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Journal of Hunger & Environmental

Nutrition
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Sustainable Food Activities Among

Consumers: A Community Study
a

Mary K. Griffin & Jeffery Sobal

a

Arnot Ogden Medical Center , Elmira , New York , USA

Division of Nutritional Sciences, Cornell University , Ithaca , New

York , USA
Published online: 21 Nov 2013.

To cite this article: Mary K. Griffin & Jeffery Sobal (2013) Sustainable Food Activities Among
Consumers: A Community Study, Journal of Hunger & Environmental Nutrition, 8:4, 379-396, DOI:
10.1080/19320248.2013.816995
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Journal of Hunger & Environmental Nutrition, 8:379396, 2013

Copyright Taylor & Francis Group, LLC
ISSN: 1932-0248 print/1932-0256 online
DOI: 10.1080/19320248.2013.816995

Sustainable Food Activities Among

Consumers: A Community Study
MARY K. GRIFFIN1 and JEFFERY SOBAL2
1

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Arnot Ogden Medical Center, Elmira, New York, USA

Division of Nutritional Sciences, Cornell University, Ithaca, New York, USA

Consumers engage in many types of sustainable activities. A mail

survey of 663 adults in one community examined the practice of
sustainable food activities. Respondents participated in an average
of 3 of 13 types of sustainable food activities, with women, older,
and more educated consumers participating more frequently.
Sustainable food activity participation was associated with few
health conditions, except that food allergies were associated with
more involvement in farmers markets, choosing organic foods,
being vegetarian, and composting. These findings suggest that particular demographic categories of individuals and health problems
may lead to greater involvement in sustainable food activities.
KEYWORDS sustainable, consumers, health, food, environment,
community, allergies, organic, vegetarian, farmers market

INTRODUCTION
Sustainable food systems are conceptualized in a variety of ways by different groups of people.18 Sustainable food systems have a variety of
impacts and outcomes, including environmental, social, economic, and
nutritional. Movement toward greater food system sustainability requires
both changing the system itself as well as changing the way consumers
use the system. There has been considerable discussion and analysis of
sustainable food production, processing, and distribution. Less attention has
The authors thank the Division of Nutritional Sciences at Cornell University for partially
funding this project, and Thomas Lyson and Jennifer Wilkins for suggestions.
Address correspondence to Jeffery Sobal, Division of Nutritional Sciences, Cornell
University, Savage Hall, Room 407, Ithaca, NY 14853, USA. E-mail: js57@cornell.edu

379

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380

M. K. Griffin and J. Sobal

been given to the sustainability of consumer food acquisition, preparation,

and consumption activities or the impact of such behaviors on health outcomes. This study makes a preliminary attempt to examine the prevalence
and patterns of selected sustainable food activities among consumers and to
assess associations between those activities and selected health conditions.
Sustainability balances concerns about environmental quality, economic
vitality, and social justice among all sectors of society and has social,
economic, and ecological dimensions.9 Strategies for achieving sustainable
food and nutrition systems have been introduced within each dimension.
Strategies in the social dimension include programs that preserve and promote the family farm lifestyle, the economic viability of rural communities,
local food production and consumption, and community food security.3
Changes in the economic dimension include increased family farming,10 commitment to purchasing local foods, new market networks such as direct
contact between farmers and consumers,11,12 and increased involvement
of consumers in agriculture and food preparation.12 Ecological dimension
changes include diversification of crops,13 as well as production of organically grown foods, consumption of fresh and minimally processed whole
foods of plant origin, and eating a seasonal diet.1
The current postindustrial food system is characterized as resource
intensive, vertically integrated, globalized, commercialized, and ecologically
damaging.14,15 Relocalization of food systems has been encouraged to promote sustainability,16 including many activities that individual consumers can
engage in.10
Consumers play a critical role in fostering food system sustainability.
Public participation in the food system is encouraged by eating in local
foodsheds17 and by making efforts to conserve energy and resources
by shortening commodity chains.18,19 Delineating which consumer food
activities are sustainable is highly problematic. What may be sustainable
in one food system at one time for one person may not necessarily
be sustainable for another. Activities most frequently cited as supporting
food system sustainability are organic food production,20,21 participation in
local production and consumption venues such as farmers markets, community gardens, food cooperatives, and community-supported agriculture
(CSA);15,16,2228 shopping at organic, natural, or health food stores;29,30
vegetarianism;3032 and reducing and recycling food waste.16,33,34 Other activities that may be considered sustainable are home food preservation, because
this practice may use local and homegrown foods,24,35 and self-production
through hunting and fishing,36 which contributes to low-input acquisition
and locally based food systems. Sustainable food behaviors of reusing bags,
reusable products, composting, and recycling are associated with ecological
sensitivity.37
In this investigation, the conceptual framework for examining
sustainability was grounded in systems theory, which provides a framework

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Sustainable Food Activities Among Consumers

381

for examining interrelationships among events and organisms.38 Systems theory holds that activities that produce quite different outcomesfor example,
hunting and food shoppingare interrelated because they influence central
outcomes of food behaviors, such as the environment and human health.
The food system provides a common framework that encourages holistic
and interdisciplinary examinations of food, eating, and nutrition.
Sustainable consumer food system participation may be associated with
better or worse health of the people involved in the system. Two mechanisms
may be operating in a sustainable food activity and health relationship: selection and causation.39,40 Selection occurs when people with health problems
(or those trying to prevent them) engage in more sustainable food activities, such as when people who feel at risk for cancer eat more organically
grown foods.41 Causation occurs when people who engage in sustainable
food activities improve their health as a result of their participation, such as
when people who become vegetarians lose weight42 or those who garden
lower their blood pressure.36
Sustainable food activities are thought to contribute to improved human
health in several ways.24,36,43 Home and community gardening have been
associated with improved high-density lipoprotein cholesterol,36,44 lower
blood pressure,36 greater fruit and vegetable consumption,24,45 and greater
overall nutrient intake.36 CSA participation is also associated with eating more
fruit and vegetables.46 Food preservation may also be linked with higher
nutrient intake.35 Positive social outcomes have also been associated with
gardening, including community building through helping others and food
sharing, increased social interactions, and greater life satisfaction.24,26 Both
selection and causation may occur simultaneously, and it is methodologically difficult to definitively sort out the contribution of each. However,
some data may support or minimize one type of mechanism over the
other.
Despite the central role that consumers play in food system
sustainability, little data about consumer participation in sustainable food and
nutrition activities are available at the community level. Literature searches
of the nutrition, food science, medical, economics, consumer science, and
sociological bibliographic databases reveal few studies. Most of the focus
has been on institutional and organizational membership and changes to
achieve sustainability,37 and consumer participation can be described as
a black box in existing data about sustainability. The present investigation therefore attempted to (1) characterize the prevalence of a variety of
selected sustainable consumer activities, their interrelationships, and demographic predictors in one community and (2) examine associations between
sustainable consumer activities and a variety of health conditions, controlling
for demographic characteristics, in one community. The goal was to provide
groundwork that could contribute to further knowledge about sustainable
consumer food behaviors.

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M. K. Griffin and J. Sobal

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METHODS
The cross-sectional mail survey was conducted on a sample of residents in
one county in Upstate New York in 1999.47,48 The survey sought to quantify
the number of county consumers who participate in behaviors and practices at multiple stages of the food and nutrition system, including those
that contribute to sustainability, and to examine food system associations
with health conditions. The study was approved by Cornell Universitys
institutional review board.
Respondents were asked whether they engaged in 13 potentially
sustainable food activities: gardening; hunting; fishing; home food preservation; grocery shopping at sustainable food retailers (stores selling primarily
locally grown, organically grown, or whole foods); identifying organic or
ecological food choice considerations as important when grocery shopping;
membership in a food co-op, a CSA farm, or a community garden; going to
the farmers market; practicing vegetarianism; and composting food waste.
These activities were chosen based on a review of the agriculture, nutrition,
economics, food marketing, and sociology literature on sustainable food systems. The survey content was also reviewed by a nutritional biochemist, a
rural sociologist, a community nutritionist, and an agriculture extension specialist and revised based on their comments. It should be noted that reported
participation in sustainable activities, and not motivations for such participation, were investigated. For the purposes of this analysis, we regarded
consumer engagement in activities that contributed to a locally based, environmentally sound, and socially just food system as sustainable, regardless
of intention for participating in such activities.
Additionally, a sustainability index was developed to permit analysis of
multiple sustainable food activities together. This index was constructed by
summing the number of sustainable activities for each person. The index
has possible values of 0 to 13, where each persons score representing the
number of sustainable activities they performed. The minimum value was
zero because there were no activities in the sustainability index in which
consumers had to participate. The internal reliability coefficient for the index
had an alpha of .67.
Respondents answered questions about having 12 health conditions,
including high cholesterol, obesity, hypertension, food allergies, heart disease, diabetes, anemia, heart attack, cancer, food poisoning, bulimia, and
anorexia nervosa. These illnesses were chosen based on their prevalence
in the United States (ie, obesity, hypertension, heart attack), their association with diet as a contributing factor (ie, high cholesterol, cancer, food
poisoning, heart disease), and the role of diet and nutritional status in
treatment (ie, anemia, diabetes, eating disorders, food allergies). Openended questions asked respondents to self-report body weight and height.
Body weight and height were later converted to body mass index (BMI)

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Sustainable Food Activities Among Consumers

383

to measure obesity in the sample, with individuals with a BMI 30

identified as obese.49 Respondents also self-reported overall health status,
rating it as either excellent/good or fair/poor. Self-reported health is a valid
measure of health status50,51 and appears to be a good predictor of morbidity and mortality.52 Finally, a series of 8 demographic questions were
asked, including gender, ethnicity (Caucasian, African American, Hispanic,
Asian American, and Native American), age, household size, marital status,
employment, educational achievement, and student status.
The survey was mailed to a sample of county residents randomly
selected from an address database of telephone numbers supplemented with
automobile registrations to reduce selection bias against residents with no
phone or an unlisted phone number. The sample was drawn by a commercial sampling firm. The total design method53 was employed to maximize
response rate, with a postcard reminder and 2 follow-up letters sent to
nonrespondents. From the initial mailing and postcard follow-up, 449 surveys
were completed, 4 individuals refused to participate, and 125 were undelivered because the addressee had died or left no forwarding address. The
second mailing produced 173 completed surveys, 7 refusals, and 25 undeliverables. From the third mailing, 45 surveys were completed, 5 refused to
participate, and 19 were undelivered. A total of 667 surveys were completed,
giving an overall response rate of 65% of deliverable surveys. No gender,
race, or educational differences existed between the 3 mailings, but older
people responded more to earlier mailings (P < .05). Four respondents were
excluded because they were under 18 or did not live in the county. The final
sample size was 663.
Multivariate logistic regressions were used to examine the aggregate
independent effects of demographic characteristics on sustainable food activities and health conditions. Regression diagnostics were run for each of the
models,54 and chi-square analyses confirmed significance for those models
that were not good fits to the data.
Chi-square tests were used to examine whether participation in individual sustainable food activities was related to nutrition and health conditions.
There was an increased risk of type I error due to the large number of
multiple comparisons made, so significance was reported at .05, .01, and
.001 to permit readers to individually consider type I error risk.55 Finally,
the sustainability index was regressed on the demographic variables using
multiple linear regression. The index was also used as a predictor variable
for analysis of health conditions.

RESULTS
Sample Characteristics
The sample was almost evenly split by gender, and the majority of respondents (84%) were white (Table 1). The mean age of the sample was 46

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M. K. Griffin and J. Sobal

TABLE 1 Demographic Characterization of the Sample

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Characteristic
Gender
Female
Race
White
Age
Household size
Marital status
Currently married
Employment status
Currently employed
Education
High school or less
Some college or higher education degree
Student status

Sample
47%
84%
Mean = 46 years
Mean = 2.6 people
47%
66%
20%
80%
16%

17 years, and the mean household size was 2.6 2.7 persons. Approximately
half (47%) of the sample was married. Two thirds of respondents were
employed (66%). Over 60% had a bachelors degree or higher (61%), and
16% were currently students. Comparing the sample demographics with the
census data for the county revealed that the survey sample was fairly representative with respect to gender, race, and household size. However, the
sample tended to be older and more likely to be employed than the population. Educational achievement was also higher in the survey sample. This
might be explained by the lower percentage of students in the sample compared with the student population reported by the US Census.

Sustainable Food and Nutrition Activities

Responses to the questions that assessed participation in sustainable food
and nutrition activities are shown in Table 2. Many (57%) had visited the local
farmers market within the past year, and a large number (42%) also ranked
ecological issues as very or somewhat important food choice considerations. Women and older people more often participated in both activities,
and consumers with more education also more often visited the farmers market. Over one third of respondents (36%) reported that they grew a fruit or
vegetable garden or composted food waste (36%). None of the demographic
variables were significant predictors of gardening, indicating that gardening
was fairly homogeneous across this population. Respondents living in households with more people were significantly more likely to compost. Nearly
one third of the sample rated organically grown foods as an important food
choice factor (31%), with women, non-whites, older people, and people
who were employed more likely to consider buying organic foods. Onequarter (25%) stated that they preserve foods. Women, older people, and

385
0.07
0.39
0.32
0.26
0.24
1.32
0.73

1.55
1.35
1.07
0.57
0.52
0.65
1.33

10.9
11.0
10.6
9.6
4.0

2.9 (19)

2.3 (15)

(72)
(71)
(69)
(63)
(26)

0.34

0.47
0.22
0.73

0.32
0.24
0.70

36.0 (233)
35.8 (232)
30.8 (197)
0.64

0.05

0.53

42.2 (267)

24.6 (157)

0.09

0.97

57.1 (374)

0.03

0.03

0.03
0.02
0.01
0.01
0.01

0.02

0.01
0.01
0.03

0.02

0.02

Age

8.37

0.79
0.42

0.10
0.01

7.90

1.39
0.38
0.26
2.02
7.42

0.03
0.00
0.02
0.20
0.46

0.12
0.43
0.43
0.74
0.73

0.45
0.10
0.86

0.56

0.43

Employment
(working)

0.43

0.11
0.12
0.15

0.11

0.16

Marital
(married)

0.06

0.01

0.07
0.02
0.02

0.03

0.04

Household
size

0.35

0.13

0.27
0.46
0.41
0.00
0.12

0.23

0.07
0.06
0.10

0.05

0.43

Education

8.39

8.55

1.15
2.46
1.34
2.19
7.33

0.15

0.11
0.57
0.71

0.39

0.03

Student

a
Cell numbers are regression coefficients (betas) from logistic regressions. Sustainable activity is the dependent variable. Dependent variable coding: 0 =
no participation, 1 = participation.
Significant at P .05; P .01; P .001.

Farmers
market
Ecological
foods
Compost
Garden
Organic
foods
Preserve
food
Co-op
Hunt
Fish
Vegetarian
Sustainable
shopper
Community
garden
CSA

Race
(white)

Gender
(male)

Response
(%)

Demographic variables

TABLE 2 Sustainable Food Activities by Demographic Characteristicsa

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M. K. Griffin and J. Sobal

those with more education were more often involved in preserving foods.
Few reported hunting (11%) or fishing (11%) for food or shopping at the food
cooperative (11%). Men and individuals with fewer years of education more
often reported hunting or fishing for food, but women, older consumers,
the employed, and the more educated more often belonged to the food
co-op. Almost 10% of the sample was vegetarian, with vegetarianism more
prevalent among the unmarried, the employed, and the student population.
A small number (4%) fit into the category of sustainable grocery shopper,
representing individuals who grocery shopped principally at the co-op, the
farmers market, or health food stores. No demographic characteristics were
associated with sustainable shopping. Very few belonged to a community
garden (3%) or a CSA farm (2%). Non-whites and consumers living in larger
households were more likely to belong to a community garden, and women
were more likely to belong to a CSA.
To measure broader participation in sustainable food system activities,
a sustainability index was developed to quantify the number of sustainable
activities consumers participate in. This index had a possible range of scores
from 0 to 13. Figure 1 shows how the sample of county consumers scored on
the index. The mean score was 2.7 2.1 activities. The maximum number
of sustainable activities performed within the sample was 9. Almost 16% of
this sample was not involved in any sustainable practices, and only 1% was
involved in 9.
The index was regressed on demographic characteristics to determine
whether demographics influence the number of sustainable activities a consumer participates in (Table 3). Being a woman, older, and employed was
associated with greater involvement in sustainable food system practices.

Number of participants

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386

FIGURE 1 Sustainability index scores. Sustainabilty Index = Sum of an individuals sustainable

food activities. The mean Sustainability Index was 2.7 2.1 behaviors.

387

Sustainable Food Activities Among Consumers

TABLE 3 Sustainability Index by Demographic Variablesa
Demographic variables
Gender Race
(male) (white)

Age

Sustainability 0.71 0.03 0.02

Index

Houshold Marital Employment

Student
size
(married) (working) Education (student)
0.01

0.14

0.88

0.05

0.31

a Cell

numbers are regression coefficients (betas) from linear regression. Sustainability index is the dependent
variable.
Significant at P .01; P .001.

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Health Measures
Data about the health conditions measured here are shown in Table 4.
Obesity, hypercholesterolemia, and hypertension were the most frequently
reported nutritional problems, each reported by 16% of respondents. The
average BMI of the sample was 24.61 5.16 for women and 26.27 4.39 for
men, which is within the overweight but not obese BMI range for people
of average height (65 ). Nearly 11% of the sample reported having food
allergies, and 8% reported cases of heart disease. Five percent of respondents stated that they had diabetes, less than 5% of the sample reported
anemia, and less than 4% reported that they had experienced a heart attack.
Cancer was reported by only a few (3%) respondents, and food poisoning
was reported by only 2%. Similarly, a very small number of respondents
(n = 4) reported having bulimia nervosa. None of those surveyed reported
having anorexia nervosa, which was anticipated because this illness is rare
and frequently denied by those who have it. Over 80% reported that their
overall health was excellent or good (81%).

Sustainability and Health Conditions

Controlling for demographics, sustainable activities were also compared with
health conditions to test the hypothesis that sustainable food and nutrition
activities are associated with fewer negative health conditions. Bivariate and
multivariate results are shown in Table 4.
Preserving foods was positively associated with high cholesterol.
Shopping at the farmers market, composting, choosing organic foods,
and vegetarianism were positively associated with food allergies. Choosing
organic foods and going to the farmers market were also negatively associated with cancer. Community gardening was associated with more reported
cases of diabetes. There was a significant association between vegetarianism
and bulimia; however, this finding should be interpreted with caution given
the small number of positive cases of bulimia in the sample.
The sustainability index was compared with each nutrition and health
problem to determine whether a persons score on the sustainability index

388

0.19

0.05
0.45
0.76
0.48
0.37
0.01
0.33
1.12
0.02

8.50

0.14

16.0

15.9
15.6
10.5
7.8
5.2
4.7
3.7
3.2
1.9

0.6
0.0
81.0

1.43

0.15

0.03
0.06
0.19
0.47
0.85
0.58
0.27
0.64
0.69

0.29

10.20

0.19

0.09
0.15
0.23
0.66
0.46
0.25
0.77
1.01
0.59

0.15
0.46
0.68
0.40
0.14
0.11
0.73
0.21
0.85
1.88

0.31

0.03

0.16

2.11

0.42

0.16
0.05
0.62
0.04
0.08
0.41
0.25
2.40
0.59

0.29

1.41

0.16

0.13
0.26
0.16
0.49
0.64
0.20
0.54
0.27
0.24
0.38
0.12
0.39
0.13
0.13
0.56
0.17
0.12
6.38

0.31
0.06
0.44
0.40
0.56
0.13
1.62
0.38
0.18

2.01 7.60 7.56

0.21 0.09 0.13

0.45
0.04
0.23
0.14
1.08
0.71
0.48
8.00
0.50

0.48 0.56 0.19

Fish

6.22
0.31
0.12
0.11
0.47
0.24
7.01
7.29
0.22
7.91

6.48

3.13

0.77

0.47

Sustainable
shopping

0.21
0.01
0.91
0.37
0.04
0.22
7.43
7.42
1.15

0.47

Vegetarian

7.37

0.65

0.69
1.11
0.82
5.15
1.77
0.00
6.86
7.12
1.66

0.12

Community
garden

7.65

5.24

0.59
0.67
0.28
5.42
1.87
5.08
7.01
7.76
0.93

0.83

CSA

a Cell

numbers are regression coefficients (betas) from logistic regressions. Health condition is the dependent variable. Dependent variable coding: 0 = condition not reported, 1 =
condition reported.
Significant at P .05; P .01.

High
cholesterol
Obesity
Hypertension
Food allergies
Heart disease
Diabetes
Anemia
Heart attack
Cancer
Food
poisoning
Bulimia
Anorexia
Self-reported
health

0.54

Frequency Farmers Ecological

Organic Preserving
(%)
market
foods
Compost Gardening foods
foods
Co-op Hunt

TABLE 4 Health Conditions by Sustainable Food Activitiesa

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Sustainable Food Activities Among Consumers

389

TABLE 5 Correlations of Health Conditions With the

Sustainability Indexa

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Health condition

Adjusted sustainability index

High cholesterol
Obesity
Hypertension
Food allergies
Heart disease
Diabetes
Anemia
Heart attack
Cancer
Food poisoning
Bulimia
Anorexia
Self-reported health

0.04
0.03
0.01
0.13
0.09
0.17
0.05
0.26
0.33
0.21
0.56

Cell numbers are regression coefficients (betas) from logistic regressions. Health condition is the dependent variable.
Dependent variable coding: 0 = condition not reported, 1 =
condition reported.
Significant at P .05; P .01.

was associated with health. Table 5 shows the logistic regression coefficients for the sustainability index and health conditions, after adjusting for
demographics. The index was positively associated with bulimia and food
allergies; that is, the higher a person scored on the index, the more likely he
or she was to report these illnesses. However, the number of cases of bulimia
was so small that the regression model shown here did not satisfactorily
fit the data. The index score was negatively associated with cancer, meaning that individuals who participated in more sustainable food and nutrition
activities reported significantly less cancer. The number of cancer cases was
also small, but this result was also supported by bivariate chi-square tests
with individual sustainable activities, so this association may warrant future
examination with a larger sample size. The sustainability index was positively
associated with reported food allergies.

DISCUSSION
This study provided a portrait of sustainable food system participation in one
community. Our findings revealed that the most popular sustainable food
activities among consumers spanned the food system and contributed to all
3 dimensions of a sustainable food system: social (through farmers market
patronage), economic (through organic and ecological food choice considerations), and ecological (through composting and gardening). In addition,
this investigation revealed a selection mechanism through which food system
participation and health may be related.

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M. K. Griffin and J. Sobal

On average, consumers in this sample were involved in about

3 sustainable food activities. Women, older, and more educated consumers
more often participated in sustainable food practices. Overall sustainable
food activity participation may be higher than reported here, because this
investigation focused on individual participation rather than total household
participation.
Numerous demographic characteristics were associated with individual
sustainable food activities. Women more often belonged to a CSA farm or
the food co-op, preserved foods, went to the farmers market, and were
concerned with buying organic or ecologically friendly foods, whereas men
more often hunted and fished for food. This may reflect gendered food roles
in society in which hunting and fishing are seen as male activities56,57 and
women are responsible for food acquisition and preparation.58 Non-white
ethnicities were more likely to consider buying organically grown foods or
belong to a community garden, possibly because of the close proximity of
organic food stores, markets, and community gardens to minority neighborhoods in this community. Older consumers more often preserved foods,
visited the farmers market, were members of the food cooperative, and
ranked organic and ecological food choices as important, perhaps because
of increased awareness of health or environmental issues or their associations
with traditional activities of the past. This contrasts with previous work30,59
that found that younger people were more concerned with the environment.
Larger households more often composted and engaged in community gardening, perhaps because there were enough individuals to achieve an economy of scale that permitted their efforts to be perceived as more worthwhile.
The employed more often chose organic foods, shopped at the co-op, and
were vegetarian, likely because these individuals had sufficient finances for
purchasing organic, co-op, or vegetarian foods. People with more education
more often went to the farmers market or belonged to the co-op, whereas
people with less education more often hunted, fished, and preserved food.
Consumers with more education may be more aware of environmental issues
or possess sufficient resources for participating in sustainable food activities,
whereas those with less education may have fewer resources to spend on
food and so produce and process more of their own food.
A few apparent disparities in the data warrant further discussion. Nearly
one third of consumers responded that ecological and organic considerations
were important factors in their food shopping choices, but few reported
belonging to the food co-op (11%) or shopping at natural food stores (4%),
where such foods are most likely to be found. Consumer science theory
acknowledges existing disparities between consumer attitudes and consumer
behaviors,60 which may explain the results in this sample.
Sustainable food activities were associated with a few health outcomes,
supporting the systems theory postulate that seemingly independent activities

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are interconnected through their influence on the external environment.38

Consumers who visited the farmers market, chose organic foods, practiced
vegetarianism, and composted reported more food allergies. Perhaps individuals with allergies increased participation in these activities as a way to
achieve greater control over their food supply and intake. Shopping at the
farmers market and considering organically grown foods were associated
with fewer cases of cancer. Most foods marketed at farmers markets are
whole fruits and vegetables, and increased fruit and vegetable consumption
is a preventive risk factor for cancer.6163
Sustainability index scores were positively associated with food allergies, suggesting a higher prevalence of allergies among consumers who
participate in more sustainable food activities. This contrasts with prior literature that found that sustainable food activities were associated with good
health.24,36,44 However, sustainability index scores were negatively associated
with cancer, indicating that sustainable food activities and positive health
outcomes are also linked. This suggests that both selection and causation
mechanisms may operate in this community to link health and sustainable
food system participation and that future research is needed to examine these
processes.
Several limitations of the study need to be considered when interpreting these findings. This investigation used a cross-sectional design, which
can reveal associations but not demonstrate direction of causality between
sustainable food activities and health. Only a single county was analyzed,
which limits the application of these findings to other local and national
food systems. The use of a mailed questionnaire permits the investigator to reach a large and diverse proportion of the population; however,
capturing the responses of a large number of individuals comes at the
cost of limiting the amount of in-depth information that may be collected.
Nonrespondents may have had different levels of sustainable food system
participation and health status. Self-report bias to the questionnaire was possible, although mail surveys produce less social desirability responses than
face-to-face or telephone interviews.53 Another limitation of this analysis
is that we did not examine intentions behind participation in sustainable
food activities. It is possible that the people examined here who participate in sustainable activities may not be motivated by food system
sustainability. For example, some people may go to a farmers market for
social reasons or garden to have better tasting tomatoes, not because they
believe in the sustainability of locally grown foods. Although such activities contribute to food system sustainability regardless of the motivations
underlying them, this is an important consideration for identifying strategies for encouraging sustainable consumer behaviors. Future studies need to
investigate sustainable behaviors, sustainable attitudes, and the relationships
between them.

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Efforts to improve human health and environmental health are operating simultaneously in Western societies. However, there are concerns that
preserving natural resources will come at the cost of human health and
food security16,64 and arguments that the strategies implemented to achieve
healthier diets are destructive to the environment.16,65 Coveney and Santich65
proposed the concept of sustainable gastronomy in which foods are
produced, acquired, prepared, and consumed in ways that consider environmental health as well as human health. Our results suggested that sustainable
food activities and diet-related health outcomes are connected, thus lending
support to the need for a sustainable gastronomy. For some consumers, participation in sustainable food activities was associated with fewer reported
illnesses, whereas for others their involvement was associated with more
negative health conditions. Sustainable food system involvement and human
health may be therefore linked in a complex relationship in which participation shapes health outcomes (human health) and health outcomes shape
participation (environmental health). This is a significant finding that stands
in contrast to previous work24,36,44 suggesting that participation in sustainable
activities may influence health in a causal fashion.
Consumer participation in sustainable food activities as shown in this
investigation was low. Only a small proportion of US food consumption
involves sustainable activities; thus, considerable increases would be necessary to have a substantial impact on the global food system. In order
to achieve more sustainable food and eating, health professionals, environmentalists, and food system professionals should develop policies and
programs that encourage sustainable food activities among consumers.30,66
Increasing consumer awareness of the connection between their contributions to a sustainable food and nutrition system and their health27 is also
important.
This analysis was a preliminary attempt to examine sustainable food
activities among consumers and raises as many questions as it attempts to
resolve. The sustainable food consumption movement is young, and some
data from this study may be useful in providing baseline comparisons for
later investigations. Future research needs to extend and replicate these findings by assessing other potentially sustainable activities (like membership
in organizations working toward food system sustainability), determining
motivating attitudes and beliefs about sustainable food activities, using longitudinal designs to consider change and selection and causation in the
direction of relationships, examining other samples in other places, and using
additional demographic variables and other measures of health. Activities
related to recently emergent sustainable food system issues, like genetically
modified organisms, also need to be considered in future research. We hope
that sustainable consumer food activities will be on the agenda for future
research that examines motivations and support for engaging in sustainable
food activities.

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