Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital Tremona Road, Southampton, SO16 6YD, UK.
National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD, UK.
Int J Behav Nutr Phys Act. 2019 Jan 30;16(1):12. doi: 10.1186/s12966-019-0772-y.
To improve population diet environmental strategies have been hailed the panacea because they require little agency or investment of personal resources; this contrasts with conventional strategies that rely on individuals to engage high levels of agency and make deliberate choices. There is an immediate need to improve understanding of the synergy between the psychological and environmental determinants of diet in order to optimise allocation of precious public health resources. This study examined the synergistic and relative association between a number of food environment and psychological factors and the dietary behaviours of a population sample of women with young children.
Women in Hampshire were recruited from children's centres and asked about their demographic characteristics, psychological resources, dietary behaviours (food frequency questionnaire) and perceptions of healthy food access and affordability. Three local food environment factors were objectively assessed: i) spatial access to food outlets using activity spaces; ii) healthfulness of the supermarket where women did their main food shop, (based on nine in-store factors including price, placement and promotion on seven healthy and five less healthy foods); iii) nutrition environment of children's centres visited frequently by the women, assessed via staff-administered questionnaire. A theoretical model linking environmental factors to dietary behaviours, both directly and indirectly through three factors representing individual agency (psychological resources, perceived food affordability, perceived food accessibility), was tested using Structural Equation Modelling.
Complete data were available for 753 women. The environment of women's main supermarket was indirectly related to their dietary behaviours through psychological resources and perceived food affordability. Shopping at supermarkets classified as having a healthier in-store environment was associated with having greater psychological resources associated with healthy eating (standardised regression weight β = 0.14SD, p = 0.03) and fewer food affordability concerns (β = - 0.14SD, p = 0.01), which in turn related to healthier dietary behaviours (β = 0.55SD, < 0.001 and β = - 0.15, p = 0.01 respectively). The three food environment factors were not directly associated with dietary behaviour (p > 0.3). The overall model fit was good (CFI = 0.91, RMSEA = 0.05 [0.05, 0.06]).
This pathway analysis identified three focal points for intervention and suggests that high-agency interventions targeting individual psychological resources when combined with low-agency supermarket environment interventions may confer greater benefits on dietary behaviours than either intervention alone.
为改善人口饮食环境，人们大力倡导采取策略，因为这些策略几乎不需要个人投入精力或资源；而传统策略则依赖于个人投入大量精力，做出深思熟虑的选择。当前，人们急需深入了解饮食的心理和环境决定因素之间的协同作用，以便优化宝贵公共卫生资源的配置。本研究以有年幼子女的女性人群为研究对象，调查了一系列食物环境和心理因素与人群饮食行为之间的协同和相对关联。
在汉普郡，研究人员从儿童中心招募了女性参与者，并询问了她们的人口统计学特征、心理资源、饮食行为（食物频率问卷）以及对健康食品可及性和可负担性的看法。使用活动空间客观评估了 3 个当地食物环境因素：i）食物供应点的空间可达性；ii）女性主要购物超市的健康程度（基于包括价格、放置和促销在内的 9 个店内因素，对 7 种健康食品和 5 种不太健康食品进行评估）；iii）经常光顾的儿童中心的营养环境，通过工作人员管理的问卷进行评估。通过结构方程模型，检验了直接和间接通过代表个体能动性的 3 个因素（心理资源、感知食物负担能力、感知食物可及性）将环境因素与饮食行为联系起来的理论模型。
共纳入 753 名女性，完成了完整的数据采集。女性主要超市的环境通过心理资源和感知食物负担能力间接与她们的饮食行为相关。在被归类为店内环境更健康的超市购物与更有利于健康饮食的心理资源（标准化回归权重β=0.14SD，p=0.03）和更少的食物负担能力担忧（β=-0.14SD，p=0.01）有关，而这些又与更健康的饮食行为相关（β=0.55SD，p<0.001 和β=-0.15，p=0.01）。这 3 个食物环境因素与饮食行为没有直接关联（p>0.3）。整体模型拟合度良好（CFI=0.91，RMSEA=0.05[0.05，0.06]）。
本路径分析确定了 3 个干预重点，并表明针对个体心理资源的高能动性干预措施与低能动性超市环境干预措施相结合，可能比单一干预措施更有益于饮食行为。
