| dc.description.abstract | Food choices are complex and better understood when the influences of factors at various levels are recognized, such as the individual and environment. Despite the growing interest in the contribution of environment to food consumption, findings are still inconsistent and the evidence is restricted to high-income countries. Objective: To identify fruit and vegetable (FV) intake and the individual and environmental factors associated with this consumption among users of the Health Academy Program (HAP) of Belo Horizonte, Minas Gerais. Methods: This thesis will be presented in three articles, one ecological study and two cross-sectional studies. In the ecological study the purpose was to perform an exploratory analysis of the environmental conditions and their relationship with FV intake. The cross-sectional studies aimed to identify the association between individual ability and the perceived food environment with FV consumption; and to examine the individual, family and environmental factors associated with this consumption. The study was conducted with all users aged 20 years or older from HAP centres sampled via stratified cluster sampling, stratified by the nine administrative districts of the municipality. Data collection included face-to-face interviews with users of HAP centres (individual and family domain), as well as FV store audits (environmental domain) contained within 1,600 m buffer zones at HAP sites. The individual data investigated were: biological and socioeconomic variables (sex, age, marital status, income, occupation and education) and psychosocial variables (stage of change, self-efficacy, decisional balance; and individual ability - answers to items on likert scale regarding perceived affordability, time and preparation skills). In order to evaluate food environment, we measured variables from home food environment (household food security), community nutrition environment (density, proximity, accessibility and type of food stores) and the consumer nutrition environment (sanitary-hygienic condition of food stores; quality of access to FV evaluated by the Healthy Food Store Index - HFSI, composed of variables of availability, variety, and advertising of FV and ultra-processed products). Spatial analysis techniques consisted of the Local Morans Index, Kernel intensity estimator, proximity assessment, and the construction of thematic maps. The association between individual and environmental factors and FV consumption were tested from Student t for independent samples, One-way Analysis of variance and post-hoc tests; multiple linear regressions; and multilevel linear regression. Results: In the 18 HAP centres evaluated, 3,414 individuals were interviewed and 336 food stores were analyzed in its territories. The ecological study found a FV inadequacy of 65.8% (<400 grams daily), with significant geographical variations: average consumption was higher in areas with higher income and concentration of food stores, and better index of access to healthy foods (site 2A: 410.5±185.7 g vs. site 4B: 311.2±159.9 g). Sites with poor FV consumption had the most stores with poor access to healthy foods (index in the first tertile, 10). In the same direction, the majority of participants (52.0%) were not confident about FV availability in their territory. After adjustments, individual ability was more strongly associated with FV consumption (p<0,001), compared to the food environment perception: a 1 standard deviation higher individual ability score was associated with a 35.10g higher FV intake. The multilevel analyzes corroborate these findings. FV intake varied between contexts, being higher in areas with better socioeconomic conditions and food stores with greater index of access, such as specialized FV markets. Individual-level factors significantly associated with FV intake included age, income, household food insecurity, stage of change, self-efficacy and decisional balance. After controlling for individual-level characteristics, a greater FV intake was also associated with better access to healthy food. Conclusion: This is one of the first studies to conduct a comprehensive assessment of food environment in a developing country, increasing the comprehension of the complex relationship between environmental and individual factors and FV consumption. We found inadequate intake of FV, influenced by individual (behavioral and socioeconomic), family (food insecurity) and environmental factors, which the consumer nutrition environment was more apparently predictive of healthy eating, than the community nutrition environment. The findings suggest new possibilities for interventions aimed at encouraging FV consumption. | |
