Perception of adolescents on healthy eating

Correlates of eating behaviors in adolescence: a systematic review of qualitative studies

CONTEXT

Nutrition plays a critical role in adolescence. Adolescents are vulnerable to the impact of different factors that distance them from healthy habits, increasing their risk of chronic diseases in adulthood. Qualitative methodologies allow for a better understanding of these factors.

OBJECTIVE

This systematic review aims to consolidate qualitative research evidence from the past 10 years to analyze the facilitators and barriers influencing adolescents' eating behaviors.

DATA SOURCES

Databases searched for relevant studies were Scopus, Medline/PubMed, PsycINFO, and Web of Science.

DATA EXTRACTION

A total of 4176 records were identified. The authors used the GRADE-CERQual (Confidence in Evidence from Reviews of Qualitative Research) quality-assessment tool.

RESULTS

Fifty articles with qualitative or mixed methodologies were finally included. The most applied techniques were focus groups and semi-structured interviews. The factors influencing adolescents' diets were classified into 4 dimensions: individual, social, community, and macrosystem factors. The most influential were the following-(1) at the individual level: gender (facilitator or barrier), taste and appearance of food (barrier), and lack of time (barrier); (2) at the social level: parents' and caregivers' influence (facilitator or barrier), peer group influence (barrier), and socioeconomic position (barrier); (3) at the community level: school food environment (facilitator or barrier), neighborhood food environment (barrier), household food environment (facilitator or barrier), food insecurity (barrier), and availability and affordability of ultra-processed foods (barrier); and (4) at the macrosystem level: digital tools (facilitator or barrier).

CONCLUSIONS

This systematic review identified several facilitators and barriers influencing eating behaviors among adolescents. Qualitative research provides a rich source of knowledge to inform interventions aimed at improving adolescents' diets. Qualitative research is very useful for collecting researches that help to implement intervention programs that improve adolescent nutrition.

Nutrition quality and food and packaging waste associated with the school food system: A pilot, citizen science study in an Irish secondary school

BACKGROUND

School is an important setting for creating healthy and sustainable food environments. Using participatory methods, this pilot study examined food and packaging waste and nutrition quality within the school food system.

METHODS

One secondary school in Ireland participated in a waste audit. Eleven male students (15-17 years) participated as citizen scientists. Students collected waste over 1 day and documented data on waste categories. Nutrition labels were photographed for analysis. Students created a video and participated in a focus group. Quantitative data were summarised using descriptive frequencies. A Nutrient Profile Model was applied to summarise nutrition quality. The focus group discussion was analysed using content analysis.

RESULTS

Highest weights of waste were organic waste (14.2 kg), paper and cardboard (5.0 kg), and hard plastics (4.1 kg). Materials banned by the European Union Single Use Plastics Directive were found. Recycling bins were contaminated with food waste. Nutrition labels from 132 food packages were analysed, of which 115 items (87%) were low-nutrient, energy dense foods. Confectionary, energy bars and desserts and savoury snacks were the most common packaged food groups. Students were not surprised by the unhealthy food choices; however, they were shocked and saddened at the waste practices. Their proposed solutions mapped across individual, community and organisational levels.

CONCLUSIONS

The methodologies allowed successful engagement with students on this topic. The use of unnecessary plastics to serve food, poor waste separation practices, and the production of avoidable waste from low-nutrient, energy-dense products were key issues identified. Students proposed solutions that are achievable in the short-term.

How do adolescents classify foods as healthy and unhealthy?: A qualitative inquiry from rural India

Indian adolescents exhibit obesogenic dietary habits including low intake of fruits and vegetables and increasing consumption of fast food and carbonated beverages. Adolescents' classification of healthy and unhealthy foods is likely to have significant implications for their dietary behaviour, and consequently, their health. However, there is limited evidence about the ways Indian adolescents classify foods as healthy or unhealthy. Hence, this qualitative study was designed to explore how Indian adolescents classify nutritious or non-nutritious food choices. Convenience sampling was used to recruit the study participants from Tikari village in Uttar Pradesh, India. Underpinned by the social constructivist lens, the adolescents were interviewed face-to-face in Hindi. All the interactions were digitally recorded, transcribed verbatim, and translated into English prior to data analysis. Transcribed data were analysed thematically using inductive as well as deductive coding, and subsequently, conceptual themes were extracted. A total of thirty-nine adolescents (twenty boys; nineteen girls) aged 10-19 years participated in this qualitative inquiry. The adolescents classified healthy and unhealthy foods based on the following six themes: (i) Food groups and nutrients; (ii) Health and immunity; (iii) Type of ingredient; (iv) Place and time of food preparation; (v) Packaging; and (vi) Parental influence. These findings can inform school-based food literacy interventions to foster healthy dietary habits and cooking skills among Indian adolescents.

Skipping breakfast associated with socioeconomic and lifestyle factors in Brazilian adolescents

The aim is to estimate the prevalence and evaluate the association of socioeconomic and lifestyle factors with skipping breakfast among Brazilian adolescent students. A cross-sectional study carried out with adolescent ninth-graders from Brazilian public and private schools participating in the 2015 National School Health Survey. The prevalence of skipping breakfast (less than five days/week) and its respective 95% confidence intervals were estimated and stratified by gender according to demographic, socioeconomic, and lifestyle factors, self-perceived body image, and attitudes towards weight. A three-block hierarchical Poisson regression, considering the complex sample design. The prevalence of skipping breakfast was 35.6%, higher among girls than boys. In both genders, skipping breakfast was positively associated with the highest socioeconomic level, morning school shift, paid work, regular consumption of alcoholic beverages, living only with the mother, the father or neither, the irregular consumption of school food and meals with parents, considering oneself too fat/fat and trying to lose weight. In general, skipping breakfast was associated with socioeconomic factors and lifestyle behaviors harmful to health among adolescent students.

Mudanças na frequência do consumo de refeições em adolescentes residentes em área de vulnerabilidade social da região metropolitana do Rio de Janeiro, Brasil

Resumo O objetivo deste estudo foi descrever as mudanças na frequência do consumo de refeições de adolescentes residentes na região metropolitana do Rio de Janeiro, em período de 5 anos. Utilizaram-se dados de dois estudos transversais, de base populacional, que foram realizados por meio de visitas domiciliares. Em 2005, a amostra final foi de 1089 domicílios com 511 adolescentes (de 12 a 18 anos), e em 2010 de 1121 domicílios com 314 adolescentes. A frequência do consumo de refeições foi obtida por meio de questionário autopreenchido e a avaliação da adequação de peso dos adolescentes foi realizada com base nos pontos de corte do IMC por sexo e faixa etária. Houve aumento da substituição diária do almoço tradicional por lanche (3,7% para 13,7%) e no consumo do jantar tradicional (62,9% para 72,0%). Os adolescentes com sobrepeso consumiram o desjejum com menor frequência do que aqueles sem sobrepeso (2005: 68,3% vs 79,3% p=0,02, 2010: 59,5% vs 77,4% p=0,03). Conclui-se que houve aumento da substituição diária do almoço tradicional por lanche e no consumo do jantar tradicional no período de 5 anos. Ademais, a prática do desjejum diário se associou com a classificação de IMC nos dois momentos do estudo, de modo que aqueles com sobrepeso consomem o desjejum com menor frequência.

How Does the Family Influence Adolescent Eating Habits in Terms of Knowledge, Attitudes and Practices? A Global Systematic Review of Qualitative Studies

Promoting healthy eating habits can prevent adolescent obesity in which family may play a significant role. This review synthesized findings from qualitative studies to identify family barriers and facilitators of adolescent healthy eating in terms of knowledge, attitudes, and practices (KAP). A literature search of four databases was completed on 31 July 2020; qualitative studies that explored family factors of adolescent (aged 10 to 19 years) eating habits were included. A total of 48 studies were identified, with the majority being from North America and sampled from a single source. Ten themes on how family influences adolescent dietary KAP were found: Knowledge—(1) parental education, (2) parenting style, and (3) family illness experience; Attitudes—(4) family health, (5) cultivation of preference, and (6) family motivation; Practices—(7) home meals and food availability, (8) time and cost, (9) parenting style, and (10) parental practical knowledge and attitudes. This review highlights five parental characteristics underlying food parenting practices which affect adolescents’ KAP on healthy eating. Adolescents with working parents and who are living in low-income families are more vulnerable to unhealthy eating. There is a need to explore cultural-specific family influences on adolescents’ KAP, especially regarding attitudes and food choices in Asian families.

Conocimientos, percepciones y uso del rotulado de alimentos y bebidas en un grupo de adolescentes de Argentina

Introducción El rotulado de alimentos es una herramienta importante para mejorar la nutrición y fortalecer la ciudadanía de los consumidores en las primeras etapas de la vida y en la adolescencia. Objetivo Explorar los conocimientos, percepciones y el uso del rotulado de alimentos y bebidas en un grupo de adolescentes de la Provincia de Buenos Aires, Argentina, para el año 2019. Metodología Diseño cualitativo con enfoque fenomenológico. La recolección de datos se realizó a través de una encuesta semiestructurada y grupos focales con selección de 29 estudiantes. Los resultados fueron analizados mediante la técnica de análisis de contenido. Resultados El rótulo de alimentos tuvo baja utilización. El grupo de adolescentes reconoció la importancia que tendría su uso en la salud de las personas. Se observó una baja potencial utilización a futuro. Se encontraron diferencias de género en la percepción sobre la importancia que se le asigna a la alimentación. Los adolescentes realizaron recomendaciones de posibles mejoras de las etiquetas que incluya una perspectiva inclusiva. Conclusión El nivel de conocimientos, el uso efectivo del rotulado de alimentos y la potencial utilización a futuro por parte de los/las adolescentes fue baja. Se recomienda repensar el diseño y generar estrategias de salud pública dirigidas a promover el uso de etiquetados nutricionales en grupos y contextos específicos.

Family influence on the nutritional status and eating habits of six to nine year-old children

ABSTRACT Objective To investigate whether caregivers’ attitudes, beliefs, practices, alimentary habits, and nutritional status influence the alimentary habits and nutritional status of children aged six to nine years. Methods This cross-sectional study included 164 children and a family member (caregiver) each (n=164), carried out in the family health units of the municipality of Ribeirão Preto (SP), Brazil. Weight and height measurements were performed; each child was then evaluated by the application of both the Child Feeding Questionnaire and 24h recall (for calculating the Healthy Eating Index Revised), in addition to the assessment of adherence to healthy eating steps of the Ministry of Health, through a questionnaire. Results The results showed that the prevalence of being overweight was 18.3% in children and 32.9% in caregivers, and the prevalence of obesity was 15.9% and 37.9%, respectively. Most of the 56 children categorized as overweight also had overweight caregivers (82.1%; n=46). Concerns regarding children’s weight control were higher among caregivers responsible for overweight children (3.6±1.29). In contrast, caregivers responsible for children below or at normal weight demonstrated a greater tendency toward getting children to eat (3.3±0.97 and 3.9±0.99, respectively). The average score; of the children’s Brazilian Healthy Eating Index Revised (50.0±13.6) was similar to that of their caregivers (56.5±12.1). Conclusions Caregivers have a direct influence on the nutritional status and eating habits of children; therefore, they should be targeted in the processes of nutritional intervention for the prevention and treatment of childhood obesity.

Qualidade da dieta segundo a autoavaliação de adolescentes: resultados do ISACamp-Nutri

Resumo Objetivou-se estimar as prevalências de autoavaliação da qualidade da dieta de adolescentes e identificar os motivos de não a considerar muito boa/boa; calcular o escore global e de cada componente do Índice de Qualidade da Dieta Revisado (IQD-R) segundo as categorias de autoavaliação. Estudo transversal de base populacional com amostra por conglomerados e em dois estágios, realizado em Campinas-SP. Foram analisadas 891 entrevistas. As prevalências de autoavaliação da qualidade da dieta foram de 57,3% como muito boa/boa, 34,6% como regular e 8,1% como ruim/muito ruim. A autoavaliação como regular ou ruim foi associada ao consumo de doces, salgadinhos/biscoitos, cereais integrais (10-14 anos) e de fast-food (15-19 anos). Para os que foram classificados com pior qualidade da dieta (1º tercil dos escores do IQD-R), 52,5% consideravam a alimentação muito boa/boa e apenas 13,1% como ruim/muito ruim. O escore do IQD-R revelou-se significativamente menor nos que achavam a alimentação ruim (50,0 pontos) comparados aos que disseram muito boa/boa (55,4 pontos). Os que consideravam a alimentação ruim apresentaram consumo inferior de frutas, cereais integrais, e superior de gorduras sólidas e açúcares. Os achados revelam incoerência na autoavaliação da qualidade da dieta em relação aos escores insatisfatórios observados.

FREQUENCY OF MEALS CONSUMED BY BRAZILIAN ADOLESCENTS AND ASSOCIATED HABITS: SYSTEMATIC REVIEW

OBJECTIVE

To analyze the studies that identified the frequency of meals ingested by Brazilian adolescents and associated habits.

DATA SOURCES

A systematic search was made in the databases and electronic databases: MEDLINE/PubMed, The Latin American and Caribbean Center of Information in Health Sciences (BIREME), Scopus, Web of Science and Embase, with articles published between January/2007 until December/2017, which addressed the evaluation of the frequency of meals performed by adolescents, considering or not associations with eating patterns and meal replacement.

DATA SYNTHESIS

6,608 studies were obtained through the search and nine were included in this review, all of them with a cross-sectional design. Eight studies used school surveys and only one was a population survey. Seven studies evaluated the frequency of the main daily meals that ranged from 47.0 to 79.0% at breakfast, from 65.0 to 98.4% at lunch, and from 51.0 to 94.0% at dinner. Five studies identified the frequencies of consumption of snacks between meals, finding higher values for afternoon snack (variation from 42.0 to 78.0%). Regarding the substitution of meals for snacks, in three of the four selected studies; it was observed that this practice occurred mainly in substitution of dinner (24.6 to 42.0%).

CONCLUSIONS

Breakfast was the most omitted meal for adolescents, and dinner was replaced with snacks. Among the between meal snacks, the afternoon snack was the most consumed.

The Family as an Actor in High School Students' Eating Habits: A Qualitative Research Study

In order to discover family conceptions and their difficulties with regard to healthy eating habits during the school day, a qualitative study framed in the phenomenological, exploratory, and explanatory perspective has been carried out to detect and describe the aspects and interrelationships that shape the study phenomenon. The researchers performed triangulation techniques and information analysis support with the Atlas-ti programme. As participants, the students' parents belonging to public secondary education high schools in Huelva, and the capital and its province were included. The participants were intentionally chosen based on established selection and segmentation criteria. Four main categories were obtained from the triangulated analysis. Healthy breakfast, school snack, school cafeteria, and promotion of healthy food measures. Other subcategories were established within them. Families are well aware of the composition of a healthy breakfast, although this is often not translated into practice. Lack of time, comfort and market influence are the main challenges they encounter for their children to acquire healthy habits. The maintenance of healthy habits, their responsibility and control on behalf of the family, and promoting fruit consumption and healthy products from the part of the centre and its cafeteria were highlighted as improvement proposals.

Subjetividades de los adolescentes con respecto a la promoción de la salud: contribuciones a la enfermería

Introducción: Los adolescentes representan una parte importante de la población con particularidades relacionadas con el estilo de vida, por lo que es necesario promover acciones que fomenten hábitos saludables. En esta perspectiva, comprender las subjetividades que influencian los comportamientos de salud típicos de la adolescencia se vuelve esencial para la salud y la atención de enfermería, ya que las opciones de autocuidado están marcadas de singularidades. Objetivo: Exponer las subjetividades de los adolescentes sobre el autocuidado en el contexto de la promoción de la salud y la enfermería. Materiales y Métodos: Enfoque de investigación fenomenológica heideggeriana con 17 adolescentes de una escuela pública en Minas Gerais realizada entre octubre y diciembre de 2016. El movimiento analítico hermenéutico permitió la aparición del fenómeno en estudio. Resultados: Sobre el autocuidado, los adolescentes expresaron que van al médico sólo cuando se necesita; saben que tienen que cuidar su salud, pero no hacer ejercicio o comer de forma saludable y cuidar su salud ahora, sino porque en el futuro puede convertirse en un problema. De los participantes, el 68% reportó haber desarrollado actividad física durante las clases de educación física y el 30% informó haber consumido alcohol. Discusión y Conclusiones: Al comprender las subjetividades de los adolescentes sobre el autocuidado, las enfermeras encuentran mayores elementos para realizar acciones de salud dirigidas a estimular comportamientos saludables que resultarán una mejor calidad de vida en el presente y a futuro. Como citar este artigo: Paula JA, Melo MCSC, Amorim TV, Salimena AMO, Paiva ACPC, Nascimento RCN. Subjetividades de adolescentes face à promoção da saúde: contribuições para a enfermagem. Rev Cuid. 2020; 11(1): e895. http://dx.doi.org/10.15649/cuidarte.895

Socio-Ecological Influences on Adolescent (Aged 10-17) Alcohol Use and Unhealthy Eating Behaviours: A Systematic Review and Synthesis of Qualitative Studies

Excess body weight and risky alcohol consumption are two of the greatest contributors to global disease. Alcohol use contributes directly and indirectly to weight gain. Health behaviours cluster in adolescence and track to adulthood. This review identified and synthesised qualitative research to provide insight into common underlying factors influencing alcohol use and unhealthy eating behaviours amongst young people aged 10–17. Sixty two studies met inclusion criteria. Twenty eight studies focused on alcohol; 34 focused on eating behaviours. Informed by principles of thematic analysis and meta-ethnography, analysis yielded five themes: (1) use of alcohol and unhealthy food to overcome personal problems; (2) unhealthy eating and alcohol use as fun experiences; (3) food, but not alcohol, choices are based on taste; (4) control and restraint; and (5) demonstrating identity through alcohol and food choices. Young people faced pressure, reinforced by industry, to eat and drink in very specific ways, with clear social consequences if their attitudes or behaviour were deemed unacceptable. No qualitative studies were identified with an explicit and concurrent focus on adolescent eating behaviours and alcohol consumption. Further exploratory work is needed to examine the links between food and alcohol in young people’s emotional, social and cultural lives.

Construction and Validation of an Instrument to Evaluate Knowledge on Healthy Eating in Schoolchildren

Objective: To validate the content and appearance of an instrument to evaluate knowledge on healthy feeding. Materials and Methods: Methodological study of validation of content, appeareance with 22 judges, and semantic validation with 12 schoolchildren from 4th and 5th grades in primary school education, ranging in age between nine and ten years. The Scale-Level Content Validity Index (S-CVI) ≥ 0.90 and the Item-Level Content Validity Index (I-CVI) ≥ 0.80 were considered approved in the validation. The Binomial test was used through the p value of the proportion (rejecting the H0 if p ≤ 0.80) to select items that should be revised or modified (items validated at significance level ≤ 0.05). Results: The instrument was validated with S-CVI = 0.93 and I-CVI ≥ 0.80 in the 12 items evaluated, with the mean proportion of “non-discordance” among judges = 0.93. The instrument with the suggested modifications was submitted to the target audience and completely approved by all the participating students. Conclusion: This instrument can be used during the health education activities of the School Health Program and the Family Health Program to promote healthy feeding with children between nine and ten years of age.

Healthy eating through the eyes of adolescents: A qualitative analysis of messages from the Dietary Guidelines for the Brazilian Population

ABSTRACT Objective To evaluate the interpretation by adolescents of messages contained in the Dietary Guidelines for the Brazilian Population. Methods Qualitative study of adolescents distributed across “conversation circles”. Each group received messages about healthy eating from the Dietary Guidelines and was instructed to develop materials containing their own interpretation thereof, using appealing wording and format. Content analysis was then used to evaluate these materials. Results Presentation of the produced materials revealed a focus on placing the participants at the center of the process and highlighting the dynamic and innovative nature of each strategy. Corpus analysis identified three clusters of meaning: (I) Food classification and selection model: The participants showed comprehension of the different formulations of foods and their impacts on health, but using other terms. A reductionist understanding of the composition of a healthy diet was observed; (II) Environment and eating practices: the environment was characterized as conducive or not to healthy eating, and open-air markets were recognized as spaces for healthy choices. Creating recipes was judged a wise choice to be shared; and (III) Diet-related individual and collective wellness: consequences of unhealthy food intake were linked to physical and emotional well-being. Concerns were raised about the use of natural resources and the impact of pesticides on individuals and the environment. Conclusion To facilitate understanding of the Dietary Guidelines, the wording of its messages must be adapted, and the discussion about healthy eating and proper diet must be broadened to ascribe greater value to the act of cooking in this population.

Health and nutrition in public and private schools in the city of Recife

Abstract Objectives: to analyze the implementation of initiatives and environments promoting healthy feeding as well as the practice of physical activity in public and private schools in Recife. Methods: the schools selected in the City of Recife (n=39) are part of the sample in the Study of Cardiovascular Risks in Adolescents (ERICA). The degree of implementation was estimated by means of interviews with the school manager emphasizing the following components: community participation, presence of healthy environments, partnership with the health segment, monitoring of nutritional status and nutrition policies. The variables selected were assigned points whose sum rated them as satisfactory implementation, poor implementation and critical implementation. Results: the promotion of healthy eating as well as the practice of physical activity was satisfactorily implemented in 13.8% of public schools. However, no private schools obtained such rating. Public schools, when compared to private schools, showed themselves to be more structured, concerning the policies and environments promoting healthy eating and school community participation, however, they showed greater fragility regarding the promotion of physical activity practice and nutritional status monitoring. A few schools had satisfactory implementation in the partnership with the health segment. Conclusions: public and private schools have presented barriers which compromise the full implementation of initiatives and environments promoting healthy eating and physical activity practice.