Navigating Globalized Food Environments: Market Access, Consumer Behavior, and Dietary Diversity in the Galapagos Islands of Ecuador

OBJECTIVES: This study has two objects: (1) determine whether different types of food environment measures shape diet outcomes; (2) determine whether consumer behavior modifies the association between geographic food environments and diet outcomes. METHODS: Household sociodemographic data and individual data including diet recalls are from 429 participants in the Healthy Family Study conducted in San Cristóbal island Galápagos in 2018. Geocoded market inventory and price data were obtained at the same time using the Nutritional Measurement Survey for stores (NEMS-S). Geographic food environment measures were based on market access and market survey stores. Experience-based food environment measures were based on factor analyzed consumer behavior strategies for each household. Diet quality and diversity scores were based on Global Dietary Recommendations (GDR) scoring schema. Linear regressions tested the relationships between diet outcomes and food environment measures and included key sociodemographic covariates. Interactions terms between geographic and experience-based food environment measures were included. RESULTS: Objective 1: Increasing nearest market score was associated with lower healthy food intake (β = −0.14) and higher unhealthy food intake (β = 0.14). Increasing preferred market price index was associated with lower unhealthy food intake (β = −0.31). Higher prioritization of convenience when food shopping was associated with lower of healthy food intake (β = −0.47). Objective 2: the relationship between food environment measures and diet outcomes is strongly modified by consumer behavior. For households that prioritize convenience when food shopping, price and inventory at the nearest market was most associated with diet. For households that prioritize quality when food shopping, price and inventory at the preferred market was most associated with diet. CONCLUSIONS: Market inventory can be healthful to some and deleterious to diets of others, depending how they navigate their food environments. “Objective” measures of quality and access that fail to consider consumer behavior may fail to capture realistic representations of food environment and diet relationships. FUNDING SOURCES: This research is funded by an NIH/FIC R21 and the Carolina Population Center for training support and general support.