The interaction between individual, social and environmental factors and their influence on dietary intake among adults in Toronto

Health outcomes related to vegetable and fruit consumption are widely recognized in the literature. This study investigates how dietary intake is influenced by individual, social, and environmental factors in the Toronto Census Metropolitan Area. The analysis and findings are based on data from the Canadian Community Health Survey which provides self-reported vegetable and fruit intake from 6,513 adults in 2009-2010. Food environment measures were constructed from commercial databases using kernel density estimates and network drive times. Spatial and multivariable techniques were used to determine the associations between diet, the food environment, and other health and socioeconomic factors. Particular emphasis was given to understanding the interaction between the food environment and socioeconomic position. Unexpectedly, supermarket density was found to have an inverse association with vegetable and fruit intake. Interaction terms for individuals with low income and reduced mobility produced different responses in men and women, confirming that the influence of the food environment is not uniform for all subgroups.