Exploring relationships between changing food environments, food consumption behaviour, attitudes and nutrition outcomes for urban Vietnam

Abstract

Food systems in Vietnam are transforming due to economic development, urbanisation, increasing disposable incomes and related changes in consumer food purchasing and consumption behaviour. As a result, the food retailing sector in Vietnam has been undergoing a rapid growth in the number of modern food retail outlets, including hypermarkets, supermarkets, and mini-markets or convenience stores. Design of effective policy approaches to address potential adverse nutrition outcomes related to these changes requires an understanding of the interrelationships between urban food market environments, food shopping and consumption behaviour, attitudes and concerns about food safety and nutrition, and nutrition outcomes. This thesis attempts to empirically disentangle these relationships for urban Vietnam. The main empirical chapters of this thesis use a novel primary dataset from the Vietnamese Urban Food Consumption and Expenditure Study (VUFCES), which includes individual-level information from 1,700 urban households in the two largest cities of Vietnam: Hanoi and Ho Chi Min City. The VUFCES was conducted in 2016 – 2017 by a team of researchers, including the author of this thesis. Data collection methods included a household survey and 24-hour food diaries of the food and beverages consumed by each household member. The first study explores the relationship between urban households’ choice of food retail format, household income and time constraints, and household food quality and safety concerns. No significant relationship is found between concerns about food safety and food expenditure shares at different retail outlets. Concerns about food prices and freshness are negatively associated with food expenditure shares at modern retail outlets. The second study examines the relationships between three dimensions of food access (affordability, accessibility, acceptability), caloric (energy) intake and share of calories from carbohydrates, protein and fat for individual adults. Increasing disposable income is associated with higher caloric intake; possibly due to a substitution of carbohydrates with protein and fat. Further distance to wet market is associated with a higher share of calories from fat for individuals from lower income households. Greater nutrition concern is associated with lower caloric intake and a lower share of calories from fat. In the third study, we provide insight on the interrelationships between nutrition label use, health concerns, and consumption of food and beverages with added sugars for adults and adolescents. Nutrition label use and health concerns about sugar are significantly associated with a lower share of calories from sugars. Policies aiming to improve food safety through food market modernisation are likely to have heterogenous, and perhaps unintended consequences for different subgroups of the urban Vietnamese population. Rather than encouraging food market modernisation, the Vietnamese Government should focus on improving the market conditions of traditional outlets and increasing their competitive position relative to modern retail outlets. Providing good market access, is necessary to maintain an adequately balanced diet. Finally, nutrition labelling could also be an effective policy mechanism to reduce the negative health impacts of increasing availability and consumption of food and beverages with added sugars.