Original Article

Individual and Neighborhood Environmental Factors Affecting Healthy Eating among Korean Rural Adults

Abstract

Background: Although it is recognized that social and environmental factors influence healthy eating behaviors, few studies have investigated the association between environmental factors and healthy eating among rural adults in Korea. We aimed to identify individual and neighborhood environmental factors influencing adherence to fruit and vegetable intake among adults living in rural areas using an ecological approach.

Methods: The study sample comprised 1,582 adults from 38 rural areas from Chungbuk Province, South Korea in 2017 who provided individual- and neighborhood-level data. Neighborhood-level data were obtained by aggregating individual-level responses measured for each residential town resulting in an average value for each neighborhood-level variable for the 38 rural areas. The data were merged and used for a series of multilevel logistic regression analyses.

Results: Among the individual-level factors, age, alcohol drinking, physical activity, self-efficacy for healthy eating, and social support for healthy eating were significantly associated with adherence to fruit and vegetable intake. Among the neighborhood-level factors, social cohesion and perceived neighborhood safety were significantly associated with adherence to fruit and vegetable intake.

Conclusion: Multifaceted intervention strategies to increase consumption of fruits and vegetables should include behavioral modification, social support, and improvement of neighborhood environments.

 

1. World Health Organization (2018). Increas-ing fruit and vegetable consumption to reduce the risk of noncommunicable dis-eases. https://www.scirp.org/%28S%28lz5mqp453edsnp55rrgjct55%29%29/reference/referencespa-pers.aspx?referenceid=2491273
2. Yip CSC, Chan W, Fielding R (2019). The associations of fruit and vegetable intakes with burden of diseases: A systematic re-view of meta-analyses. J Acad Nutr Diet, 119(3):464–81.
3. Korean Ministry of Health & Welfare, Ko-rea Center for Disease Control & Pre-vention (2020). Korea Health Statistics 2019: Korea National Health and Nutri-tion Examination Survey (KNHANES Ⅷ-1). Available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8289475/
4. Sallis JF, Owen N, Fisher EB (2008). Ecolog-ical models of health behavior. In: Health behavior and health education: Theory, research, and practice. 4th ed. Ed, JF Sallis, N Owen, EB Fisher. Jossey-Bass, San Francisco, CA, USA, pp. 465–86.
5. Suglia SF, Shelton RC, Hsiao A, et al. (2016). Why the neighborhood social environ-ment is critical in obesity prevention. J Urban Health, 93(1):206–12.
6. Lucan SC, Hillier A, Schechter CB, et al. (2014). Objective and self-reported fac-tors associated with food-environment perceptions and fruit-and-vegetable con-sumption: A multilevel analysis. Prev Chronic Dis, 11:E47.
7. Gase LN, Glenn B, Kuo T (2016). Self-efficacy as a mediator of the relationship between the perceived food environment and healthy eating in a low income popu-lation in Los Angeles County. J Immigr Minor Health, 18(2):345–52.
8. Dean WR, Sharkey JR (2011). Rural and ur-ban differences in the associations be-tween characteristics of the community food environment and fruit and vegeta-ble intake. J Nutr Educ Behav, 43(6):426–33.
9. Kim SJ, Choi MK (2014). Factors associated with fruit and vegetable consumption of subjects having a history of stroke: Using 5th Korea National Health and Nutrition Examination Survey (2010, 2011). Korean J Community Nutr, 19(5):468–78.
10. Waters CN, Zoellner JM, Estabrooks PA, et al. (2018). Is the availability of healthy foods related to fruit and vegetable con-sumption in a rural, health-disparate re-gion? J Hunger Environ Nutr, 13(3):289–303.
11. Becker TB, Contreras D, Porth O (2021). Differences in eating and physical activity behaviors, and perceived accessibility and availability barriers between midwestern rural and urban adults. J Hunger Environ Nutr. doi:10.1080/19320248.2021.1930318
12. Kim B, Hyun HS (2018). Associations be-tween social and physical environments, and physical activity in adults from urban and rural regions. Osong Public Health Res Perspect, 9(1):16-24.
13. Snijders TAB, Bosker RJ (2012). Multilevel analysis: An introduction to basic and advanced multilevel modeling. 2nd ed. Sage Publications, Thousand Oaks, CA, USA.
14. Clark MM, Abrams DB, Niaura RS, et al. (1991). Self-efficacy in weight manage-ment. J Consult Clin Psychol, 59(5):739-44.
15. Fitzgerald A, Heary C, Kelly C, et al. (2013). Self-efficacy for healthy eating and peer support for unhealthy eating are associat-ed with adolescents’ food intake patterns. Appetite, 63:48–58.
16. Sampson RJ, Raudenbush SW, Earls F (1997). Neighborhoods and violent crime: A multilevel study of collective ef-ficacy. Science, 277(5328):918–24.
17. de Jesus M, Puleo E, Shelton RC, et al. (2010). Associations between perceived social environment and neighborhood safety: Health implications. Health Place, 16(5):1007–13.
18. Echeverria SE, Diez-Roux AV, Link BG (2004). Reliability of self-reported neigh-borhood characteristics. J Urban Health, 81(4):682–701.
19. Kim E, Ju SY (2020). Association of fruit and vegetable consumption with asthma: Based on 2013–2017 Korea National Health and Nutrition Examination Sur-vey. J Nutr Health, 53(4):406–15.
20. Kegler MC, Swan DW, Alcantara I, et al. (2014). The influence of rural home and neighborhood environments on healthy eating, physical activity, and weight. Prev Sci, 15(1):1–11.
21. Dulin A, Risica PM, Mello J, et al. (2018). Examining neighborhood and interper-sonal norms and social support on fruit and vegetable intake in low-income communities. BMC Public Health, 18(1):455.
22. Kawachi I, Berkman LF (2014). Social capi-tal, social cohesion, and health. Soc Epi-demiol, 2:290–319.
23. Liese AD, Bell BA, Barnes TL, et al. (2014). Environmental influences on fruit and vegetable intake: Results from a path ana-lytic model. Public Health Nutr, 17(11):2595–2604.
24. Flint E, Cummins S, Matthews S (2014). Do perceptions of the neighbourhood food environment predict fruit and vegetable intake in low-income neighbourhoods? Health Place, 24:11–5.
25. Glanz K, Sallis JF, Saelens BE, et al. (2005). Healthy nutrition environments: Con-cepts and measures. Am J Health Promot, 19(5):330–33.
Files
IssueVol 52 No 4 (2023) QRcode
SectionOriginal Article(s)
DOI https://doi.org/10.18502/ijph.v52i4.12445
Keywords
Healthy eating Fruit and vegetable intake Neighborhood environment Multilevel analysis

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How to Cite
1.
Kim B, Yi JM. Individual and Neighborhood Environmental Factors Affecting Healthy Eating among Korean Rural Adults. Iran J Public Health. 2023;52(4):747-755.