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Document Type

Open Access Dissertation

Degree Name

Doctor of Philosophy (PhD)

Degree Program

Public Health

Year Degree Awarded

2018

Month Degree Awarded

May

First Advisor

Nancy Cohen

Second Advisor

Elena Carbone

Third Advisor

Bethany Bradley

Subject Categories

Community Health | Environmental Studies

Abstract

The overall diet quality of U.S. older adults is less than optimal, featured by inadequate fruits and vegetables (FV), whole grains and dairy, and excessive sodium and fat. The current food environment can be challenging for older adults to improve their FV consumption. Both perceived and observed food environments are linked to FV consumption and health outcomes such as Body Mass Index (BMI) with mixed results. My research was guided by a social-ecological framework and the theory of planned behavior (TPB) to identify environmental supports for FV consumption in older adults. Adults aged 60 and older in Massachusetts, Iowa, and Illinois completed a survey on their perceptions of the food environment related to enablers of FV consumption (facilitators of behavioral change such as accessibility and affordability), and their attitudes, subjective norms (SN), perceived behavioral control (PBC), intention, and FV intake, which are all constructs of TPB. We also assessed the food environment and its impact on FV intake and BMI in older adult respondents of the 2015 Behavioral Risk Factor Surveillance System in western Massachusetts. Overall, participants perceived their food environment for FV consumption positively. Respondents from all participating states perceived accessibility as the most important enabler, followed by affordability, transportation, social support and living accommodation/assistance. Supermarkets were rated the most important behavioral setting across all study sites. Participants proposed recommendations for improvement to address availability, accessibility and affordability of FV, and food quality. PBC was positively associated with intention to meet FV recommendation, fruit intake and vegetable intake while SN was negatively associated with fruit intake. PBC was positively associated with total FV intake only in participants who rated perceived accessibility positively. No significance was found between observed environmental enablers and FV intake or BMI. Weak evidence suggested that the ratio of healthful food retailers was negatively associated with meeting the dietary recommendation for FV. Future research will benefit from a design that combines both individual and environmental determinants of FV consumption in older adults. Improved assessment of perceived and observed food environments will enhance the strength of studies that investigate the effects of the community food environment on dietary intake.

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