Linking food insecurity to perceptions of food environments and diet quality: implications for health promotion in regional Australia

Food insecurity is a growing public health concern in Australia; yet, health promotion programs aimed at creating supportive food environments have received limited attention. This study examined how perceptions of the food environment and perceived diet quality differ by food insecurity status, offering insights to guide Ottawa Charter-aligned health promotion strategies in regional Australia. An online cross-sectional study was conducted among adults residing in the Illawarra/Shoalhaven regions of Australia. Food insecurity was assessed using the 18-item USDA Household Food Security Survey Module (HFSSM). Perceived food environment was measured with 11 Likert-scale questions (1 = strongly agree to 5 = strongly disagree) covering food availability, accessibility, affordability, and advertising. Perceived diet quality was assessed using a single self-rated question (1 = excellent to 5 = poor), alongside reported daily servings of fruits, vegetables, and sugar-sweetened beverages (SSBs). A binary food insecurity variable (food secure HFSSM = 0; food insecure HFSSM ≥1) was used to examine associations using linear regression, adjusting for relevant sociodemographic variables. Of 666 respondents, 38% (n = 255) experienced food insecurity (8% marginal, 19% moderate, 12% severe). Food-insecure respondents reported poorer perceptions of their overall food environment (β = 0.38; 95% CI: 0.25, 0.51), including significantly poorer perceptions of the availability of healthy food, food accessibility, and food affordability. They also reported lower perceived diet quality (β = 0.33; 95% CI: 0.15, 0.50), lower vegetable intake, and higher intake of SSBs. This study is the first to demonstrate that food insecurity is associated with poorer perceptions of the food environment and diet quality in regional Australians, underscoring the need for coordinated and multi-sectoral health promotion programs.