Adolescents' perspectives on food literacy and its impact on their dietary behaviours

A cross-sectional study of the association between food literacy and dietary intake among Danish adolescents

Food literacy is theorized to be associated with healthy dietary intake. However, empirical knowledge on the association between adolescents' food literacy and dietary intake is limited. The aim of this study was to investigate the association between food literacy and dietary intake among Danish schoolchildren aged 11-13 years. The study applied a cross-sectional design using baseline data from a cluster-based quasi-experimental controlled study in a sample (n = 377) of Danish school children. Mixed model analyses were performed to investigate the associations between overall food literacy as well as its five competencies ("to know", "to do", "to sense", "to care", and "to want") and dietary intake of vegetables, fruit, fish, meat, discretionary foods, and sugar-sweetened beverages. Positive associations were found between overall food literacy (E = 1.493, p = 0.002) as well as the competencies "to know" (E = 1.249, p = 0.027), "to do" (E = 1.236, p = 0.028), "to sense" (E = 1.183, p = 0.029), and "to care" (E = 1.249, p = 0.018) and intake of vegetables. The study also found a positive association between the competency "to want" and intake of fruit (E = 13.50, p = 0.037), "to care" and intake of fish (E = 2.050, p < 0.001), and a negative association between the competency "to want" and intake of meat (E = 0.748, p = 0.003) and sugar-sweetened beverages (E = 0.576, p = 0.0021). No associations were found between overall food literacy or any of its five competencies and intake of discretionary foods. These findings suggest that improving specific aspects of food literacy may have a potential to promote healthier dietary intake, though additional research is needed.

Adolescents' Perceptions About Healthy and Sustainable Diets: A Qualitative School-Based Study in Portugal

In this qualitative study, we explored Portuguese adolescents' perceptions of diet, sustainability, and health through six focus group discussions (FGDs). Fifty-five adolescents (10-18 years) participated. FGDs focused on sustainability in food choices and its health impact, with our primary interest in their perceptions. Results showed a limited comprehension of "sustainable/sustainability," especially among younger participants. Those aware of sustainability recognized its diverse aspects, including health, economic, and ecological domains. Some adolescents recognized the link between health and sustainability in their diets, emphasizing the need for food literacy. These findings emphasize the importance of public health and sustainable policies among Portuguese adolescents.

Knowledge and practices in preventing nutritional anaemia of the urban poor adolescents in Kuala Lumpur, Malaysia

Background: Anaemia has been identified as a major public health problem that affects both developed and developing countries, including Malaysia. To prevent anaemia, knowledge is a key parameter for changing attitudes and practices. Aim: This present study aims to determine the association of knowledge and practices in preventing nutritional anaemia with anaemia status of urban poor adolescents in Kuala Lumpur, Malaysia. Methods: A total of 209 urban poor adolescents (50.7% males and 49.3% females) aged 10 to 17 years old were recruited from eight low-cost flats (People Housing Programme) in Kuala Lumpur, Malaysia. A self-administered questionnaire was used to assess the sociodemographic characteristics, knowledge and practices in preventing nutritional anaemia. Anaemia status from the haemoglobin level concentration was determined using HemoCue® 201  +  hemoglobinometer. Results: The prevalence of anaemia among urban poor adolescents was 58.4%, particularly prevalent among females (p < 0.001) and household size of six and above (p  =  0.036). Only 29.2% and 10.0% of them were found to have good levels of knowledge and practices in preventing nutritional anaemia, respectively. Adolescents with high knowledge level tended to be anaemic as compared to poor knowledge level (AOR(95% CI)  =  2.20 (1.02, 5.61), p < 0.05) after adjusting for sex, household size and monthly household income. Conclusion: Findings showed high prevalence of anaemia and low levels of knowledge and practices of nutritional anaemia prevention among the urban poor adolescents. Nutrition education and intervention are needed to improve the anaemia status of the urban poor adolescents.

Toward Sustainable Diets-Interventions and Perceptions Among Adolescents: A Scoping Review

Adolescence is an important life stage during which shifts toward more healthy and sustainable diets can be promoted. Adolescents have increasing influence over their food choices, informed by their developing personal knowledge and values, affecting long-term dietary behaviors into adulthood. The recent literature regarding adolescents' (1) perceptions of environmentally sustainable diets and (2) interventions to support adolescents to eat sustainably was reviewed in this study. We reviewed published literature that focused on adolescent participants and their perceptions of, or interventions to support, sustainable dietary habits. Five electronic databases were searched to include studies published since 2012 that met the inclusion criteria, including reporting of participants aged between 11 and 18 years, reporting on adolescents' perceptions of sustainable diets or interventions implemented to improve the sustainability of adolescents' diets, and framed in the context of sustainability. Data were extracted, including study and participant characteristics, methodology, and results in relation to each of the 2 research focus areas. Twenty-eight articles were included in the review. Findings suggest that adolescents' understanding of what constitutes sustainable eating is poor. Adolescents who had previously received education regarding sustainable diets valued nature and health, or were from a rural or indigenous community, were more likely to value environmentally sustainable-food choices. Interventions which target adolescents' understanding of and aspiration to make sustainable-food choices appears to improve their attitudes toward sustainable food, whereas interventions to increase the availability of sustainable foods improved the environmental sustainability of adolescents' dietary intake. Multicomponent, tailored, and community-based interventions were most effective; however, the long-term effect of these interventions remains unclear. More research is needed in low- and middle-income countries, with consideration of adolescents' level of autonomy in food choice in local food environments and the long-term effectiveness of interventions. Systematic Review Registration: Open Science Framework identifier osf.io/h3jz6.

"We know what we should be eating, but we don't always do that." How and why people eat the way they do: a qualitative study with rural australians

BACKGROUND

There is evidence that most people are aware of the importance of healthy eating and have a broad understanding regarding types of food that enhance or detract from health. However, greater health literacy does not always result in healthier eating. Andreasen's Social Marketing Model and Community-Based Social Marketing both posit that, in order to change health behaviours, it is crucial to understand reasons for current behaviours and perceived barriers and benefits to improved behaviours. Limited research has been conducted, however, that explores these issues with general populations. This study aimed to help address this gap in the evidence using a qualitative methodology.

METHODS

Three group discussions were conducted with a total of 23 participants: (1) young women aged 18-24 with no children; (2) women aged 35-45 with primary school aged children; and (3) men aged 35-50 living with a partner and with pre- or primary school aged children. The discussions took place in a regional centre of Victoria, Australia. Transcriptions were thematically analysed using an inductive descriptive approach and with reference to a recent integrated framework of food choice that identified five key interrelated determinants: food- internal factors; food- external factors; personal-state factors; cognitive factors; and sociocultural factors.

RESULTS

We found that food choice was complex, with all five determinants evident from the discussions. However, the "Social environment" sub-category of "Food-external factors", which included family, work, and social structures, and expectations (or perceived expectations) of family members, colleagues, friends, and others, was particularly prominent. Knowledge that one should practice healthy eating, which falls under the "Cognitive factor" category, while seen as an aspiration by most participants, was often viewed as unrealistic, trumped by the need and/or desire for convenience, a combination of Food-external factor: Social environment and Personal-state factor: Psychological components.

CONCLUSIONS

We found that decisions regarding what, when, and how much to eat are seen as heavily influenced by factors outside the control of the individual. It appears, therefore, that a key to improving people's eating behaviours is to make it easy to eat more healthfully, or at least not much harder than eating poorly.

Relationships among Sleep Time, Physical Activity Time, Screen Time, and Nutrition Literacy of Adolescents: A Cross-Sectional Study in Chongqing, China

Background: Unhealthy lifestyles among adolescents are reaching alarming levels and have become a major public health problem. This study aimed to assess the relationship between sleep time, physical activity (PA) time, screen time (ST), and nutritional literacy (NL). Methods: This cross-sectional online study involving adolescents aged 10-18 years was conducted in September 2020 in 239 schools in Chongqing, China. NL was measured using the "Nutrition Literacy Scale for middle school students in Chongqing (CM-NLS)". According to the recommended by the Chinese dietary guidelines (2022), we divided the sleep time of junior high school students into <9 h and ≥9 h, high school students into <8 h and ≥8 h, divided the workdays into weekend PA time < 1 h and ≥1 h, and divided the workdays into weekend ST < 2 h and ≥2 h. The multinomial logistic regression model was used to examine the association. Results: A total of 18,660 adolescents (50.2% males) were included. The proportion of participants that were junior high school students and attended boarding schools was 57.2% and 65.3%, respectively. Compared with senior high school students, junior high school students had a higher level of NL. Whether on workdays or weekends, participants with sleep time ≥ 8/9 h, PA time ≥ 1 h, and ST < 2 h per day had higher levels of NL. On weekdays, participants who met the sleep time ≥ 8 h/9 h (OR = 1.48, 95% CI: 1.36, 1.62) and PA time ≥ 1 h (OR = 1.69, 95% CI: 1.59, 1.81) had higher reporting of NL levels. Conclusions: Sleep time, PA time, and ST were positively correlated with NL among adolescents, especially junior high school students.

Creating Food Learning Opportunities for Adults Within Urban Settings: A Framework for Food Pedagogies

Globally, food is acknowledged as a primary focus for addressing challenges facing cities. City councils create and support food-related policies or strategies to enhance healthy and sustainable environments, and multiple food practitioners engage closely with these initiatives. However, the visibility of educational aspects of food within governments, policy development, public spaces, or across society is limited. There is a lack of evidence about how pedagogical frameworks can inform these initiatives. This study aims to develop a draft food pedagogies framework, whose application can inform food initiatives beyond the classroom to increase adults' awareness of, engagement with and empowered action relating to food, with the goal to advance societal health and sustainability. A qualitative approach included semi-structured interviews with 39 experienced food leaders from diverse food-related fields in Australia. Using thematic analysis, five key themes to assist adults learn about food in everyday life settings were identified: (1) Making use of (in)formal pedagogical spaces in communities; (2) Encouraging interactions with a range of people related to food; (3) Creating enjoyable and practical experiences as part of daily lives; (4) Developing supportive and transparent systems that reflect communities' needs; and (5) Utilizing broader social issues. A proposed framework, based on the five themes and existing theoretical frameworks, can be used to inform policy makers and diverse food practitioners to develop urban food strategies that aim to create food-centred changes within urban settings toward societal health and sustainability.

Food in my life: How Australian adolescents perceive and experience their foodscape

Food choice has long been recognized as an interaction between psychological, social, cultural, economic, and biological forces through life course events and experiences. Adolescence is a particularly sensitive life stage during which personal and external environments influence food decisions and attitudes that can have long-term implications. Young people represent future households, yet little is understood about their perspectives on, and experiences of, their foodscape. To address this, a photovoice study with thirty-two students was undertaken at three state high schools with differing foodscapes in South East Queensland (Australia). Adolescent perspectives on foodscapes highlighted the food in front of them (either common or favourite foods), food routines, their emotional relationship with food, and the important role that family has in shaping their relationship with food (in particular mothers). Adolescents demonstrated an astute awareness of healthy/good and unhealthy/bad foods in relation to ingredients, ways of eating and different types of foods. Yet they expressed noticeable confusion on this matter, referring to some foods as "healthy-ish", or describing a "balanced" diet as consuming something healthy followed by something unhealthy. We found that adolescents are inundated by discretionary foods on a daily basis, however, are not particularly cognisant of them. These findings have direct implications for preventative health messages targeting adolescents.

Rethinking Adolescent School Nutrition Education Through a Food Systems Lens

BACKGROUND

Obesity-driven nutrition education in schools does not appear to result in healthier adolescent food choices. This study explored food systems as an alternative pedagogical approach to engage students in nutrition education.

METHODS

After playing a food systems computer game, 250 13- to 16-year-old students in 5 Western Australian secondary schools, participated in group discussions to distinguish learning and interests in food systems. Discussion records were thematically coded using constant comparative analysis.

RESULTS

Students reported crop growth, food production and food waste, healthier food choices, and food systems as knowledge outcomes of game play. They requested additional content on food production, costing, handling, processing, and accessing local produce. Experiential activities were preferred pedagogical approaches.

CONCLUSIONS

Cross-curricular pedagogy which embraces human and planetary health through a food systems lens, can engage adolescents in nutrition education. Transformational computer games are effective to engage, educate and stimulate inquiry in food systems education.

Boys and girls differ in their rationale behind eating: a systematic review of intrinsic and extrinsic motivations in dietary habits across countries

Background

Boys' and girls' food habits diverge in adolescence (13-18 years). This contributes to unequal risks of adverse health outcomes based on sex and gender in adulthood (e.g., heart diseases in men vs. disorder eating in women). Though multi-factorial, why these dietary differences occur is unclear.

Purpose

To identify the reasons why adolescents' motivation behind dietary habits differs among genders.

Methods

Four databases were searched following PRISMA guidelines. Eligible studies had to use qualitative methodology and report at least one gender unique theme. Reported themes were thematically analyzed, with a sub-analysis by country where the studies were conducted. Quality appraisals were assessed using the Critical Appraisal Skills Programme checklist.

Results

In the 34 eligible articles (n = 1,694 returned) two overarching themes emerged that dictated dietary habits in adolescents: Self-motivators and Uncontrollable factors. Gender differences arose whereby girls highlighted more external motivators (e.g., eat healthier, change dietary habits around boys and be thin to fit traditional norms) over their dietary habits. In contrast, boys focused on more internal motivators (e.g., gain autonomy, eat for enjoyment and pursue gains in physical performance). This suggests that motivation underlying how boys and girls eat differs. These trends were largely consistent across countries.

Conclusion

Boys' and girls' food habits are not motivated by the same factors. To create more effective dietary interventions targeting health promotion, unique motivations behind food habits need to be understood and incorporated.

Systematic review registration

Identifier: CRD42022298077.

Turkish version of the 'food and nutrition literacy questionnaire for Chinese school-age children' for school-age adolescents: a validity and reliability study

BACKGROUND

In this study, it was aimed to examine the psychometric characteristics of the scale named 'Food and Nutrition Literacy Questionnaire for Chinese School-age Children (FNLQ-SC)' in Turkish school age adolescents.

METHODS

The research was carried out with 341 school-age adolescents aged 10 to 17 years. The Cronbach's α coefficient was used to evaluate internal consistency reliability and the test-retest method was applied. The construct validity was assessed by exploratory factor analysis (EFA) and confirmatory factor analysis (CFA), and the content validity was assessed by the Pearson correlation coefficient.

RESULTS

EFA indicated that the Turkish version of FNLQ-SC had three factorial structures that accounted for 42.0% of the total variance. The overall Turkish version of FNLQ-SC questionnaire had acceptable internal consistency (Cronbach's α = 0.679). The dimensional structure obtained in the EFA was controlled by CFA and the three-factor model showed acceptable goodness-of-fit indices (χ2/df = 1.924, RMSEA = 0.052, CFI = 0.864, GFI = 0.949). The Pearson correlation coefficients between each dimension and the overall questionnaire ranged from 0.300 to 0.842. Multiple linear regression analysis indicated that age, gender, grade of class, being an only child and discussing nutrition information with families had an effect on food and nutrition literacy (R2 = 0.312; p < 0.001).

CONCLUSION

The Turkish version of FNLQ-SC has good reliability and construct validity to assess the food and nutrition literacy of Turkish school age adolescents.

Pulse-Based Nutrition Education Intervention Among High School Students to Enhance Knowledge, Attitudes, and Practices: Pilot for a Formative Survey Study

BACKGROUND

Promoting pulse consumption in schools could improve students' healthy food choices. Pulses, described as legumes, are rich in protein and micronutrients and are an important food choice for health and well-being. However, most Canadians consume very little pulse-based food.

OBJECTIVE

This pilot study sought to investigate outcomes of a teacher-led, school-based food literacy intervention focused on the Pulses Make Perfect Sense (PMPS) program in 2 high schools in Saskatoon, Saskatchewan.

METHODS

Both high schools were selected using a convenience sampling technique and have similar sociodemographic characteristics. The mean age of students was 16 years. The intervention comprised 7 key themes focused on pulses, which included defining pulses; health and nutritional benefits of pulses; incorporating pulses into meals; the role of pulses in reducing environmental stressors, food insecurity, and malnutrition; product development; taste testing and sensory analysis; and pulses around the world. A self-administered questionnaire was used to assess knowledge, attitudes, practices, and barriers regarding pulse consumption in students at baseline and study end. Teachers were interviewed at the end of the intervention. Descriptive statistics and the nonparametric Mann-Whitney U test were used for analysis.

RESULTS

In total, 41 and 32 students participated in the baseline and study-end assessments, respectively. At baseline, the median knowledge score was 9, attitude score was 6, and barrier score was 0. At study end, the median knowledge score was 10, attitude score was 7, and barrier score was 1. A lower score for barriers indicated fewer barriers to pulse consumption. There was a significant difference between baseline and study-end scores in knowledge (P<.05). Barriers to pulse consumption included parents not cooking or consuming pulses at home, participants not liking the taste of pulses, and participants often preferring other food choices over pulses. The teachers indicated that the pulse food-literacy teaching resources were informative, locally available, and easy to use.

CONCLUSIONS

Despite the improvements in knowledge, attitude, and practice, pulse consumption did not change significantly at the end of the intervention. Future studies with larger samples are needed to determine the impact of PMPS on knowledge, attitude, and practice of high school students.

Adaptation of the Food Literacy Questionnaire for school children to Turkish: validity and reliability study

Food literacy is the ability to understand the nature of food and its level of importance, to obtain, process, analyze, and use information about food. This study aims to translate and cross-culturally adapt the Food Literacy Questionnaire for school children (FLQ-sc) into Turkish and to study its psychometric properties of reliability and validity. The study was conducted with 303 students aged 12-14 in Kayseri, Turkey. A pilot study was conducted with 36 students, and a test-retest was conducted with 219 students, 2 weeks after the first study was performed. Data were collected with the sociodemographic data form and FLQ-sc. Linguistic, content, face, and construct validity were evaluated for validity. Cronbach's alpha and intraclass correlation coefficients (ICCs) were calculated for the reliability evaluation. Model validity was tested with confirmatory factor analysis. Root mean square error of approximation (RMSEA), χ2/SD, and goodness-of-fit index (GFI) statistics were in good agreement. Comparative fit index (CFI), Tucker-Lewis index (TLI), and standardized root mean square error of approximation (SRMR) statistics were at acceptable levels (RMSEA = 0.033, χ2/SD = 1.324, GFI = 0.958, CFI = 0.944, TLI = 0.939, SRMR = 0.063). The Cronbach's alpha coefficient for the total scale score was quite good (0.795). The ICC for test-retest reliability was good (0.874) for the total scale score.  Conclusion: The Turkish version of the Food Literacy Questionnaire for school children (FLQ-sc) is a valid and reliable measurement tool and can be used to evaluate food literacy levels in Turkish children aged 12-14. What is Known: • It is important to acquire knowledge and skills in food literacy from childhood because the behaviors learned during childhood and adolescence regarding food intake and preparation continue into adulthood. • In addition to the limited scales evaluating the food literacy levels of children, there is no scale evaluating the food literacy levels of Turkish children between the ages of 12 and 14. What is New: • The Turkish version of FLQ-sc is a valid and reliable scale for evaluating the food literacy levels of Turkish school children. • Scale is a suitable tool to ensure the comparison of food literacy levels in different student groups and measure abstract concepts such as education.

Nutrition Education Improves Knowledge of Iron and Iron-Rich Food Intake Practices among Young Adolescents: A Nonrandomized Controlled Trial

Introduction

Nutrition education targeting adolescents' health has the potential to enhance their well-being into adulthood. This study assessed the impact of nutrition education on the knowledge of iron and iron-rich food intake practices of adolescents living in rural communities in Ghana.

Method

An intervention study was conducted among 137 adolescents; 69 were assigned to the intervention group and 68 to the control group. Participants and guardians in the intervention group were involved in the nutrition education programme for six months. Participants in both groups completed sociodemographic, knowledge of iron, and iron-rich food intake practice questionnaires at pre- and postintervention. Data were analyzed by chi-square and t-tests.

Results

At postintervention, the mean knowledge score (p < 0.05) in the intervention group and control group was 5.3 ± 1.7 and 3.9 ± 1.9, respectively. Interventions (76%) and controls (46%) had good knowledge status. The mean knowledge score of participants with good knowledge status in the intervention group was 6.1 ± 0.8 (p < 0.05), and the control group was 5.6 ± 0.7 (p < 0.05). Forty-two percent of participants in the interventions and 26% in the controls had good food intake status. Participants with good food intake status had mean food intake scores of 3.2 ± 0.4 (p < 0.05) and 3.8 ± 0.7 (p < 0.05) for the intervention and control groups, respectively. Both groups increased and had the same mean food intake score (1.5 ± 1.4, p > 0.05), however, relatively higher in the intervention group.

Conclusion

Nutrition education improved the knowledge of iron and iron-rich food intake practices of participants in the intervention group compared to the control group. Nutrition education should be a critical component in the management and prevention of micronutrient deficiency in adolescents.

School lunchboxes as an opportunity for health and environmental considerations: a scoping review

Very little research has focussed on children's school lunchboxes from both a health and environment standpoint. This scoping review explores studies that considered children's lunchbox food consumption trends at school and the environmental impacts of lunchbox contents. We conducted a scoping review of peer-reviewed literature with a focus on lunchboxes of children in preschool or primary school settings that contained food packed from home, through the lens of food and nutrition in combination with environmental outcomes-particularly food and/or packaging waste. The review included 10 studies, with articles from Australia, USA, Spain, New Zealand and the UK. Half of them were intervention studies aiming to shift knowledge levels and attitudes of teachers, parents and children with regard to reducing packaged food choices and food waste, and improving dietary habits. Acknowledging the complexity of lunchbox packing and consumption practices, this review recommends the consideration of socio-ecological influences on children's health and sustainability behaviour, and mobilizing their pro-environmental agency.

Parent's food literacy and adolescents nutrition literacy influence household's food security and adolescent's malnutrition and anemia: Findings from a national representative cross sectional study

Introduction

Food and nutrition literacy are widely fundamental to improve the food security and reduce the double burden of malnutrition and iron deficiency in low- and middle-income countries.

Objectives

This study aimed (1) to assess the nutrition literacy (NL) of Lebanese adolescents and their parents' food literacy (FL), (2) to investigate the impacts of adolescents' NL and parental FL on (a) the household food security, (b) the adolescents' self-reported food security, and (c) the adolescents' nutrition status with a focus on malnutrition and anemia.

Methods

A national representative sample of 450 parent-adolescent dyads [parents: mean age ± standard deviation (SD) = 46.0 ± 7.0, mothers: 59.0%; adolescents: mean age ± SD = 15.0 ± 3.0, girls: 54.6%] were interviewed. Anthropometric and blood hemoglobin measurements were performed for adolescents. The Arab Family Food Security Scale and the Adolescent-Level Food Security Scale were used.

Results

Around 45.0% of the adolescents were nutritionally illiterate, and nearly half (47.8%) of parents had poor FL. Around 68.2 and 54.0% of the households and adolescents were food insecure, respectively. Moreover, 6.7, 4.7, 32.2, and 16.7% of the adolescents were stunted, thin, overweight/obese, and anemic, respectively. Poor parental FL increased the risk of household food insecurity (FI) by 2.7 times, p < 0.001. Adolescents' nutrition illiteracy increased their FI risk by 60.0% (p = 0.02). The number of offspring, household income, crowding status, and participants' residence also influenced the percentage of FI and malnutrition prevalence among households and adolescents.

Conclusion

Improvements in FL and NL are promising to mitigate FI malnutrition in Lebanon.

Executive functions and household chores: Does engagement in chores predict children's cognition?

INTRODUCTION

The benefits of completing household chores appear to transfer beyond managing day-to-day living. It is possible that chore engagement may improve executive functions, as engagement in chores require individuals to plan, self-regulate, switch between tasks, and remember instructions. To date, little research has been conducted on household chores and executive functions in children, for whom these skills are still developing.

METHODS

Parents and guardians (N = 207) of children aged 5-13 years (M = 9.38, SD = 2.15) were asked to complete parent-report questionnaires on their child's engagement in household chores and their child's executive functioning.

RESULTS

Results of the regression model indicated that engagement in self-care chores (e.g., making self a meal) and family-care chores (e.g., making someone else a meal) significantly predicted working memory and inhibition, after controlling for the influence of age, gender, and presence or absence of a disability. For families with a pet, there was no significant relationship between engagement in pet-care chores and executive function skills.

CONCLUSION

We strongly recommend that further research explore the relationship between chores and executive functions. It is possible that parents may be able to facilitate their child's executive function development through encouraging participation in chores, whereas chore-based interventions (e.g., cooking programmes) may also be used to target deficits in ability.

Impacts of Self-Efficacy on Food and Dietary Choices during the First COVID-19 Lockdown in China

The COVID-19 pandemic has caused a global public health emergency, increasing the prevalence of emotional distress, and potentially leading to altered diet behavior. Self-efficacy measures various aspects of perceiving and understanding emotions. The present study was carried out with the objective of understanding the effect of emotional self-efficacy on dietary behavior and quality. It also shed light on which elements contributed to the link between food-related behavior and perceived dietary quality during the first lockdown of the COVID-19 pandemic. Based on the factor analysis of nineteen food groups, choices, consumption, and socioeconomic status were examined in a sample of 441 Chinese participants. Multiple linear regression examined the association between food consumption, dietary quality, and self-efficacy. Contrary to prior research, the intake of salty snacks and alcoholic beverages dropped by 3.3% and 2.8%, respectively, during the first lockdown. Emotional self-efficacy negatively mediated the relationship between socioeconomic status and dietary quality. In conclusion, emotional self-efficacy is a well-established tool for evaluating how Chinese people cope with negative emotions. As an individual's dietary quality was affected during the imposed lockdown, the present study offers valuable insight into psychosocial factors that may contribute to health disparities by advocating for organized nutritional support in future epidemic-related quarantines.

Development of a conceptual framework of food and nutrition literacy in children

BACKGROUND

This study aimed to develop a conceptual framework to better understand food and nutrition literacy and its dimensions and components among Iranian children.

METHODS

The study included three sub-studies. First, two qualitative studies were conducted to explore experts' and students' perspectives and experiences regarding the topic. A comprehensive qualitative literature review was then conducted to identify food/nutrition literacy definitions and its components in the relevant literature. The data of the above three sub-studies were compiled as text data and were analyzed utilizing MAXQDA₂₀₁₀ software.

RESULTS

Two main domains, including cognitive and skill domains, emerged from the data analysis. The cognitive domain consisted of food- and nutrition-related knowledge included four subcategories "nutrition knowledge", "lifestyle knowledge", "food safety knowledge", and "knowledge of food and its preparation") as well as "food and nutrition understanding". The skill domain consisted of three dimensions: "functional", "interactive", and "critical" food and nutrition literacy.

CONCLUSIONS

The developed framework highlights the importance of integrated application of all dimensions of food and nutrition literacy among this population group. It can assist policymakers and curriculum developers in assessing education curricula and developing effective strategies for teaching and learning to increase students' food and nutrition literacy.

"I was pushed over the edge, but I didn't die" - A qualitative case study of Danish school children's food literacy at FOODcamp

Food literacy (FL) is a goal for many food camps aimed at improving school children's culinary skills and food knowledge. FL in relation to children has been defined as constituting five competencies: "to do" (practical skills),"to know" (knowledge), "to sense" (sensory experiences), "to care" (care for self and others), and "to want" (to be willing to act). However, understanding the processes and mechanisms that relates to school children's FL remain underexplored. The aim of this study was to identify underlying mechanisms operating at a food camp and elucidate how they relate to FL competencies among school children. A qualitative embedded case study design was used to explore this with a Danish food camp programme 'FOODcamp' targeting school-going children aged 12-14 years, constituting an instrumental case. A theory-driven abductive research strategy was used to facilitate analytical generalization. Five schools and nine classes participating in FOODcamp were recruited for the study. Data comprised 10 focus group discussions conducted with children, nine interviews conducted with teachers, and 10 days of observation at FOODcamp. The analysis resulted in 12 conceptually derived mechanisms operating at a food camp namely 'hands-on with food and kitchen utensils', 'use of all senses', 'help and recognition', 'theoretical reflection', 'from farm to table', 'try new and scary things', 'experimenting', 'genuine participation', 'cook from scratch', 'principles', 'meal group community' and 'food group community'. These mechanisms were in various combinations and in a dynamic interplay with contextual conditions related to school children's five FL competencies. The conceptually derived mechanisms may guide future research and practice by highlighting various processes and contextual conditions, given that they are adapted to the specific possibilities of a given context and age group.

Exploring young Australians' understanding of sustainable and healthy diets: a qualitative study

OBJECTIVE

This qualitative study aimed to explore young Australians' perspectives, motivators and current practices in achieving a sustainable and healthy diet.

DESIGN

Semi-structured online interviews were conducted with young Australians. Interviews were audio-recorded using the online Zoom platform, transcribed and analysed using a deductive analysis method by applying the Theoretical Domains Framework and inductive thematic data analysis.

SETTING

Young Australians recruited via social media platforms, noticeboard announcements and flyers.

SUBJECTS

Twenty-two Australians aged 18 to 25 years.

RESULTS

The majority of participants were aware of some aspects of a sustainable and healthy diet and indicated the need to reduce meat intake, increase intake of plant-based foods, reduce food wastage and packaging and reduce food miles. Young adults were motivated to adopt more sustainable dietary practices but reported that individual and environmental factors such as low food literacy, limited food preparation and cooking skills, lack of availability and accessibility of environmentally friendly food options and costs associated with sustainable and healthy diets hindered their ability to do so.

CONCLUSIONS

Given the barriers faced by many of our participants, there is a need for interventions aimed at improving food literacy and food preparation and cooking skills as well as those that create food environments that make it easy to select sustainable and healthy diets. Future research is needed for longitudinal larger scale quantitative studies to confirm our qualitative findings. In addition, the development and evaluation of individual and micro-environmental-based interventions promote sustainable and healthy diets more comprehensively.

Effects of University Students’ Perceived Food Literacy on Ecological Eating Behavior towards Sustainability

Due to the COVID-19 pandemic and industrialized food systems, people’s eating behavior has become seriously restricted. Especially, university students have started to overly depend on processed foods and carnivorous diets, and it places a huge burden on society by inducing the deterioration of health and environmental sustainability. Therefore, this study was undertaken to examine the effects of university students’ perceived food literacy on ecological eating behavior towards sustainability. A total of 395 university students in South Korea participated in this research. First, students’ food literacy components, which are reading labels and budgeting, healthy snack styles, healthy food stockpiling and resilience and resistance, exert positive influences on ecological eating behavior; second, the other two components, which are food preparation skills and social and conscious eating, have no positive impact on ecological eating behavior. Finally, the influences of food literacy on ecological behavior are significantly moderated by gender differences. This suggests that strengthening university students’ food literacy through education is necessary to promote ecological eating behaviors and advance the development of sustainable society.

Higher food literacy scores are associated with healthier diet quality in children and adolescents: the development and validation of a two-dimensional food literacy measurement tool for children and adolescents

BACKGROUND/OBJECTIVES

Most child and adolescent food literacy measurement tools focus on nutrition and food safety. However, the importance of aspects related to the food system such as food distribution and food waste and their effects on environmental sustainability is growing. We therefore developed and validated a two-dimensional tool for children (8-12 years old) and adolescents (13-18 years old) that can comprehensively measure food literacy. The association of food literacy with diet quality and self-reported health was assessed.

SUBJECTS/METHODS

First, we developed a food literacy conceptual framework that contains food system and literacy dimensions through a literature review, focus group interviews, and expert review. After a face validity study, we conducted the main survey (n = 200) to validate the questionnaire. Construct validity and reliability were assessed using exploratory factor analysis (EFA), confirmatory factor analysis (CFA), and Cronbach's alpha.

RESULTS

As a result of the Delphi study, content validity was confirmed for the remaining 30 items after two items were excluded (content validity ratio = 0.86). Eleven items were excluded from the EFA results, while the CFA results indicated appropriate fit indices for the proposed model (comparative fit index = 0.904, root mean square error of approximation = 0.068). The final food literacy questionnaire consisted of 19 questions and comprised 5 factors: production, distribution, selection, preparation and cooking, and intake. Food literacy was positively associated with diet quality, as assessed by the Nutrition Quotient score, in both children and adolescents and with self-reported health in adolescents.

CONCLUSIONS

Based on this integrated conceptual framework, a two-dimensional 19-item food literacy measurement tool was developed and verified for practical use to improve the diet quality and food-related environmental sustainability awareness of children and adolescents.

Identifying effective interventions to promote consumption of protein-rich foods from lower ecological footprint sources: A systematic literature review

Addressing overconsumption of protein-rich foods from high ecological footprint sources can have positive impacts on health such as reduction of non-communicable disease risk and protecting the natural environment. With the increased attention towards development of ecologically sustainable diets, this systematic review aimed to critically review literature on effectiveness of those interventions aiming to promote protein-rich foods from lower ecological footprint sources. Five electronic databases (Medline, Web of Science, Scopus, Embase and Global Health) were searched for articles published up to January 2021. Quantitative studies were eligible for inclusion if they reported on actual or intended consumption of protein-rich animal-derived and/or plant-based foods; purchase, or selection of meat/plant-based diet in real or virtual environments. We assessed 140 full-text articles for eligibility of which 51 were included in this review. The results were narratively synthesised. Included studies were categorised into individual level behaviour change interventions (n = 33) which included education, counselling and self-monitoring, and micro-environmental/structural behaviour change interventions (n = 18) which included menu manipulation, choice architecture and multicomponent approaches. Half of individual level interventions (52%) aimed to reduce red/processed meat intake among people with current/past chronic conditions which reduced meat intake in the short term. The majority of micro-environmental studies focused on increasing plant-based diet in dining facilities, leading to positive dietary changes. These findings point to a clear gap in the current evidence base for interventions that promote plant-based diet in the general population.

Barriers to Urban Food Action: Relevance of Food Pedagogies

Cities strive to feed growing populations while at the same time minimize the environmental impacts of their food systems. To support cities to achieve their goals, they require systematic and practical actions, including identification of the needs and capacities of food practitioners to guide and support food-related policies and initiatives. This study aims to explore barriers to food-related actions in everyday settings and the potential of a food pedagogy framework to overcome such barriers. Semi-structured interviews were conducted with 39 experienced food leaders from diverse food-related areas in Australia. Thematic analysis identified six key themes related to weaknesses in food-related actions, including lack of: a broad understanding about food; acknowledgement of values of food in everyday lives; a broad pedagogical lens; a responsible entity; organizational supports; and coordination between stakeholders and communities. Existing national and global food initiatives were reviewed using a pedagogical framework to identify presence of these barriers to actions, together with strategies that aimed to avoid or diminish such barriers. The findings confirm that a pedagogical approach has potential to enhance the roles and capacities of food practitioners and provide support for government and community structures to achieve a common vision of healthy and sustainable urban food systems.

Examining Elementary School Children's Knowledge about Food and Nutrition in Southwestern Ontario, Canada

Purpose: Knowledge is fundamental to helping children make nutritional choices that support lifelong healthy behaviours. This study (i) investigates elementary school children's knowledge about food and nutrition and (ii) identifies sociodemographic factors influencing children's reported knowledge.Methods: In 2017-2019, a survey was administered to 2443 students (grades 5-8) at 60 schools across southwestern Ontario, Canada, and a parent survey was used to validate self-reported sociodemographics. Multiple regression was used to analyse children's knowledge scores and related sociodemographic factors. A total knowledge score was calculated by summing correct responses derived from 46 individual questions in the student survey.Results: Mean total knowledge score was 29.2 out of a possible 46 points (63.5% correct). Students demonstrated some knowledge and awareness of strategies to encourage fruit and vegetable consumption, healthy food selection, nutrition, and food preparation skills, although knowledge of food guide recommendations and locally sourced produce were limited. Female sex, family income, and rurality were associated with higher knowledge scores.Conclusions: Results provide insight regarding strengths and gaps in elementary-school children's food and nutrition knowledge. Poor performance of students on specific food guide-related questions suggests that the general guidance of the 2019 Canada's Food Guide might be better understood by children and adolescents.

Food Literacy and Its Associated Factors in Non-Dialysis Patients with Chronic Kidney Disease in China: A Cross-Sectional Study

PURPOSE

Nephrology professionals' understanding of food literacy (FL) and influencing factors is significant for nutrition management, which is key to controlling disease progress among non-dialysis patients with chronic kidney disease (CKD). However, few studies have explored FL in CKD patients. Hence, this study aimed to investigate the level of FL of non-dialysis patients with CKD and to analyze influencing factors in China.

PATIENTS AND METHODS

A total of 203 CKD patients without dialysis were recruited from August to December 2020 to participate in a cross-sectional study. Food literacy was assessed by a modified short food literacy questionnaire for adults. Related influencing factors were measured by the motivation for dietary self-control scale and the satisfaction with dietary behavior scale. Data were also collected regarding patients' health information-seeking behavior (four items), satisfaction and compliance with dietary advice from healthcare professionals (two items), and demographics and clinical diagnoses.

RESULTS

The mean age of patients was 44.5 years (range 18 to 75), and 42.5% were male. Most (50.2%) were in stages 1-2 of CKD. The mean FL score of these patients was 38.75±0.38. The multivariable linear regression analysis shows that secondary educational level (β=0.221, p=0.004), motivation for controlling diet (β=0.198, p=0.003), satisfaction with dietary behaviors (β=0.319, p<0.001), and health information-seeking behavior (β=0.146, p=0.019) were significant influencing factors.

CONCLUSION

Food literacy of Chinese CKD patients without dialysis should be improved. Patients with higher education levels exhibit more active information-seeking behaviors, have greater satisfaction with dietary behaviors, and their motivation for dietary self-control is more likely to be associated with better FL. Healthcare workers should be aware of factors influencing FL and attempt to integrate assessment of FL into routine food-related education for CKD patients.

Improved food literacy among schoolchildren as an effect of a food camp intervention: Results of a controlled effectiveness trial

Food literacy (FL) refers to an individual's prerequisites for their engagement with food. Schoolchildren's FL has been defined in terms of five competencies: "to know"(e.g food-related knowledge), "to do" (e.g cooking skills), "to sense" (e.g. less well-explored sensory experiences), "to care" (e.g. taking care of oneself and others) and "to want" (e.g. willingness to take a stand and act). A cluster-based quasi-experimental effectiveness trial on the effects of a school-based intervention, "FOODcamp," on FL, health literacy, and school well-being was conducted. A total of 640 school children in grades 6 and 7 (mean age = 12 years) attended this one-week camp and participated in different food-related classes and activities. Linear mixed models controlling for the nested structure of data showed small but significant effects for the following FL dimensions: "to do (E = 0.098, CI (0.035-0.161), p = 0.002), "to sense" (E = 0.152, CI (0.073-0.232), p < 0.001), and "to know" (E = 0.086, CI (0.022-0.150), p = 0.009) as well as for overall FL (E = 0.078, CI (0.034-0.122), p = 0.001). No effects were found for the dimensions "to want" or "to care". The intervention also had a small but significant effect on children's health literacy but not on school well-being. These findings demonstrate the value of FOODcamp and the positive impacts of a relatively brief intervention on children's FL.

Essential food and nutrition knowledge and skills for primary school children: Australian parents' opinions

Purpose

This paper examines the views of Australian primary school parents regarding the food and nutrition education (FNE) curriculum. Associations with personal values (Universalism and Hedonism) and demographic measures were also explored.

Design/methodology/approach

An online survey was conducted among 787 parents in March 2021. Parents rated the importance of 17 FNE topics. They were also asked about their support for six curriculum improvements and to state their own improvement suggestions.

Findings

Parents viewed the “Effect of food on health” and “Food hygiene” as the most important topics. Three FNE components were derived: (1) food safety and preparation, (2) health and nutrition information, (3) food origins and environmental sustainability. The “Food safety and preparation” component score was associated with both universalism-nature and hedonism values but negatively associated with parental education. The “Health and nutrition information” component score was associated with universalism-nature value and main language spoken at home. Lastly, the “Food origins and environmental sustainability” component score was associated with universalism-nature value. The two personal values, universalism-nature and hedonism, were more strongly associated with parents' views of curriculum topics than parental demographic characteristics. Parents had several criticisms of current FNE, including school food environments not resonating with FNE taught in the classroom and that FNE might increase the risk of eating disorders. They also suggested that the FNE curriculum should support both parents and teachers by providing relevant resources and training.

Originality/value

Australian parents' views of the importance of FNE topics and how to improve FNE in primary schools have been under-examined.

“We should at least have basic survival skills, right?”: young males support mandatory food skills education

Purpose

This study explored young males' suggestions for food skills education in three domains: food selection and planning, food preparation and food safety and storage. It also solicited young males' perspectives on mandatory food skills education.

Design/methodology/approach

This descriptive qualitative study employed a semi-structured interview guide. A one-page list of food skills was provided to each participant to form a consistent basis for the interviews. Data were analyzed using the constant comparative method.

Findings

Forty-four young men aged 17 to 35 participated in the study. Thirty-seven supported mandatory education for food skills. Gender stereotypes around food skills were identified as a barrier to young males enrolling in elective food skills courses. When asked how food skills should be taught, the two main strategies mentioned were “online” and “hands-on.” Most participants identified skills in the food preparation domain as essential to include in the curriculum, although some recognized the importance of incorporating skills from all three domains.

Practical implications

Understanding important characteristics of effective food skills education for young males may increase their participation in school, virtual and community-based food skills education. Curricular content should consider young males' interests and baseline competencies and emphasize practical hands-on skills. Mandatory food skills education in secondary schools for all genders represents a comprehensive solution.

Originality/value

This study is among the first to report young males' opinions on crucial components of, and methods for, effective food skills education for this population.

'We are all in this together': Investigating alignments in intersectoral partnerships dedicated to K-12 food literacy education

BACKGROUND

Activities to foster food literacy in young people are increasingly common in schools, driven both by the public health sector and by curriculum mandates from education officials in government. In Canada, both Kindergarten-Grade 12 (K-12) classroom teachers and educators from community organisations deliver food literacy education programmes in schools, often framed as partnerships working in the interests of young people.

OBJECTIVE

The study examines the alignment between what both classroom teachers and community educators state are the desired outcomes for students of their food literacy education work and the topics/activities they engage in with students.

DESIGN SETTING AND METHOD

We surveyed and interviewed teachers and community educators in British Columbia, Canada, and utilised participant observation and secondary data from food literacy education network activities.

RESULTS

Shared food literacy education goals and topics/activities were evident in the responses of classroom teachers and community educators. Teachers framed their food literacy education programmes around the curriculum-as-plan - in this case, the provincial curriculum known as the BC Curriculum - and then enacted a lived curriculum that students experienced in the classroom. Community educators offered programmes that were initially designed to meet their organisation's focus, but which varied in terms of how much of the BC Curriculum was addressed.

CONCLUSION

Our results show broad alignment between teachers and community educators in food literacy education goals and practices; however, there is potential to increase this alignment and build stronger partnerships that support teachers in enacting the BC curriculum and meeting the needs of their students.

Children's Perceptions about Environmental Sustainability, Food, and Nutrition in Chile: A Qualitative Study

Food is inextricably linked to human health and environmental sustainability; however, very little is known about children’s perceptions of the concept of sustainability in the context of food choices. We aimed to explore the perceptions of Chilean schoolchildren about environmental sustainability, food, and nutrition. Eight online focus groups were conducted with boys and girls aged 8–9 (n = 30). Questions related to environmental sustainability, pocket money, and food characteristics such as price, front-of-package (FOP) warning label, and eco-labels were included. Data analysis was conducted using ATLAS.ti through a hybrid content analysis approach. Five central themes were identified: (1) children’s favorite snacks, (2) knowledge of sustainability, (3) sustainability and eco-labels use, (4) healthfulness of food products, and (5) pocket money and food prices. Most children were not aware of the meaning of “environmental sustainability”, but the concept was understood when it was explained in plain language. Participants showed awareness about the environmental impact of their eating behavior, had a positive perception of eco-labels, and identified food with fewer warning labels as “better” options. Results indicate that children understand the concept of sustainability in food if it is communicated clearly, and that eco-labels may be an effective tool in that effort.

Gender plays a role in adolescents' dietary behaviors as they transition to secondary school

Little research explores how changes in adolescents' peer, family and school environments may influence dietary behaviors during the shift from elementary school to secondary school and whether boys and girls experience these changes in similar ways. Drawing on Bronfenbrenner's socio-ecological model and Ridgeway's gendered framework, thematic analysis of twenty-seven semi-structured interviews with parent-adolescent dyads reveals that changes in adolescents' peer, family and school environments affect dietary behaviors following the transition in gendered ways. Within the peer context, food facilitates friendships among girls. Girls use food to forge intimate relationships with their peers whereas boys do not report relying on their peers to influence their dietary choices. In the family environment, gender-based body ideals (i.e., being strong and fit for boys versus being thin for girls) become more apparent and influential over adolescents' dietary behaviors. In some families, parents oppose gender-based body ideals (i.e., food restriction among girls) whereas in others, parents' expectations around food become supportive of gendered norms (i.e., encouraging food consumption among boys to gain muscle or acquiring food literacy skills among girls). Within the school context, socializing emerges as a key priority above eating at lunchtime, but boys and girls engage in this socialization differently. Girls use their lunch hour to socialize with peers through sedentary activities whereas boys socialize through team sports. In summary, gender plays a role in how changes in the peer, family and school environments influence boys' and girls' dietary behaviors as they transition into secondary school. Future public health interventions should consider using a targeted gender approach to encourage adolescents to make healthier food choices.

Health Literacy and Food Literacy for K-12 Schools in the COVID-19 Pandemic

BACKGROUND

Food literacy, a sub-area of health literacy, is achieving attention in schools, academia, research, health care, businesses, and governments worldwide. Against the current COVID-19 pandemic backdrop, the relevance of food literacy's interconnected attributes such as nutritional knowledge, food skills, and food environment is gaining traction. Enhancing health and food literacy in the K-12 school environment are important empowerment tools with the potential to reduce health inequalities as vulnerable people are at risk of limited health literacy.

METHODS

We aim to clarify the meaning of food literacy and its relationship to health literacy and other factors influencing eating behavior.

RESULTS

We offer a proposed conceptual model depicting connections between relevant theories and constructs in the field of health and nutrition. Concrete actions are offered that contemporary schools can take guided by the utility of the model.

CONCLUSIONS

This visual can help guide schools' multidimensional health and food literacy efforts while considering the realities of the current COVID-19 pandemic context and beyond. This model will provide an overarching reference for schools to consider key constructs to support practice, research, policy, and intervention efforts to advance their health and food literacy agendas.

The differential effects of viewing short-form online culinary videos of fruits and vegetables versus sweet snacks on adolescents' appetites

Social media culinary videos are a prominent feature across various social media platforms and constitute one of many media platforms that expose audiences to food. Given that there is a link between exposure to food content through food media and nutrient intake, our study aimed to investigate the effects of exposure to social media culinary videos on adolescents' appetites. We conducted a pre- and posttest study with 126 middle school children (M_age = 13.9, SD = 1.2). Participants saw a social media culinary video either demonstrating the preparation of a sweet snack (n = 50) or a fruit and vegetable snack (n = 76). As dependent variables, we examined hunger, general desire to eat, liking of the foods portrayed, intentions to eat and prepare the portrayed foods, and actual food choice behavior. The findings showed that the videos had no effects on hunger or general desire to eat but influenced food choice behavior, liking of the foods, and intentions to eat and prepare the foods portrayed. The sweet snacks video reduced the liking of fruits and vegetables and indirectly reduced the odds of choosing a fruit over a cookie, through intentions to eat sweet snacks. The fruits and vegetables video reduced the liking of sweet snacks and resulted in higher intentions to prepare healthy snacks. In conclusion, a single exposure to short-form culinary videos had effects on various food-related outcomes. While the positive effects of the fruits and vegetable video frame these videos as potential platforms to stimulate healthy eating and food preparation, the effects of the sweet snacks video warn of negative influences. Further research on prolonged repetitive exposure is warranted.

Knowledge and practices of dietary iron and anemia among early adolescents in a rural district in Ghana

The study assessed knowledge and practices of dietary iron intake and anemia among early adolescents in the Asante-Akim Municipality of Ghana. A cross-sectional study was conducted among 137 adolescents, aged 10-14 years. Structured questionnaire was used to collect data on sociodemographic, knowledge of iron, and anemia, and iron intake practices. Hemoglobin levels were determined using Hemocue 301. Data were analyzed using descriptive, chi-square test, and binary logistics regression. The mean age of participants was 11.5 years. About 40% had knowledge of iron deficiency anemia, 29.4% knew anemia causes, 86% knew symptoms of anemia, and 35% knew anemia consequences. Although 41.2% of participants knew its prevention as eating iron-rich foods, 31.4% knew the food sources of iron, and 4.4% mentioned animal-based foods as rich sources, with the bulk (27%) mentioning plant-based foods instead. Moreover, 18.2% knew iron enhancers, while 0.7% knew iron inhibitors. More chicken consumers (72.2%) than nonconsumers (56.6%) met the Estimated Average Requirement for dietary iron intake (Chi-square 3.4, p = .073), while more dried fish consumers (88%) than nonconsumers (66.7%) had normal hemoglobin levels (Chi-square 4.5, p = .050). Knowledge of food sources of iron and iron-rich foods was positively associated with intake of chicken, fresh fish, and dried fish. Moreover, lower knowledge of iron-based food sources (β = -1.015, p = .020) and iron-rich foods (β = -2.188, p = .015) was inversely associated with beef intake. Anemia was negatively associated with chicken (β = -0.310, p = .416) and dried fish (β = -1.299, p = .045) consumption. Majority of the adolescents had low knowledge of iron. Chicken and dried fish intake reduced the risk of anemia development. Our study may be the first to assess knowledge on iron, anemia, and its impact among young Ghanaian adolescents. Our findings provide insights into this topic, calling for to improve knowledge, and practices on anemia in Ghanaian adolescents.

Development and Pilot Testing of a Food Literacy Curriculum for High School-Aged Adolescents

Adolescent obesity and poor diet quality are increasingly prevalent and could be mitigated with attainment of food literacy. However, as these programs for adolescents are lacking, the purpose of this project was to develop a food literacy curriculum for high school-aged adolescents. The curriculum was designed in accordance with food literacy attributes and components utilizing Backward Design, Social Cognitive Theory, and Constructivism. After expert committee review, pilot testing was completed in two low-income communities by a trained facilitator and observer. Detailed observations were collected during pilot testing to assess achievement of learning objectives. Modifications were made to lesson procedures as required. The resulting curriculum, Teens CAN: Comprehensive Food Literacy in Cooking, Agriculture, and Nutrition, contains 12 modules of experiential lessons and application activities within three topics. Agriculture lessons concentrate on the food supply chain and food environments; nutrition lessons include food groups while focusing on nutrients of concern for underconsumption; and cooking lessons include food safety, budgeting, and preparation. Teens CAN provides a comprehensive and necessary approach to advancing food literacy in adolescents. Future directions include assessing dietary implications after participating in Teens CAN lessons and employment of an innovative two-tiered cross-age teaching model.

Promoting healthy eating habits among youth according to their preferences: Indications from a discrete choice experiment in Tuscany

INTRODUCTION

The incidence of overweight among youth in Western Countries requires the implementation of initiatives to promote healthy lifestyles. Although under particular conditions obesity is not preventable, drawing attention on factors affecting teenagers' preferences can ameliorate the efficacy of public interventions designed for health promotion.

METHODS

This study aims at eliciting teenagers' food preferences through a discrete choice experiment, conducted in Tuscany using a webAPP survey, with the participation of more than 4,700 teenagers. Respondents expressed their preferences for breakfast food based on three attributes: food quality, packaging and claim. The survey also collected information on respondents' socio-demographic characteristics, social influence and media use for food information.

RESULTS

Teenagers' preferences for healthy foods seem positively related with their own level of food literacy. The tendency of respondents to read labels and nutritional facts is positively associated with preferences for healthier foods. Peers' influence is not significant, while family influence has a positive impact on teenagers' healthy choices. Internet usage is associated with unhealthy choices with a healthy aspect.

CONCLUSION

The results can be useful in defining effective actions for the promotion of healthy behaviors among teenagers, either in communication and awareness campaigns or in education and activation initiatives, with respect to the reading and interpretation of nutritional facts and labels, the role of family and friends, and the use of media.

Identifying Differences in Nutrition-Related Learning Interests of Adolescent Students

BACKGROUND

In this study, we examined nutrition-related topics among adolescent students attending schools with different Indices of Community Socio-Educational Advantage (ICSEA).

METHOD

Participating students (N = 206) from 5 schools in Western Australia completed a paper-based questionnaire on nutrition-related topics. Frequencies and independent chi-square tests were used to identify differences between sexes and school ICSEA.

RESULTS

Of the participating students, 75% were interested in learning about 8 of 16 topics. We found statistically significant differences by sex (p < .01) for "Eating the right foods for preventing illness and disease," "Eating the right food for being active" among girls, and "Reducing food waste" among boys. We also noted differences by school ICSEA.

CONCLUSION

Acknowledging sex and socioeducational differences in teaching and learning may help teachers to engage adolescent students in nutrition education.

Adolescents' views on high school food environments

ISSUE ADDRESSED

This study explored adolescents' views on high school food environments and potential strategies to help them to make informed food choices.

METHODS

Fifteen focus groups were conducted with 131 adolescents aged 12-17 years from three high schools in South East Queensland, Australia. Adolescents were asked how their school food environment (dis)encouraged them to eat healthy and what schools could do to help them eat healthier. All focus groups were audio recorded. Data were analysed using content and thematic data analysis methods.

RESULTS

Four major themes emerged: food availability and affordability; food related policy and regulations; nutrition education; and attitudes, preferences and practices. Adolescents stated that nutrition education within the school curriculum and positive role modelling by peers and school staff in healthy eating were the major factors in helping them to make informed food choices. In contrast, high availability, affordability, fundraising, peer pressure, positive attitudes and negative role modelling towards unhealthy foods impacted unhealthy dietary behaviours.

CONCLUSIONS

Emerging results indicate that adolescents do not perceive the current high school food environments as helping them to make healthy food choices. Adolescents suggested limiting unhealthy foods in high schools by implementing strict food and beverage policies, compulsory nutrition education classes and changing attitudes towards healthy foods as strategies to improve high school food environments. SO WHAT?: This study highlights the importance of high school food environments in impacting adolescents' food choices. Strategies identified by adolescents inform public health practitioners and school authorities on how high school food environments could be tailored to help them in making better food choices.

Development and validation of a food literacy instrument for school children in a Danish context

Food literacy (FL) is an aim of food education and cooking interventions, but is defined and measured in different ways. In this study we developed, tested, and validated a FL instrument targeting children aged 12-14 years that builds on a broad 5-dimensional FL concept that includes the competencies of knowing and doing, as well as the rarely investigated competencies of using the senses, caring for others, and wanting to participate as a citizen regarding food issues. The study had 3 phases: 1) item development involving an expert panel; 2) scale testing comprising a face validity test with 12 pupils and a test with 817 pupils, of which 267 took part in a retest; and 3) scale validation including testing dimensionality by confirmatory factor analysis (CFA), internal reliability by Cronbach α, external reliability by intraclass coefficient (ICC), and convergent and predictive validity by regression analysis. CFA showed an acceptable model fit, confirming the concept of FL as 1 factor and its 5 distinct competencies as subfactors. There was good internal reliability for total FL score (α = 0.85) and good external test-retest reliability (ICC = 0.92). Convergent validity for a similar health literacy construct was significant for the total FL scale and its 5 competencies; this was also true for the predictive validity of FL with food intake as an outcome. This 37-item, 5-dimensional FL instrument can be used to assess FL levels in children and can guide food and nutrition education.

FOODLIT-PRO: conceptual and empirical development of the food literacy wheel

Pursuing food systems' sustainability is crucial. Given the risk constituted by unhealthy diets, scarce research on food-related adjacent fields, and inconsistency across food literacy conceptualizations, this study aims to explore the constructs' definition and develop a conceptual and empirical framework of food literacy. A quantitative approach was taken on previously obtained qualitative outcomes from 30 interviews with experts from food-related fields. Food literacy was defined by a four-dimension model: Cooking Skills, Preserve and Analyse, Choice and Acquisition, Search and Plan. The framework Food Literacy Wheel integrates the construct definition, food literacy determinants (Internal, External) and influential factors (Nutritional, Psychological, Health, Learning Contexts, Policy, Industry, Sustainability, Social and Cultural). Allowing a broader perspective of food literacy within major food systems, this study contributes with new insights for future instruments and interventions, paving the way to develop/implement food literacy-related multi-sectorial and multilevel actions.

School readiness to adopt a school-based adolescent nutrition intervention in urban Indonesia

OBJECTIVE

To identify school community readiness to adopt a school-based adolescent nutrition intervention.

DESIGN

Cross-sectional study: mixed-methods design. The community readiness model was used to guide instrument development and qualitative analysis. Quantitative data are presented using descriptive statistics. Each statement was rated on a seven-point Likert scale, thereby producing scores between 1 (strongly disagree) and 7 (strongly agree).

SETTING

Ten of the twenty current public secondary schools in Bogor, Indonesia.

PARTICIPANTS

Ninety teachers and ten school principals.

RESULTS

Eating behaviour problem awareness was present among all participants; awareness of efforts to improve eating habits was also present, but these efforts were perceived as having low efficacy; support from the City Education Authority and Health Authority was present, but the support type did not match the perceived needs; nutrition education had not been implemented across the entire school community due to competing priorities; existing nutrition policies did not provide concrete scenarios and clear guidelines for nutrition-friendly schools; the availability and accessibility of healthy foods at schools were considered to be key factors in improved adolescent nutrition; positive attitudes existed among respondents towards the implementation of various nutrition programmes, and the median and mode were seven in all types of school-based intervention.

CONCLUSIONS

The school community readiness level regarding school-based adolescent nutrition interventions is currently in the action phase, implying that community leaders have begun organising efforts to address issues in adolescent nutrition and are aware of their consequences. Future support should be directed towards improving existing efforts and offering concrete ideas and clear policy guidelines for implementation.

Enablers and barriers to implementation of and compliance with school-based healthy food and beverage policies: a systematic literature review and meta-synthesis

OBJECTIVE

Schools have been recognised as a potential setting for improving young peoples' food and beverage choices; however, many schools fail to adhere to healthy food and beverage policy standards. The current study aimed to explore the enablers and barriers to effective implementation of and compliance with school-based food and beverage policies.

DESIGN

Systematic review and meta-synthesis. Eight electronic databases were searched for articles in June 2019. Studies were eligible for inclusion if they reported on implementation and/or compliance of school-based food and/or beverage policies with outcomes relating to enablers and/or barriers. This review had no restrictions on study design, year of publication or language. Seventy-two full-text articles were assessed for eligibility, of which twenty-eight were included in this review.

SETTING

Studies conducted globally that focused on schools.

PARTICIPANTS

School-based healthy food and beverage policies.

RESULTS

Financial (cost of policy-compliant foods, decreased profit and revenue), physical (availability of policy-compliant foods, close geographical proximity to unhealthy food outlets) and social (poor knowledge, understanding, and negative stakeholders' attitudes towards policy) factors were the most frequently reported barriers for policy implementation. Sufficient funding, effective policy communication and management, and positive stakeholders' attitudes were the most frequently reported enablers for policy implementation.

CONCLUSIONS

There is a need for better communication strategies, financial and social support prior to school-based food policy implementation. Findings of this review contribute to a thorough understanding of factors that underpin best practice recommendations for the implementation of school-based food policy, and inform those responsible for improving public health nutrition.