Healthy eating in globalized food environments: market access and consumer behavior in the Galápagos Islands of Ecuador

Food environments are the interface between food systems and consumers. Although market access contributes to diet intake, consumer behavior determines food acquisition practices yet is often neglected in food environment research. Implementing sustainable food system transformations in climate-vulnerable, trade-dependent settings requires effective integration of both geographic and experienced-based measures of access. This study in the Galápagos Islands (i) develops measures for geographic and experience-based food environments (EFEs) and (ii) links diet outcomes to these food environment measures independently and when interacted. Cross-sectional household data including diet recalls come from 388 participants in the Healthy Family Study from San Cristóbal Island, Galápagos in 2018. Geocoded market inventory and price data were obtained in 2018 using the Nutritional Environment Measurement Survey for Stores (n = 60). Geographic food environments were created from market scores and distribution. EFEs were based on factor analyzed consumer behavior strategies. Diet quality was defined using the global dietary recommendations score. Adjusted linear regressions tested the relationships between diet and food environment measures and included sociodemographic covariates. Interactions between geographic and EFEs were tested. This study showed that higher prioritization of convenience when food shopping was associated with lower healthy food intake. However, the relationship between food environment measures and diet is strongly modified by consumer behavior. For convenience-prioritizing households, the nearest market proved most associated with healthy diet outcomes. For households with a food-driven purchasing strategy, the preferred market was most associated with healthy diet outcomes. These findings show that market inventory can be healthful or deleterious to diets, depending on how individuals navigate their food environments. Empirical measures of food access that neglect to consider consumer behavior may fail to capture realistic representations of food environment and diet relationships. These findings underscore the importance of tailoring food system changes to incorporate context-specific consumer behavior.