SPATIAL AND SOCIAL DIMENSIONS OF GALAPAGOS FOOD ENVIRONMENTS: A MIXED METHODS STUDY OF DIET QUALITY

Food environments encompass the built and social dimensions that inform food acquisition, preparation, and consumption. Having poor access to healthy food options is commonly associated with poor diet quality and deleterious health outcomes. However,differences persist between dietary implications of perceived versus measured food environments. In short, dietary intake is a function of more than the food options “out there” and consumer behavior can be an important modifier of the food environment-diet relationship. This dissertation employed a mixed methods research design to explore food environments, diet outcomes, and perceptions of healthy eating in San Cristobal Island, Galapagos, Ecuador. Located 1,000km away from the continent, Galapagos residents rely heavily on food imports to supplement limited local food production. Data on food inventory and prices was collected for all local markets (n=60) in 2018. Data collected from 388 individuals included dietary assessment, sociodemographic data, and household food purchasing strategies. Four sex-specific focus groups in 2022 obtained information concerning food-shopping habits, perceptions of and perceived barriers to healthy eating, and the effects of the COVID-19 pandemic on diets and health. This aims of this dissertation were: (1) describe Galapagos food environments using a novel geospatial measurement tool and define consumer behavior types, (2) determine whether consumer behavior modifies the association between market access and diets, and (3) ivcharacterize community perceptions of and barriers to healthy eating. Spatial patterning of market access differed by consumer behavior type. Market inventory was associated with diet outcomes and effect medication existed based on household relationships to markets. For households that prioritize convenience when food shopping, the nearest market was most associated with diet. For households with food-driven purchasing strategies, the preferred market was most associated with diet. Thematic network analysis of qualitative data showed that perceived reliance on food imports is based on individual definitions of “access” and bottlenecks across the food supply chain are the biggest impediment to healthy eating, especially during the COVID-19 pandemic. This dissertation linked spatial measures of market access to consumer behavior within the context of community-sourced perceptions of healthy eating. This approach provides a blueprint for future research in similar settings to tailor potential food environment interventions to community-oriented perspectives and behaviors.Doctor of Philosoph