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Linking Foodscapes and Dietary Behaviours: Conceptual Insights and Empirical Explorations in Canadian Urban Areas

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Linking Foodscapes and Dietary Behaviours: Conceptual Insights and Empirical Explorations in Canadian Urban Areas Université de Montréal Linking foodscapes and dietary behaviours: conceptual insights and empirical explorations in Canadian urban areas par Christelle Clary Département de médecine sociale et préventive École de santé publique Thèse présentée en vue de l’obtention du grade de Philosophiae Doctor (PhD) en Santé publique option Promotion de la santé Octobre, 2015 © Christelle Clary, 2015 Université de Montréal Faculté des études supérieures et postdoctorales Cette thèse intitulée : Linking foodscapes and dietary behaviours: conceptual insights and empirical explorations in Canadian urban areas Présentée par Christelle Clary A été évaluée par un jury composé des personnes suivantes : Dr. Sylvana Côté, président-rapporteur Dr. Yan Kestens, directeur de recherche Dr. Lynne Mongeau, membre du jury Dr. Jean-Michel Oppert, examinateur externe Dr. Marie Marquis, représentante du doyen de la FES Résumé La manière dont notre environnement influence le lieu et la nature de nos achats alimentaires n’est pas bien comprise. Un accès facilité ou limité aux commerces d’alimentation dits « sains » et « non-sains » a été considéré comme central dans la relation entre environnement et comportements alimentaires. De fait, la recherche a surtout tenté d’établir un lien entre, d’une part, facilité d’accès aux commerces « sains » et comportement sains, et, d’autre part, « déserts alimentaires » ‒ ces environnements socialement défavorisés offrant un accès limité aux sources d’alimentation saine ‒ et comportements non sains. Les écrits en santé publique manquent cependant de perspective sur les facteurs influençant le lieu et la nature des achats alimentaires dans les situations où les options qui s’offrent aux individus sont multiples, saines et moins saines. Pourtant, dans les villes occidentales caractérisées par une densité de commerces élevée et une mobilité individuelle facilitée, la réunion des conditions d’accès aux commerces d’alimentation « sains » comme moins « sains » est probablement situation courante. Partant de ce constat, cette thèse explore le lien entre environnements et comportements alimentaires dans plusieurs grandes villes canadiennes. En premier lieu, un cadre conceptuel est proposé, qui décrit les multiples facteurs influençant le lieu et la nature des achats alimentaires. Partant du postulat couramment adopté selon lequel les individus cherchent à tirer un maximum de bénéfices de leur environnement, ce cadre souligne l’importance de considérer les caractéristiques des commerces d’alimentation « sains » et « non sains » (ex. localisation, prix) en relation avec les préférences, moyens et contraintes des individus. L’attention est cependant attirée sur la capacité limitée des individus à opérer des choix pleinement informés. En effet, la réalisation de ces choix s’opère parfois sans grande conscience, en réaction à certains stimuli environnementaux. Sont notamment discutées les situations dans lesquelles le caractère approprié d’un comportement alimentaire est implicitement suggéré par i l’environnement. Il est proposé que les densités relatives de commerces alimentaires « sains » et « non-sains » dans l’environnement auquel les individus sont exposés reflèteraient la relative popularité de ces lieux d’achat, et suggèreraient quels types de commerce il est « approprié » d’utiliser. Pour tester la plausibilité d’une telle proposition, cette thèse explore dans quelle mesure le pourcentage de commerces « sains » dans l’environnement des résidents adultes de cinq grands pôles urbains au Canada est associé à leur consommation de fruits et légumes. Les recherches présentées dans cette thèse portent à la fois sur les environnements autour du lieu de résidence (environnement résidentiel) et autour des divers lieux fréquentés par ces individus (environnement non résidentiel). Sont également testées d’éventuelles différences homme-femme dans ces associations, des différences de genre ayant été soulignées dans les recherches s’intéressant à la relation entre environnements et comportements alimentaires. Conformément aux hypothèses émises, une association positive entre pourcentage de magasins « sains » dans l’environnement résidentiel et consommation de fruits et légumes est observée. Une relation plus forte chez les hommes que chez les femmes est également relevée. En revanche, la consommation de fruits et légumes n’est pas reliée au pourcentage de magasins « sains » dans l’environnement non résidentiel et ce, ni chez les hommes ni chez les femmes. En proposant un cadre conceptuel innovant, que viennent en partie conforter les résultats de notre recherche empirique, cette thèse contribue à la construction d’une meilleure compréhension des influences environnementales sur les comportements de santé. Mots-clés: environnement alimentaire; accès; exposition; environnements résidentiel et non résidentiel; comportements alimentaires; fruits et légumes; différences de genre; adultes; Canada. ii Summary In westernised cities where food is mostly acquired in the retail and catering environment, there may be a link between the foodscape - i.e. the multiplicity of publicly available sites where food is displayed for purchase - and where and what we buy and eat. Yet, how the foodscape shapes dietary behaviours remains unclear. Ease and difficulty of access to “healthy” and “unhealthy” food sources has been recognised as central in the foodscape-diet relationship. As a result, empirical research has mostly investigated the associations between ease of access to healthy outlets and healthy behaviours, on one hand, and “food deserts” – deprived environments lacking access to healthy food outlets – and unhealthy behaviours, on the other hand. However, public health literature lacks perspective on the factors that influence where to purchase and what to eat in situations of multiple – healthy and less healthy – choices. Yet, in industrialised urban contexts characterised by pervasive food retail and facilitated individual mobility, conditions for accessing both healthy and less-healthy food sources are probably commonly met. Based on these observations, this thesis intents to explore the relationship between foodscapes and dietary behaviours in Canadian urban areas. Firstly, conceptual insights on the multiple factors shaping where to shop and what to eat are provided. Drawing from the commonly held assumption that individuals operate choices that tend to maximize their self-interests, the proposal highlights the importance of considering food outlets’ characteristics (ex. localisation, price, services offered) relatively to individuals’ preferences, constraints and means. However attention is brought on individuals’ limited ability to operate fully-informed choices. Food choices sometimes unfold without much deliberation, as a result of the mere perception of cues in the environment. Especially discussed are the situations where exposure to cues signaling appropriateness of a dietary behaviour provokes the adoption of similar behaviours. It is then suggested that the relative densities of healthy and unhealthy outlets individuals iii get exposed to may drive a normative message about the relative popularity of these places, and suggest which places are “appropriate” to use. This thesis then investigates the extent to which relative exposures to healthy and unhealthy food outlets are associated to dietary behaviours. Drawing on multiple secondary datasets pertaining to adult residents of five large Canadian cities, associations between the percentage of healthy outlets in the residential neighborhood and fruit and vegetables intake are examined. As literature highlighted gender differences in the foodscape-diet relationship, whether these associations are different for men and women are further investigated. Finally, these investigations extend to the non-residential environment. Consistent with our expectations, our research provides evidence of a positive association between the percentage of healthy outlets around home and fruit and vegetable intake. Stronger associations for men than for women were further observed. However, fruit and vegetable intake was not related to the non-residential foodscape, neither for men nor for women. By providing conceptual justification for, and empirical evidence of, a link between dietary behaviours and relative exposures to healthy and unhealthy outlets, this thesis contributes to better understand how the foodscape shapes dietary behaviours. Keywords: foodscape; access; relative exposure; residential and non-residential environments; dietary behaviors; fruit and vegetable; gender-differences; adults; Canada. iv Table of contents Résumé ......................................................................................................................................... i Summary .................................................................................................................................... iii Table of contents ........................................................................................................................ v List of tables ............................................................................................................................. viii List of figures .............................................................................................................................. ix List of abbreviations .................................................................................................................... x Remerciements .........................................................................................................................
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