The influence of the food environment and socio-ecological determinants on early childhood dietary intake: A mixed methods exploration

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Comans, Tracy

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Cameron, Catherine M

Gallegos, Danielle

Thornton, Lukar

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2020-03-31
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Introduction: The incidence and prevalence of childhood obesity continues to be a public health concern of global significance with physical inactivity and excess energy intake being key contributors to this problem. Food preferences are vital determinants of food intake in very young children and given that preferences and eating habits are established early in life and are maintained through the adult years, it is critical to establish the foundations of healthy eating as early as possible. Recent decades have seen increasing interest in food environments and health. Indeed, whilst research in this area has been expanding rapidly, it is often difficult to establish consistent relationships regarding the food environment and health outcomes such as obesity. Exploring food environments through mixed methods enquiry and in the Australian context may enhance our current understanding of food environments and diet, particularly food acquisition, provision and consumption decisions and socio-ecological determinants associated with food decisions and practices. Aim and methodology: The overarching purpose of this thesis is to investigate the influence of the food environment and socio-ecological determinants on dietary intake in early childhood and by exploring aspects and determinants of food acquisition, provision and consumption within local food environments. This was achieved by undertaking three separate yet inter-related studies using an explanatory sequential mixed methods research design. The studies within this thesis include 1) a systematic review synthesising qualitative evidence regarding the influence of local food environments on food behaviours; 2) latent variable modelling of cross-sectional and longitudinal cohort data identifying patterns of dietary intake in early childhood and investigating associations with demographic and socio-economic indicators, as well as identifying changes in early childhood dietary patterns over time; and 3) a qualitative interview study exploring how early childhood dietary intake and quality are influenced by caregiver interactions and decisions within local food environments. Results: Regarding food acquisition practices, synthesis of existing qualitative literature identified that availability, accessibility and affordability continue to be key determinants of store choice, often resulting in less healthy food purchasing behaviours. Further to this, availability, quality and characteristics of food stores greatly influence in-store purchases. An array of coping strategies were utilised within different food environments to make optimal purchasing decisions, often within financial constraints. An investigation of food consumption in early childhood identified three patterns of dietary intake at three years of age including 1) Highly Unhealthy, 2) Healthier and 3) Moderately Unhealthy, whilst two patterns were identified at five years of age (Unhealthy and Healthier). Approximately one eighth of children transitioned from the healthier to unhealthy dietary pattern between three and five years. Australian children’s diets continue to fall well short of healthy eating recommendations and diet quality appears to be declining through the childhood years. Unhealthy eating patterns in childhood are associated with factors such as young mothers, working mothers, living in a two-carer household and fathers with a higher Body Mass Index (BMI). The above-mentioned determinants of food access and purchasing behaviours within community and consumer nutrition environments within the systematic review were similarly identified through the qualitative study with caregivers of young children. The latter specifically identified structural and environmental determinants of food environments that influence food behaviours as well as the behaviours and strategies caregivers and children use to acquire, provide and/or consume food within different food environments. Central to this research is that women play a dynamic gatekeeping role regarding food access and provisioning decisions that are made within families. There are also individual agency factors of women/caregivers such as food literacy, use of time and food habits/routines that both influence and contribute to gatekeeper decisions regarding food acquisition and provisioning. However, in making food decisions for the family, women as gatekeepers must also contend with children’s food demands and behaviours as well as father/paternal agency that either supports or hinders women’s ability to uphold their gatekeeper role, within the context of different environments. Implications and conclusions: It is evident that environmental factors continue to be identified as important determinants of food behaviours. Moreover, food environments as well as the provisioning decisions made within these environments are complex, multifaceted and highly contextual. Of particular significance is identifying the dynamic interplay between structural determinants (environments) and human agency in enabling or constraining individuals to enact optimal food provisioning behaviours. This research addresses a significant gap in the literature by exploring the complexities regarding the food environment and dietary intake relationship using mixed methods enquiry and provides a greater understanding regarding the dynamic interplay between food acquisition, provision and consumption and the array of influencing factors both within families and environments. The specific contribution of qualitative data has enabled exploration and expansion of our current understanding of food environments, particularly by adding depth and scope to the existing qualitative literature to guide ongoing theory, interventions and policy development. Given the suboptimal and declining quality of dietary intake in Australian children, it remains imperative to focus health promotion efforts towards the very early years of life in order to reduce disparities and inequalities that contribute to less healthy patterns of eating. It may also be pertinent to explore interactions between individual, environmental and context-specific factors within food environments in order to understand how food environments can support and promote healthy food choices.

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Thesis (PhD Doctorate)

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Doctor of Philosophy (PhD)

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School of Medicine

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The author owns the copyright in this thesis, unless stated otherwise.

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childhood obesity

food environments

Australia

diet

socio-ecological determinants

decisions

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