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A food environment perspective on the fruit and vegetable dietary behaviors of US Hispanics
Sanchez-Flack, Jennifer C.
Ayala, Guadalupe X.
Anderson, Cheryl A.M.
Martinez, Maria Elena
Background: In the US, 42.5% of Hispanics are obese, which is higher than the national prevalence rate of 34.9%. Diet is a modifiable risk factor for obesity that should be targeted to reduce and prevent disparities within the US Hispanic population. The retail food environment is an important context to study because the greatest contributor to energy intake are from foods and beverages purchased in stores. Methods: Aim 1 used NHANES data to examine fruit and vegetable (FV) intake by food store type among Hispanics. Differences between customers of various food store type categories were assessed and analyses were performed to estimate associations between intake and food store type categories. Aim 2 used baseline data from El Valor de Nuestra Salud to examine associations between in-store characteristics of product, placement and promotion and FV purchasing among Hispanic customers. Aim 3 used intervention data from El Valor to evaluate group by time differences in product, placement and promotion and group differences in FV purchasing post-intervention. Results: Aim 1 demonstrated that Hispanics who only purchased FVs from convenience stores were younger and more likely to be born in the US. Results also demonstrated that those who primarily purchased from supermarkets/grocery stores reported higher intakes of FVs than those who only purchased from convenience stores (p<.001, p=.005). Aim 2 indicated that availability of fresh FVs was associated with FV purchasing (p=.01). However, when adjusting for placement, availability of fresh FVs was non-significant. Greater shelf space dedicated to FVs (p=.01) and fewer fresh FV displays (p=.01) was associated with FV purchasing. Analyses also revealed that men reported lower FV purchasing compared to women (p=.02). Aim 3 revealed that El Valor was successful in increasing the promotion of FVs among intervention stores (p<.001) and that intervention store customers reported higher FV purchasing than control store customers (p=.04). Conclusions: The dissertation findings have important implications for practice, policy and research. The results can inform public health interventions to target in-store characteristics to encourage FV purchasing. It is important to understand and build upon the lessons learned to design, implement, and disseminate successful evidence-based programs.
Public Health (Health Behavior)
Health and Human Services
Doctor of Philosophy (Ph.D.) University of California, San Diego and San Diego State University, 2017
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