Environmental determinants of healthy eating in a Swedish region - Food promotions and the COVID-19 pandemic

Abstract

Purpose: The overall purpose of this thesis was to examine selected food environments in relation to healthy diets in Western Sweden. Specifically, we investigated food marketing and pandemic policy restrictions as environmental factors that can impact diet and lifestyles. Methods: Study I employed a quantitative content analysis of weekly supermarket advertisements. Food promotions were categorized by healthfulness according to the Nordic Nutrition Recommendations and linked to store locations stratified by a socioeconomic index. Categorical data were summarized using frequencies, percentages, and 99% confidence intervals [CI]. Logistic regression analyses assessed the association between area-level disadvantage and the promotion of unhealthy foods. Study II is a qualitative study involving semi-structured interviews with youth participants from the Swedish IDEFICS/I.Family cohort. Topics included diet, physical activity, sleep, and general well-being. Interviews were transcribed verbatim and analyzed using reflexive thematic analysis. Results: In Study I, a total of 488 advertisement sheets were collected over four weeks, comprising 29,958 individual food promotions. Of these, 66.7% were classified as either ‘unhealthy’ or ‘most unhealthy.’ Food items promoted in less advantaged areas had 25% higher odds of being ‘most unhealthy’ (OR 1.25; 99% CI: 1.17–1.33). However, the association was attenuated when adjusting for clustering at the chain. In Study II, fourteen youths aged 15–21 participated. The thematic analysis generated three key themes: Living off the clock – disrupted routines indicate that youths’ organized activities contribute to a daily structure which were disrupted during the pandemic and led to more irregular lifestyle habits. Disconnected yet digitally connected – the remote life paradox reflects that youths spent more time online during the pandemic and became socially disconnected from others than their family members. v Increased household impact on the health of meals refers to how the availability of food in the youths’ living environment changed during the pandemic, which affected their eating habits. Conclusion: These studies highlight how structural factors, such as food marketing practices and pandemic-related disruptions, operate across societal levels, shaping peoples’ food environments, and potentially counteracting healthy eating at the individual level. Further research is warranted to explore how these determinants interact within the Swedish context and to identify leverage points for promoting healthier dietary behaviors.