in the available reviews, the evidence for true determinants is suggestive, at best.

Determinants of dietary behavior among youth: an umbrella review

BACKGROUND

The literature on determinants of dietary behavior among youth is extensive and unwieldy. We conducted an umbrella review or review-of-reviews to present a comprehensive overview of the current knowledge.

METHODS

Therefore, we included systematic reviews identified in four databases (i.e. PubMed, PsycINFO, The Cochrane Library and Web of Science) that summarized determinants of observable child and adolescent dietary behaviors. Data extraction included a judgment of the importance of determinants, strength of evidence and evaluation of the methodological quality of the eligible reviews.

RESULTS

In total, 17 reviews were considered eligible. Whereas social-cognitive determinants were addressed most intensively towards the end of the 20th century, environmental determinants (particularly social and physical environmental) have been studied most extensively during the past decade, thereby representing a paradigm shift. With regard to environmental determinants, mixed findings were reported. Sedentary behavior and intention were found to be significant determinants of a wide range of dietary behaviors in most reviews with limited suggestive evidence due to the cross-sectional study designs. Other potential determinants such as automaticity, self-regulation and subjective norm have been studied in relatively few studies, but results are promising.

CONCLUSION

The multitude of studies conducted on potential determinants of dietary behavior provides quite convincing evidence of the importance of several determinants (i.e. quite some variables were significantly related to dietary behavior). However, because of the often used weak research designs in the studies covered in the available reviews, the evidence for true determinants is suggestive at best.

FRUIT AND VEGETABLE CONSUMPTION BY ECOLOGICAL ZONE AND SOCIOECONOMIC STATUS IN GHANA

The disease burden in both developed and developing countries is moving towards higher proportions of chronic diseases, and diseases such as cancers are now considered to be of public health concern. In sub-Saharan Africa, healthy behaviours such as fruit and vegetable consumption are recommended to reduce the chances of onset of chronic diseases. This paper examines the determinants of fruit and vegetable consumption in Ghana with particular emphasis on consumption by ecological zone. Data were from the 2008 Ghana Demographic and Health Survey (n=4916 females; n=4568 males). Univariate and multivariate analyses were performed using basic descriptive and Poisson regression. The main independent variable was ecological zone and the dependent variables were levels of fruit and vegetable consumption. The mean number of fruits and vegetables consumed in a week was higher among females (fruits: 7.5, 95% CI=7.3-7.7; vegetables: 8.1, 95% CI=7.8-8.3) than males (fruits: 6.2, 95% CI=6.0-6.4; vegetables: 7.9, 95% CI=7.7-8.2). There were significant differences in consumption by ecological zone. Respondents in the Savannah zone consumed less fruit than those in the Coastal and Forest zones, but the differences in fruit and vegetable consumption between the Coastal and Savannah zones were not consistent, especially for vegetable consumption. The findings suggest that one of the key interventions to improve fruit and vegetable consumption could lie in improving distribution systems since their consumption is significantly higher in the Forest zone, where the production of fruit and vegetables is more developed than in the Savannah and Coastal zones. The findings relating to household wealth challenge conventional knowledge on fruit and vegetable consumption, and rather argue for equal consideration of spatial differences in critical health outcomes.

Obesogenic environments: a systematic review of the association between the physical environment and adult weight status, the SPOTLIGHT project

Background

Understanding which physical environmental factors affect adult obesity, and how best to influence them, is important for public health and urban planning. Previous attempts to summarise the literature have not systematically assessed the methodological quality of included studies, or accounted for environmental differences between continents or the ways in which environmental characteristics were measured.

Methods

We have conducted an updated review of the scientific literature on associations of physical environmental factors with adult weight status, stratified by continent and mode of measurement, accompanied by a detailed risk-of-bias assessment. Five databases were systematically searched for studies published between 1995 and 2013.

Results

Two factors, urban sprawl and land use mix, were found consistently associated with weight status, although only in North America.

Conclusions

With the exception of urban sprawl and land use mix in the US the results of the current review confirm that the available research does not allow robust identification of ways in which that physical environment influences adult weight status, even after taking into account methodological quality.