Food environment interactions after migration: a scoping review on low- and middle-income country immigrants in high-income countries

Abstract

Objective:

To map and characterise the interactions between the food environment and immigrant populations from low- and middle-income countries living in high-income countries.

Design:

A scoping review was carried out following the framework outlined by Arksey and O’Malley, as well as Levac et al. Peer-reviewed studies in English published between 2007 and 2021 were included. Two reviewers screened and selected the papers according to predefined inclusion criteria and reporting of results follows the PRISMA-ScR guidelines. A ‘Best fit’ framework synthesis was carried out using the Analysis Grid for Environments Linked to Obesity (ANGELO) framework.

Setting:

High-income countries.

Participants:

Immigrants from low- and middle-income countries.

Results:

A total of sixty-eight articles were included, primarily based in the USA, as well as Canada, Australia and Europe, with immigrants originating from five regions of the globe. The analysis identified three overarching themes that interconnected different aspects of the food environment in addition to the four themes of the ANGELO framework. They demonstrate that in valuing fresh, healthy and traditional foods, immigrants were compelled to surpass barriers in order to acquire these, though children’s demands, low incomes, time scarcity and mobility influenced the healthiness of the foods acquired.

Conclusion:

This study brought together evidence on interactions between immigrant populations and the food environment. Immigrants attempted to access fresh, traditional, healthier food, though they faced structural and family-level barriers that impacted the healthiness of the food they acquired. Understanding the food environment and interactions therein is key to proposing interventions and policies that can potentially impact the most vulnerable.

Migration to high-income countries is linked to increased risk of non-communicable diseases ⁽¹⁾. Immigrants from low- and middle-income countries moving to high-income countries experience an abrupt change from a more traditional food environment to a modern, industrialised one⁽²⁾ and over time they suffer from higher rates of many negative health outcomes, including obesity, type 2 diabetes and other diet- and metabolism-related chronic diseases, often at a younger age^(1,3,4) . Immigrants have reported abrupt changes in the social and environmental structure including lack of time, lack of social relations, more stress, children’s preferences, taste, food insecurity and lack of access to traditional foods leading to having a less healthy lifestyle after migrating^(5,6) .

The food environment can be considered as the interface between the food system and consumers’ food acquisition⁽⁷⁾. Availability of unhealthy foods has been linked to obesity more consistently than availability of healthy foods⁽⁸⁾ as observed through the presence of energy-dense nutrient-poor foods^(9,10) and greater access to unhealthy food outlets⁽¹¹⁾; this availability has also been linked to type 2 diabetes⁽¹²⁾. Accessing foods is a complex dynamic of availability, accessibility and social, cultural and material conditions^(13,14) . Additionally, perceived access has been found to relate more to dietary behaviour than to objective measures such as distance to stores^(13–15). Residing in socioeconomically disadvantaged neighbourhoods has been consistently associated with obesogenic dietary behaviour and higher rates of diet-related non-communicable diseases^(11,16) . However, living in a neighbourhood with a high immigrant density has been found to be protective against the dietary changes acquired through acculturation⁽¹⁷⁾.

How interactions take place with the food environment are not well understood, specifically the interactions between immigrants, the food environment in the host countries and their potential impact on acquisition of food. An important step in characterising these interactions is to synthesise what is known about immigrants and their food environment. A scoping review was therefore conducted with the aim to map and characterise the interactions between the food environment and immigrant populations from low- and middle-income countries living in high-income countries, as well as identify research gaps.

Methods

A scoping review protocol was developed and revised by the research team, and the final protocol was registered with the Open Science Framework on 29 January 2021 (https://osf.io/vzx57). We performed the scoping review using the methodological framework outlined by Arksey and O’Malley⁽¹⁸⁾ and further developed by Levac et al. ⁽¹⁹⁾. The review followed five key phases: (1) identifying the research question; (2) identifying relevant studies; (3) study selection; (4) charting the data and (5) collating, summarising and reporting the results. The reporting is described as per the PRISMA-ScR guidelines⁽²⁰⁾.

Identifying relevant studies and study selection

Relevant literature on the food environment and immigrants in high-income countries published in English between 1 January 2007 and 14 May 2021 was eligible for inclusion, the latter being the date of the last search. Grey literature was subsequently not included since initial searches and reading found negligible grey literature on the subject. Three electronic databases (EMBASE, PubMed and Web of Science) were used as primary search sources. A search strategy was developed in consultation with a librarian through Uppsala University Library. Key words relevant to food environment and immigrant population were formed into a search string (see online Supplemental Table 1). Backward and forward snowballing and hand searches were performed to identify additional articles.

Two reviewers carried out the initial search and used the Rayyan QCRI for independently screening titles and abstracts⁽²¹⁾. At the title and abstract screening phase, only articles related to migration from low- and middle-income countries to high-income countries, coupled with aspects relating to the food environment, were included (see online Supplemental Table 2). The full-text screening was also performed by two reviewers; a simple data collection form was developed to assess the relevance of the articles in order to facilitate consistency in the inclusion and exclusion process. Disagreements on study selection were resolved by consensus and discussion and when necessary, consulted the third reviewer. No critical appraisal was carried out on the studies as scoping reviews do not usually include this step⁽²²⁾.

Charting the data

In this stage each of the eixty-eight articles were read thoroughly, followed by charting of the data extracted based on the PICO model (population, intervention, comparison, outcome of interest) (see Table 1). Each of the two reviewers charted half of the articles and reviewed one another’s charting.

Table 1 Charting form of included articles

Collating, summarising and reporting the results

The extracted data from the results and discussion sections of the included papers were synthesised. This was done inspired by the ‘Best fit’ framework synthesis, a practical method where data are coded into a priori themes, as well as additional themes for data that do not fit into the framework⁽²³⁾. We used the Analysis Grid for Environments Linked to Obesity (ANGELO) framework to interpret the data, with the following a priori themes: physical environment, economic environment, socio-cultural environment and political environment (see Table 2)⁽²⁴⁾. The ANGELO framework is further divided into micro and macro settings, which we did not use in our analysis as the full-text reading of the selected articles revealed that there was very little on the macro scale. Additionally, where data seemed to belong to more than one of the themes, overarching themes were created. The findings relating to each theme were discussed among the team to improve trustworthiness and to reach consensus.

Table 2 Analysis grid for environments Linked to obesity (ANGELO framework) from Swinburn et al. ⁽²⁴⁾

* In this review, the settings (micro) and sectors (macro) were not separated. This slightly modified ANGELO framework was used for the analysis.

Results

A total of 2835 records were identified in the initial search and after removal of duplicates, 2103 were screened for title and abstract. Backward, forward snowballing and search in google scholar identified eighty-seven additional articles. In total, 228 articles were eligible for full-text screening (see Fig. 1). Finally, a total of sixty-eight articles were eligible for inclusion. Out of sixty-eight articles, the vast majority (forty five) studied populations living in the USA^(25–69); ten were based in Canada^(70–79), seven from Australia^(80–86), three from the UK^(87–89), one from Switzerland⁽⁹⁰⁾, one from Norway⁽²⁾ and one from the Netherlands⁽⁹¹⁾. The immigrant groups were from Asia, Africa, Middle East, South and Central America and the Caribbean. Of these, forty two were qualitative, nine were quantitative and seventeen were mixed methods studies. Around 35 % of the studies included only women and the remaining were mixed participant populations.

Fig. 1 Flow diagram of literature search and selection

An overview of the sixty eight included studies is shown in Table 1, and the results are presented below according to themes from the ANGELO framework, followed by overarching themes.

Physical environment

Out of sixty-eight included articles, fifty two had data pertaining to the physical environment.

Host country food environments

In the low-income neighbourhoods where immigrants resided, there was easy access to fast food outlets and unhealthy food items in stores^{(30,57,61,65,87,89,91)} . Fruits and vegetables were reported as being of low quality and of limited variety in the neighbourhood stores^(28,38) . In some areas with a high proportion of immigrants, there were ethnic stores that catered to their food preferences^(74,87) , while others travelled greater distances either to access these or for greater variety or lower prices^{(2,35,40,61,84)} . In general, immigrants living in urban areas had better access to stores, as well as cultural foods, than those in rural areas⁽⁷⁸⁾ where access to a car was necessary⁽⁶⁹⁾.

Availability of specific food types

Immigrants reported that there was an overall abundance of food in the host country^(64,70,86) ; produce was always available and not just seasonally as they were used to^{(71,83,88,91)} . Eating a healthy diet based on fresh foods was challenging as they were more difficult to access, particularly in smaller metropolitan areas that depended on seasonal produce⁽⁶⁹⁾ while neighbourhoods were filled with stores providing unhealthy options^(41,61) . In larger cities and places where immigrants had resided over a longer period, it was easier to access cultural foods^(2,84) and for early arrivals from different ethnic groups it was more of a struggle⁽²⁾. Accessing halal foods in order to eat according to Islamic religious principles was essential for Muslim immigrants^(78,91) . Moreover, the articles referred to an increased availability of cultural including halal foods over time^(2,85,86,91) . In different settings, some groups had an easier time than others to find their cultural foods, though many found it a challenge^{(58,61,62,68,70,73,75,76,82,86,91)} . There was a lack of familiarity and variety thereof⁽⁸⁶⁾. Halal foods would have to be accessible for meat and meat-containing products to be considered as ‘available’ for consumption, in the same way as unfamiliar fruits and vegetables tend to be ignored^(64,78,91) . Feeling uncertain about the content of food items, particularly in the early period, meant excluding them, reducing available options⁽²⁾.

Avenues for sourcing food

Large supermarkets were considered as the basis for most immigrants’ food shopping – a one-stop shop to buy a variety of good quality, affordable food including produce in a clean environment^{(35,39,51,54,56,64,66,84,86,91)} , though some felt uncomfortable in the ‘sterile’ environment⁽⁵⁷⁾. With demand, supermarkets increased the amounts of cultural foods they sold⁽⁹¹⁾. These supermarkets were often further away, requiring transportation⁽²⁹⁾, and local stores were considered more expensive and of lower quality^(32,56,59) . In order to acquire foods, participants typically visited several stores or food sources^{(27,32,47,49,53,56,58,60,82)} particularly ethnic stores to supplement what they could procure at the supermarket.

Ethnic stores were clustered in areas where immigrants resided⁽⁵¹⁾, and they were frequented to purchase culturally specific foods including fruits, vegetables, meat and other ingredients^{(27,51,56,58,59,64,66,82,84,86)} . The ethnic shops had a personal connection with customers⁽²⁷⁾ and by speaking the language of customers, helping them to understand product labelling^(60,79) . Immigrants who had poor host country language skills, as well as those with religious dietary restrictions, preferred to rely on the ethnic stores^(57,60) and others lacked skills to buy foods outside of halal stores⁽⁷⁹⁾. In this way, they could be more independent and shop on their own⁽⁶⁴⁾. Ethnic stores were found to fill a gap in the provision of healthy food in areas deemed food deserts^(52,89) .

Other food sources were frequented primarily for fresh produce; these included farmers’ markets^{(43,46,54,56,75,82)} , Pulgas (flea markets), fruit and vegetable stands, vendors, farms, livestock markets as well as family, friends or neighbours^{(29,35,44,52,58,61,75)} or by foraging for food^{(35,52,58,75)} . Many immigrants cultivated or longed to grow their own food again^{(37,39,56,58,62,64,65,73)} , as a way to access tastier, more nutritious, culturally appropriate fresh produce they could trust, while saving money^{(37,52,54,56,58,65,75,82,86)} .

School food environment

Children of immigrants were introduced to host country foods including highly processed foods through school food^{(30,39,49,58,63,65,69,71,72,91)} , which also led to a change in preferences^(63,69) . For packed lunches, mothers soon stopped sending traditional food as they came back uneaten and learnt how to make lunchboxes in the way of the host country^(2,71,91) . Reasons for not taking traditional foods as a school lunch included lack of facilities to heat up food, not wanting to spill, food allergies, food odors, short periods to eat, and importantly, children wanting to fit in^(71–73).

Economic environment

Out of sixty-eight included articles, forty had information pertaining to the economic environment.

Socio-economic circumstances and food access

In general, immigrants had limited incomes^{(29,30,36,37,66,73,74,76)} ; the first 2 years were particularly precarious, though the financial situation of immigrants improved over time⁽⁷⁴⁾. Poverty meant that there were many competing needs and these were difficult to manage^(28,36) . Rent and utilities needed to be prioritised over other things, such as food⁽⁵⁰⁾, and likewise food was prioritised over health and other costs⁽³⁷⁾. In addition, those with families needing support in the home countries, sent remittances, further reducing their disposable income⁽⁶⁷⁾. More than half the monthly budget was spent at the beginning of the month on provisions⁽⁶⁴⁾.

Low incomes were centrally linked to food insecurity^{(35,36,38,49,50)} and food decisions are majorly impacted by income⁽⁷⁸⁾, leading to a lack of control over food choices^(86,90) . Food prices were often high in relation to the income of immigrants⁽⁷⁴⁾, which was a hindrance for buying food^(42,64,86) . This was particularly relevant for nutritious food like fruits, vegetables fish and meat that were more expensive^{(28,29,52,61,65,84–86,90)} . Culturally specific foods were also considered more expensive^{(28,40,53,57,58,63,73–76,78,80,81,84,85)} , particularly in places where there was a low presence of these foods⁽⁸⁴⁾. Even though halal stores were considered trustworthy, they were too expensive to rely on for all food purchases⁽⁷⁸⁾. For Muslim immigrants, the price of halal and non-halal foods influenced the type, quantity, quality and nutritional value of foods acquired⁽⁷⁸⁾. In addition, fruits and vegetables (and ethnic foods in some cases), were more expensive in local food stores in walkable areas and cheaper in larger stores, further away, requiring transport^{(29,46,47,50,54,56,61,76,81)} . The quality of food was a major concern, where fresh foods without chemicals were desired, ‘organic’ foods were unaffordable^(58,74) , whereas processed foods including fast food were cheap^{(28,71,85,87)} . The cost of food determined where they shopped⁽³²⁾, what they purchased and the variety they consumed^(38,55,71) . Participants needed to buy the cheapest foods, so they found the sources with the lowest prices for the items they wanted, often good quality, fresh food^(43,47,50) .

Socio-cultural environment

Forty-one articles out of sixty eight included articles had data pertaining to the socio-cultural environment.

Food values

Food values refer to immigrants’ desire for high quality, fresh, chemical-free and unprocessed foods, in particular fruits and vegetables, natural foods in their natural state^{(33,35,41,53,58,64,85,90)} , perceived as good for health^{(41,43,69,75)} . Fresh and homemade foods were important to immigrants⁽⁶⁵⁾. They regarded host country foods with suspicion and equated these foods, particularly processed, preserved, canned or frozen foods as being old, filled with chemicals and therefore unhealthy and undesirable^{(37,48,61,78)} . Even the fruits and vegetables sold were viewed as having chemicals and hence there was a strong desire for organic foods⁽³³⁾. Fruits, vegetables and meat were experienced as having less taste and fragrance as compared with their home countries^{(25,31,32,43,47,70,71,74,76,78,80,85,91)} , and this was perceived as evidence of lower quality and nutritional value^(76,78) . Some did not trust tap water for consumption and relied on bottled water⁽⁶⁴⁾. Not knowing where foods came from led to a lack of trust.

(Cultural) food preferences

Overall, immigrants expressed a strong desire to eat their traditional foods^(65,76,82) based on fresh foods they considered healthier^{(33,43,65,69,70,73,75,76,82,85)} , maintaining these eating habits was important to them^(73,82) . However, some thought that their cultural foods were ‘greasy’ and had too big portion sizes as well as consisting of lot of meat^(65,91) . Preparing traditional foods reinforced the link to the home country and was a way to pass on traditions^{(30,57,65,82)} , whereas adopting host country foods made them feel more integrated⁽⁶⁵⁾. Limited accessibility to preferred foods and the lack of flavour in host country foods forced them to find new ways of making traditional dishes^(43,70) with familiar produce^{(46,56,73,82)} . To prevent dietary acculturation, some parents tried to control children’s food choices and mainly provided traditional foods at home^(69,75) . Immigrant families varied from eating primarily traditional food to eating a combination of both traditional and host country foods^(68,85) . Parents, particularly fathers, preferred traditional food^{(63,65,66,69,79,91)} . Some immigrants living in smaller metropolitan areas adapted to what was available and served their children processed foods due to limited access to healthier foods⁽⁶⁹⁾. The convenience of host country foods was appreciated, though perceived as having potential negative health outcomes⁽⁷⁰⁾. In the home country, meat and packaged foods were seen as luxuries⁽⁶⁴⁾, while they were eaten more often after migration⁽⁶³⁾. Immigrants would sometimes crave unhealthy foods, both host country and traditional forms⁽⁶⁵⁾. For those with onset or presence of a health condition, it affected how they ate and therefore procurement to some extent⁽⁶⁹⁾. Participants from Africa, Middle East and South East Asia, most of whom were Muslim, reported that religion was very important in determining their food choices^(2,68) .

Social support networks and changing roles

Immigrants’ reported relying on social networks from the same ethnic community generally and in relation to acquiring food⁽⁵⁰⁾. The family unit was at the core of the support circle and friends and neighbours were also included⁽³⁷⁾, though they experienced much less social support and connection than in their home countries^{(37,45,50,78)} . Within the family resources were pooled and shared for food⁽³⁷⁾ and social networks mainly supported acquisition of affordable food through transport (rides in personal vehicles) and sometimes childcare^{(30,37,50,58,64)} . There was also an exchange of money, services and food with friends and other community members⁽⁶⁴⁾. Ethnic enclaves facilitated cultural norms in the host country as well as enabled easier support through social networks⁽²⁶⁾.

Although men were more involved in household chores following migration, women found themselves responsible for practically all aspects of home life, with less time for food preparation⁽⁷⁸⁾. Cooking was a responsibility that seemed allocated to women irrespective of their employment status for the majority^(25,68) . If there was no woman in the household available to cook, ready meals and convenience foods were more likely to be relied upon⁽²⁵⁾. Food went from being a social aspect of life to fulfilling more of a biological function⁽⁴⁵⁾.

Children’s influence

Children were more acculturated through exposure to outside food environments like school, neighbourhoods and peers as compared with their parents^{(33,47,58,71,73,81,82)} . They had a preference for and wanted parents to provide host country foods, often processed ones^{(30,47,58,66,71,79,91)} . Parents wanted to provide what they knew as good and healthy food, which were often rejected by their children^{(33,45,61,71,82)} and some started cooking host country foods for the whole family, in spite of protests from their husbands⁽⁹¹⁾. Prioritising family cohesion and positive relationships meant providing the desired foods^(30,66) . There was a conflict between the food parents valued and what children desired^(30,41,82) , wanting them to eat a sufficient amount⁽³⁰⁾ and being happy^(63,91) . Some parents looked for acceptable (halal) versions of fast foods⁽⁶³⁾ and learnt how to make the host country foods that the children asked for^(69,79) . In this way, children were agents structuring shopping and dietary intake⁽⁶³⁾. Some parents who had experienced food shortages compensated by letting children indulge in foods of their choice^(64,69) . In a recent study on adolescents, 60 % reported that they influenced household food selection and 21·5 % reported having full control over what was eaten at home⁽⁶⁸⁾.

Eating out

Pre-migration, eating out at restaurants was an occasional treat⁽⁴³⁾; however, after migration eating out became much more common, so much so that it became a regular event even for working class immigrants^{(43,61,70,87)} . Some immigrants found themselves time poor and eating out or consuming convenience food was a way to have something to eat that was cheap and fast, replacing to a certain extent the burden of shopping and cooking foods at home^(43,85) . Fast food restaurants were experienced as cheap and child friendly, facilitating eating out as families⁽³⁸⁾, though it took away the control over healthier choices⁽⁷⁷⁾. Families ate out more due to children’s desire for fast foods^(66,91) .

Political environment

Twenty four out of sixty-eight included articles had content pertaining to the political environment. Primarily, government support and food assistance programmes were mentioned. The use of such benefits and assistance was related to need, awareness, cultural norms, past experiences and language barriers⁽⁶⁶⁾.

Government food related benefits

Government food-related benefits, such as Women, Infants and Children, Supplemental Nutrition Assistance Program and free and reduced school meals in the USA and the Australian Centrelink were all mentioned in the studies and enabled families to have enough food till the end of the month. Food benefits were highly depended on⁽⁶⁴⁾. This was particularly appreciated in times of need^(38,58) and was seen as a facilitator to food security^(62,67,86) . Though these benefits were supplementary in nature, many families reported them as the main family food budget^{(27,37,39,49,62)} , although insufficient^{(28,29,53,63)} . However, not all immigrants accessed all benefits⁽⁶⁷⁾. The knowledge, time and resources needed to apply for state food benefits, particularly relating to automated and literacy demanding application processes, prevented some immigrants from applying^{(28,33,39,50,64)} or reapplying once they lapsed^(62,64) . Undocumented migrants or others with concerns about their immigration status may also be deterred from accessing these schemes^(29,39) .

These safety net programmes helped immigrants access healthy food and improved access to culturally acceptable, staple foods^{(30,33,37–39,53,58)} . Benefits were typically spent within 1–2 weeks of issuance^(27,49) . Immigrants then resorted to cheaper food including host country foods⁽⁵³⁾.

Food assistance

Immigrants mentioned having used emergency food assistance (food pantries, food banks) in the past, particularly in their first 2 years in the host country⁽⁷⁴⁾ and from being very reliant to not using it at all^(53,64) . Faith-based organisations providing food assistance were perceived as safe regarding immigration status since they did not require identification^(40,76) . Barriers to usage included stigma, issues of access^(40,76) as well as food being of poor quality or culturally inappropriate, like canned food^(74,76,78) . For Muslims, food assistance was often inappropriate since they did not provide halal foods, resulting in wastage⁽⁷⁸⁾. Food pantries provided standard sized packs of short term emergency food relief^(28,29) and relied on donated items, often with a long shelf life^(39,73) . There was very little fresh food and what was available was often old or rationed out quickly⁽⁷⁶⁾.

Overarching themes: interconnectedness between aspects of the food environment

In addition to the four distinct themes based on the ANGELO framework, we identified three themes that characterised the interconnectedness between different aspects of the food environment interactions and immigrant populations: time scarcity (sxiteen articles), mobility (twenty-six articles) and navigating the food environment (forty-four articles).

Time scarcity

Available time, primarily linked to gender based double work burden, played an important role in determining the extent to which immigrants could pursue food provisioning activities and therefore in which way they interacted with the food environment. This theme was a combination of the socio-cultural, economic and physical environments. Life following migration was described as hectic and time was scarce due to women being engaged in paid work, studies or other commitments, while continuing to be responsible for caring and preparing food for the family^(32,39) . For those in paid work, time scarcity was a major issue; there were often long hours⁽⁸⁰⁾, multiple jobs and long distances to travel to work, including sometimes working at night to care for children during the day⁽²⁹⁾. For some this meant ending work late when most food stores were closed, apart from corner stores that sold limited healthy options^(28,29) . These structural changes within the family shifted the eating patterns of the whole family^(45,61,71) . Lack of time as well as childcare responsibilities minimised time for shopping, making it more challenging to prioritise healthy foods and cooking from scratch^{(32,39,46,73,80)} . Not having enough time meant that food provisioning needed to be easy, fast, convenient and close by⁽⁹¹⁾. This sometimes led to time-saving shortcuts, including turning to and becoming reliant on convenience foods, leftovers, snacks, skipping meals or eating on the go, something they were aware was not conducive to their health^{(45,61,63,71,77,78)} . Cheap processed foods were used during time scarcity since traditional foods took longer to make^(65,85) . However, foreign-born women were more likely to view food provisioning as an essential task as opposed to weighing in the effort required when buying and preparing food⁽³²⁾.

Mobility

Being flexible about where to buy foods allowed access to more affordable foods that aligned with their values and preferences and therefore determined how immigrants interacted with their food environment. Money and time constraints were compounded by lack of transport⁽⁶³⁾. This theme could be seen as an interplay of the physical, socio-cultural and economic environments, as well as the previous theme, time scarcity. Being mobile was a way of trying to reduce food insecurity⁽⁵⁰⁾. Access to transport and time therefore facilitated this process by allowing for the acquisition of healthier affordable foods, by being able to travel further and to travel to multiple stores that offered the food they wanted, at prices they could afford^{(28,38,50,81,82,85)} . Proximity of food shops to home was one factor in determining access⁽⁸⁶⁾. Owning a car or relying on family and social networks within the larger ethnic group to acquire rides were key^{(44,49,50,58,62,63,86)} . Public transport routes and timings were limited for those who lived further away from the center⁽⁵⁷⁾, costing money and time, with inconvenient connections between neighbourhoods and food stores^(64,85) . Walking or relying on public transport meant carrying multiple heavy bags and quantities purchased were limited to what they could carry themselves^(62,63,82) . Additionally, being accompanied by children and walking distances^{(32,38,50,73,82)} ; this meant visiting fewer stores and some food sources were not accessible at all^(63,82) . Weather conditions and cold season were an added challenge when relying on public transport^(62,78) . Some women were dependent on others since they did not know their address, and others could not travel by taxi due to religious restrictions for women⁽⁷⁹⁾. Some could not afford cars, while others acquired personal vehicles as soon as they were able to, in order to facilitate food procurement^{(57,58,62,85)} . The high financial costs of car expenses⁽⁷⁸⁾ meant weighing whether it was worth travelling further for the amount saved in cheaper food⁽⁸⁶⁾. Cycling was mentioned by international students who pushed their cycles home loaded with groceries⁽⁸⁵⁾. Those who relied on ethnic stores for most purchases travelled further to more affordable stores^(60,66,78) . Immigrants were willing to travel through the city or beyond for food that was suitable in relation to cost, quality, what was valued and cultural preferences^{(43,46,51,62,78,81,82,84,85,88)} .

Navigation

This theme combined aspects of the economic environment, socio-cultural and physical environment with themes of time scarcity and mobility. Immigrants often faced a new language and a new food system⁽³⁵⁾ and relied on members of their community to initially guide them in the new food environment^{(49,62,63,75,78,79,86,90)} including shops, products and new ways of eating⁽²⁾. Neighbours from the same religion showed them how to identify and where to get hold of appropriate foods^(62,78) . Social media groups shared how to access and determine culturally appropriate and affordable foods, including halal foods and current deals^(78,86) . Without this, difficulties accessing foods and stores were harder to overcome^(58,63) . Yet, navigation improved with time; it took the first few years to confidently shop for foods^(2,75,76) . Pre-migration food procurement skills included acquiring quality raw, fresh foods from markets, stores or home gardens^{(35,63,73,82,83)} and now foods were in unfamiliar packaging and methods of storage, such as frozen foods^(2,66,74) . Those with little prior experience of food provisioning before migration or were cooking for themselves acquired more easy convenient food⁽⁶⁶⁾.

Lack of language skills and literacy were barriers to food security^(62,67,78) , navigating public transport^(58,64) , identifying stores, food items and deals on food^(36,64,76) or being able to read and understand food labels^{(2,58,61,63,64,73,78,79,86,90)} . For some, language barriers persisted over time, particularly for older immigrant women⁽⁶²⁾, making it harder to be independent in procuring food⁽⁷⁹⁾. For Muslim immigrants, there was a fear of not adhering to halal standards, which meant restricted options^(2,78) . This meant that some had to shop with their husbands or children^(64,86) , and therefore children had to tag along, indirectly leading to more processed foods and sweet items being bought^(63,69,79) . Some believed that if food was for sale in stores, it must be healthy⁽⁷⁹⁾. For some, there was a lack of trust even towards ‘halal’ foods as there had been cases of foods deliberately mislabelled as halal⁽²⁾. In other groups, women were better at navigating the food environment than men^(66,84) and those who migrated from urban environments found it easier to adapt to the new food environment than those from rural areas ⁽⁷⁴⁾. Physical access (location and transport) was a deciding factor in where participants purchased their food, facilitated by social networks⁽⁴⁹⁾. Self-efficacy also a played a role in perceived ease of access to fruits and vegetables⁽³⁴⁾.

Immigrants implemented a range of strategies in order to feed their families, which spanned across all the themes. Overall, they aimed for the best quality at the lowest price at the most convenient location⁽⁹¹⁾. Which strategies were used depended on a variety of factors such as access to time and money, availability of cheap food and transport⁽³⁷⁾, a working knowledge of the local language⁽²⁷⁾ and social networks. There was a cyclical pattern of having enough at the beginning of the month and having a shortage at the end of the month, when staples were relied on⁽⁶⁴⁾. The use of coping strategies that included a variety of activities to take advantage of deals^{(32,37,38,43,50,54,55,84)} , aimed at getting cheaper but healthier food^{(37,38,50,54,55,84)} , was associated with being more food secure⁽⁶⁷⁾. Shopping for fruits and vegetables meant being flexible and taking advantage of deals and seasonal foods^(38,47,54) . Time-poor immigrants particularly relied on stretching their budget⁽⁵⁵⁾ by buying inexpensive staple foods in bulk to last the month^{(27,30,37,40,49,64,76,86)} , non-perishable items to stock up on^(27,30,33) and cooking cheap traditional meals^(49,64) . Due to financial constraints, participants reported compromising on the variety^(37,50,64) and quality of food in order to have a sufficient amount to eat^(40,53) . More expensive food items were adjusted by decreasing the amount bought⁽⁸⁶⁾. Foods were prioritised in different ways, such as foods higher in protein and foods that do not spoil easily or are the most filling⁽⁵⁰⁾. Limiting the purchase of more expensive foods, supplementing with homegrown food^(27,37) and eating at home also helped to lower spending^(30,33) . Social networks sometimes functioned as a place for food sharing as well as buying prepared foods from neighbours or friends^{(37,39,44,50)} . They turned to frozen, canned and prepared foods to deal with economic access^(78,85) . When money was finished, food was sometimes bought on credit at ethnic stores⁽⁶⁴⁾. Skipping meals, eating cheap processed foods and as well as kids taking advantage of food at school were coping strategies⁽⁶⁴⁾. Cheap fast food allowed families to eat while on a budget⁽⁶⁵⁾. To afford fruits and vegetables, they frequented market stalls or Pulgas⁽⁵²⁾, as well as buying foods on sale⁽⁵⁰⁾ or buying seasonal foods⁽⁴⁷⁾. When the budget was tight, quantity was prioritised over quality^(25,46,90) . Fresh produce was weighed against more satiating higher energy foods such as fast food and meat when making decisions based on a limited budget⁽⁵⁴⁾. Fresh items were purchased and consumed more towards the first half of the month⁽⁶³⁾. Some reported reducing vegetables and meat and relying more on cheap culturally appropriate food⁽⁷⁸⁾. Some ethnic groups seemed to manage on what they had, whereas others struggled to have enough at the end of the month⁽⁶³⁾. Overall, the process was time intensive and required complex decision making and prioritising in order to make the whole effort worthwhile⁽³⁷⁾.

Discussion

In this scoping review, we identified sixty-eight studies addressing immigrants and the food environment published between 2007 and 2021. There was a paucity of research from countries other than the USA and a strong focus on women. Our major findings focus on the interactions between immigrant consumers with different aspects of the food environment and their interconnectedness: (1) Fresh high-quality natural foods and cultural foods were strongly valued, though children were more exposed to and demanded host country (often nutrient poor) foods; (2) Navigating the new food environment on a low income resulted in coping strategies where additional food skills were needed and (3) Time and mobility were key to determining potential trajectories of accessing healthier or less healthy foods.

Immigrants valued fresh, chemical-free, unprocessed healthy foods and had a set of skills and strategies to buy and prepare these, in spite of living on low incomes and facing other barriers. These values seem to be an internal motivator compelling them to surpass barriers and acquire healthier foods, stemming from a cultural or traditional discourse where simple and natural foods is deep rooted⁽⁹²⁾. Several studies have found that immigrants or less acculturated groups in high-income countries are able to acquire a healthier diet at a lower cost than the host population^(93–95), a phenomenon termed as ‘nutrition resilience’⁽⁹⁵⁾. In our study, this was shown in the industrious way they strived to access food they valued. This relates to findings demonstrating that availability in the environment and outcome behaviour are often not directly linked, but rather that the interaction is moderated by personal factors⁽⁹⁶⁾. A systematic mapping review on factors influencing dietary behaviour in immigrants and ethnic minorities living in Europe had similar findings as our review, but focused more on the individual level⁽⁹⁷⁾. Food advertising, another known influencer of food choices⁽⁹⁸⁾, was not mentioned in our studies. It is, however, likely that parents were indirectly influenced by their children’s exposure to advertisements.

Our review characterised immigrants as struggling financially. Due to the high reported costs of cultural and fresh healthy foods, they had to compromise on the quality of food in order to have enough. This was confirmed in a study that reported high costs leading to prioritising quantity over quality, therefore limiting access to fresh foods such as fruits, vegetables, fish and meat⁽⁹⁹⁾. Navigating their new food environment required food literacy in addition to the food skills that they had in order to enable healthier choices when buying packaged foods⁽¹⁰⁰⁾. An Australian study suggested that food literacy would not remove the wider environmental and economic causes of food insecurity but could decrease vulnerability to the obesogenic environment⁽¹⁰⁰⁾. Navigating this was easier if they were able to access a social network (community of the same ethnicity) that could partially bypass other barriers such as showing them where to shop or what to buy⁽⁹⁰⁾, thus making them less vulnerable. In our study, all packaged, processed and preserved foods were grouped into foods that were not fresh and therefore less healthy. A study on perceptions of processed foods among low-income and immigrant parents confirmed these findings – where packaged food including frozen and canned foods were considered processed irrespective of the contents⁽¹⁰¹⁾. This is not just an issue of knowing how to read food labels, but rather a food value that may be a hindrance to eating well in host countries, since frozen healthy foods including vegetables may be more affordable with practically the same nutritional value as the fresh versions. Also these parents bought processed foods because their children liked them, but they did not think that these foods were as healthy as fresh, homemade foods were⁽¹⁰¹⁾, indicating that solely nutrition education may not be the most appropriate approach in order to improve immigrants’ diet.

When there was a lack of income, time and mobility were buffers to food insecurity by allowing access to affordable valued foods, as confirmed in another study⁽¹⁰²⁾. In our review, lack of time stemmed primarily from women’s double work burden, confirmed by another study that showed immigrants, had a higher chance of being severely poor in both time and income⁽¹⁰³⁾, and those who were employed had younger children or were single parents were more likely to be time poor⁽¹⁰²⁾, as we found. Time scarcity seems to have an immediate effect on food choices – linked to eating out and excess energy intake, as well as a decrease in fruit and vegetable consumption⁽¹⁰⁴⁾. A study on low-income women found that nutritional value became less prioritised when food needed to be put on the table quickly; however, higher levels of confidence in food preparation and cooking skills enabled them to prioritize and make more time for cooking⁽¹⁰⁵⁾. Though the immigrants in our review were vulnerable in their new circumstances, they also had strong food provisioning skills and reported striving to access fresh, healthy food. A study on non-immigrants showed how food decisions were made weighing in time and monetary costs, as well as quality and health benefits of foods against time and effort⁽¹⁰⁶⁾. In our review, culturally valued foods, quality of foods and monetary costs seemed to weigh more than time and effort, linked to how food provisioning may be considered an essential task.

With respect to mobility, another study confirmed our findings showing that acquiring rides was found to be convenient for purchasing larger quantities at stores that were less accessible by foot, procuring higher quality foods that aligned with their values and preferences, and at the same time, avoiding the costs of car ownership⁽¹⁰²⁾. A study from Australia found that having access to independent transport was the key to accessing foods, rather than whether they lived in a food desert or not; this confirmed our findings on how reliance on public transport poses difficulties for food shopping⁽¹⁰⁷⁾. Being mobile meant that they did not have to be confined to accessing foods solely in local stores, which were considered to be more expensive as well as perceived to have foods of lower quality.

Low- and middle-income countries are also experiencing changes to their food environments and diets due to globalisation⁽¹⁰⁸⁾, which means that some changes towards a Western diet may already take place in the home country, before migration. Within country migration from rural to urban areas has also been found to cause similar changes including consumption of cheaper types, more sugar and dairy products and more meals outside of the home due to the low incomes, high food costs and lack of time in their hectic city life⁽¹⁰⁹⁾. Dietary acculturation is a dynamic, multi-dimensional and complex process⁽¹¹⁰⁾ that progresses over time. Even though in our study we see immigrants striving to maintain their food culture in different ways, it represents only a part of a broader process⁽¹¹¹⁾. Studies have shown that over time immigrants incorporate their host food cultures across a spectrum from subtle and explicit ways⁽¹¹²⁾. Our study also shows that the process of dietary acculturation is not so much an active choice solely due to changes in preferences after exposure to a new food culture, but rather due to an array of factors often out of their control, that interplay to push food decisions closer to that of their host country.

We found that a majority of the studies mentioned insufficient incomes in the different immigrant groups and the implications of this on different aspects of life, including food procurement. In order to access valued and preferred foods, immigrants reported travelling to stores to mitigate food insecurity. However, this implied a decrease in the budget by having to spend on public transport or fuel. Increased time spent travelling could potentially lead to less time for preparing and cooking, which may result in more reliance on convenience foods. Financial constraints paired with problems navigating the food environment, particularly in the early period following migration, may act as a catalyst of change that can be difficult to reverse, even though the aggravating factors may improve over time. This review also highlighted how unhealthy food exposure, primarily through schools and peers, has a ripple effect on family procurement and consumption patterns through changes in children’s food preferences, serving as a possible catalyst for dietary acculturation. The complex interactions inherent in this process could result in food insecurity and a diet that is less healthy, increasing the risk of obesity, type 2 diabetes and CVD⁽¹¹³⁾. The disproportionately high rates of non-communicable diseases including obesity among immigrants, both adults and children, is also a reflection of the cumulative effects of such changes over time⁽¹¹⁴⁾.

Strengths and limitations

We sought to characterise interactions with the food environment in a diverse group of immigrants through studies of different designs and focus. Most studies were about Latino immigrants in the USA, hence, affecting the transferability of the findings. Moreover, the experiences of men were lacking in the literature, creating a women bias. Through the search strategy, some relevant articles may have been missed, though we covered 14 years of published research in the field. Our decision to perform an additional qualitative analysis of extracted data was based on the recommendation by Levac et al., 2010⁽¹⁹⁾, though we chose to stay closer to the data through the ‘Best fit’ framework synthesis and prevented a ‘pressing in’ of the data by allowing ‘left over’ data to be analysed outside of the framework. The ANGELO framework was used as it explicitly links health aspects to the food environment.

Conclusion

This study brought together evidence from a range of studies on interactions between immigrant populations and the food environment, using the four a priori themes from the ANGELO framework including the physical, economic, socio-cultural and political environments. Additionally, we identified the overarching themes of time scarcity, mobility and navigation that illustrated these interactions and interconnected the different aspects of the food environment. Immigrants tried to access fresh, traditional, healthier food and were compelled to do so, though they faced structural and family-level barriers that affected the healthiness of acquired food. Our study points towards the need for further research on different types of immigrant groups, including asylum seekers and refugees; families v. single individuals; the perspective of men; other parts of the world other than the USA that have experienced big waves of migration and the interaction of values with objective measures of the food environment. More importantly, research needs to focus on the most vulnerable and how they can be protected and supported through this process. Understanding the food environment and interactions therein is key to proposing interventions and policies that can potentially impact the most vulnerable.