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Minaker LM, Menko P, Olona D. Development and testing of two tools to assess point-of-sale food and beverage marketing to children in restaurants. Public Health Nutr 2024; 27:e128. [PMID: 38705591 PMCID: PMC11112432 DOI: 10.1017/s1368980024000983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 04/09/2024] [Accepted: 04/15/2024] [Indexed: 05/07/2024]
Abstract
OBJECTIVE To describe the development and testing of two assessment tools designed to assess exterior (including drive-thru) and interior food and beverage marketing in restaurants with a focus on marketing to children and teens. DESIGN A scoping review on restaurant marketing to children was undertaken, followed by expert and government consultations to produce a draft assessment tool. The draft tool was mounted online and further refined into two separate tools: the Canadian Marketing Assessment Tool for Restaurants (CMAT-R) and the CMAT-Photo Coding Tool (CMAT-PCT). The tools were tested to assess inter-rater reliability using Cohen's Kappa and per cent agreement for dichotomous variables, and intra-class correlation coefficients (ICCs) for continuous or rank-order variables. SETTING Waterloo, Ontario, Canada. PARTICIPANTS Restaurants of all types were assessed using the CMAT-R (n 57), and thirty randomly selected photos were coded using the CMAT-PCT. RESULTS The CMAT-R collected data on general promotions and restaurant features, drive-thru features, the children's menu and the dollar/value menu. The CMAT-PCT collected data on advertisement features, features considered appealing to children and teens, and characters. The inter-rater reliability of the CMAT-R tool was strong (mean per cent agreement was 92·4 %, mean Cohen's κ = 0·82 for all dichotomous variables and mean ICC = 0·961 for continuous/count variables). The mean per cent agreement for the CMAT-PCT across items was 97·3 %, and mean Cohen's κ across items was 0·91, indicating very strong inter-rater reliability. CONCLUSIONS The tools assess restaurant food and beverage marketing. Both showed high inter-rater reliability and can be adapted to better suit other contexts.
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Affiliation(s)
- Leia M Minaker
- School of Planning, Faculty of Environment, University of Waterloo, Waterloo, ON N2L 3G1, Canada
| | - Patrycia Menko
- School of Planning, Faculty of Environment, University of Waterloo, Waterloo, ON N2L 3G1, Canada
| | - David Olona
- School of Planning, Faculty of Environment, University of Waterloo, Waterloo, ON N2L 3G1, Canada
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Saleh ST, Osaili TM, Al-Jawaldeh A, Hasan HA, Hashim M, Mohamad MN, Qiyas SA, Al Sabbah H, Al Daour R, Al Rajaby R, Masuadi E, Stojanovska L, Papandreou D, Zampelas A, Al Dhaheri AS, Kassem H, Cheikh Ismail L. Adolescents' use of online food delivery applications and perceptions of healthy food options and food safety: a cross-sectional study in the United Arab Emirates. Front Nutr 2024; 11:1385554. [PMID: 38628272 PMCID: PMC11018892 DOI: 10.3389/fnut.2024.1385554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 03/15/2024] [Indexed: 04/19/2024] Open
Abstract
Introduction This cross-sectional study aimed to assess Online food delivery applications (OFDA) usage trends among adolescent users in the United Arab Emirates (UAE), focusing on their perceptions of healthy food options and food safety (n = 532). Methods Sociodemographic information, frequency of OFDA use, factors affecting food choices, and perceptions of healthy food and food safety were investigated. A total perception score was calculated for each participant. Results Most participants used OFDAs weekly (65.4%), favoring fast food (85.7%). Factors like appearance and price drove food choices (65.0%), while taste and cost hindered healthy food orders (29.7 and 28.2%). Younger and frequent users had lower scores for perceiving healthy food, while seeking healthy options was associated with higher scores (p < 0.05). Females and those seeking healthy food showed higher food safety scores (p < 0.05). Discussion The study suggests tailored interventions to promote healthier choices and improve food safety perceptions among adolescents using OFDAs in the UAE.
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Affiliation(s)
- Sheima T. Saleh
- Department of Clinical Nutrition and Dietetics, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Tareq M. Osaili
- Department of Clinical Nutrition and Dietetics, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
- Department of Nutrition and Food Technology, Faculty of Agriculture, Jordan University of Science and Technology, Irbid, Jordan
| | - Ayoub Al-Jawaldeh
- Regional Office for the Eastern Mediterranean (EMRO), World Health Organization (WHO), Cairo, Egypt
| | - Haydar A. Hasan
- Department of Clinical Nutrition and Dietetics, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Mona Hashim
- Department of Clinical Nutrition and Dietetics, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Maysm N. Mohamad
- Department of Nutrition and Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Salma Abu Qiyas
- Department of Clinical Nutrition and Dietetics, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Haleama Al Sabbah
- Public Health Department, College of Health Sciences, Abu Dhabi University, Abu Dhabi, United Arab Emirates
| | - Rameez Al Daour
- Department of Clinical Nutrition and Dietetics, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Radhiya Al Rajaby
- Department of Clinical Nutrition and Dietetics, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Emad Masuadi
- Department of Public Health Institute, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Lily Stojanovska
- Department of Nutrition and Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
- Institute for Health and Sport, Victoria University, Melbourne, VIC, Australia
| | - Dimitrios Papandreou
- Department of Clinical Nutrition and Dietetics, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Antonis Zampelas
- Department of Food Science and Human Nutrition, Agricultural University of Athens, Athens, Greece
| | - Ayesha S. Al Dhaheri
- Department of Nutrition and Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Hanin Kassem
- Department of Clinical Nutrition and Dietetics, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Leila Cheikh Ismail
- Department of Clinical Nutrition and Dietetics, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
- Nuffield Department of Women’s & Reproductive Health, University of Oxford, Oxford, United Kingdom
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Raghoebar S, Mesch A, Gulikers J, Winkens LHH, Wesselink R, Haveman-Nies A. Experts' perceptions on motivators and barriers of healthy and sustainable dietary behaviors among adolescents: The SWITCH project. Appetite 2024; 194:107196. [PMID: 38154577 DOI: 10.1016/j.appet.2023.107196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 12/15/2023] [Accepted: 12/24/2023] [Indexed: 12/30/2023]
Abstract
The interplay of influences shaping dietary behaviors of adolescents needs to be well-understood to develop effective strategies stimulating healthy and sustainable behaviors. This study aimed to identify the most relevant, urgent, changeable and effective motivators and barriers of healthy and sustainable dietary behaviors among adolescents (10-19 years), as perceived by an inter- and transdisciplinary expert panel. Experts working in practice (N = 19) and academia (N = 13) - in the field of sustainability, health, nutrition and/or education - participated in this exploratory mixed-methods study. Five online semi-structured focus groups were conducted (6-7 participants). Data was thematically analyzed by two coders independently, using the socioecological framework. Subsequently, the same experts individually selected the five most relevant determinants and rated those on their urgency, changeability and effectiveness through an online questionnaire (N = 21). Participants revealed a wide system of 31 main determinants including 173 sub-determinants that motivate or hinder healthy and sustainable eating among adolescents. This system of determinants was mapped on the different layers of the socioecological model: individual factors (25 motivators; 30 barriers), social environments (15 motivators; 13 barriers), physical environments (18 motivators; 15 barriers), macro-level environments (19 motivators; 38 barriers). 'Role of peers' (social environment) was selected most as a determinant to be targeted in interventions (N = 13; urgency (M = 6.38) changeability (M = 3.85), effectiveness (M = 5.62)), followed by 'food environment around school' (N = 9; urgency (M = 5.78) changeability (M = 3.44), effectiveness (M = 5.44)), 'social influences' (N = 7; urgency (M = 5.43) changeability (M = 4.00), effectiveness (M = 5.71)), 'autonomy in development' (N = 7; urgency (M = 6.00) changeability (M = 4.29), effectiveness (M = 5.86)) and 'food availability' (N = 7; urgency (M = 6.29) changeability (M = 3.29), effectiveness (M = 6.29)). The prioritized determinants indicate that adolescents should be provided more supportive social and physical environments that promote healthy and sustainable dietary behaviors, taking into account their growing autonomy.
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Affiliation(s)
- Sanne Raghoebar
- Wageningen University & Research, Education & Learning Sciences Group, Wageningen, the Netherlands; Wageningen University & Research, Consumption & Healthy Lifestyles Group, Wageningen, the Netherlands.
| | - Anouk Mesch
- Wageningen University & Research, Education & Learning Sciences Group, Wageningen, the Netherlands; Wageningen University & Research, Consumption & Healthy Lifestyles Group, Wageningen, the Netherlands.
| | - Judith Gulikers
- Wageningen University & Research, Education & Learning Sciences Group, Wageningen, the Netherlands
| | - Laura H H Winkens
- Wageningen University & Research, Consumption & Healthy Lifestyles Group, Wageningen, the Netherlands
| | - Renate Wesselink
- Wageningen University & Research, Education & Learning Sciences Group, Wageningen, the Netherlands
| | - Annemien Haveman-Nies
- Wageningen University & Research, Consumption & Healthy Lifestyles Group, Wageningen, the Netherlands; GGD Noord- en Oost-Gelderland, Academic Collaborative Center AGORA, Zutphen, the Netherlands
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Caruso OT, McEachern LW, Minaker LM, Gilliland JA. The Influence of the School Neighborhood Food Retail Environment on Unhealthy Food Purchasing Behaviors Among Adolescents: A Systematic Review. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2024; 56:145-161. [PMID: 38284954 DOI: 10.1016/j.jneb.2023.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 11/30/2023] [Accepted: 11/30/2023] [Indexed: 01/30/2024]
Abstract
INTRODUCTION Adolescents are often exposed to food retailers selling unhealthy food items during their lunch breaks and school commutes. This systematic review examines the influence of school neighborhood food retail environments on adolescent food purchasing. METHODS A systematic search of 6 databases. Observational studies published from January 2012 to December 2022 that measured food availability, accessibility, or exposure, measured food purchasing, and focused on adolescents (aged 10-19 years) were eligible for inclusion. RESULTS Twelve studies with 97 findings were included. Thirty-one findings indicated that a school neighborhood with a high density of unhealthy food retail, a school with unhealthy food retail nearby, or exposure to unhealthy food retail on the journey to/from school was associated with higher prevalence and frequency of unhealthy food purchases. DISCUSSION Adolescents' food purchasing behaviors may be meaningfully affected by their school neighborhood food retail environment; however, the included studies have many methodological shortcomings. IMPLICATIONS FOR RESEARCH AND PRACTICE Results identify the need for new studies that measure food purchasing, use comprehensive definitions of food retail environments, and adopt more rigorous methods to approximate exposure to food retail. More robust evidence would strengthen the rationale for policy or program interventions and potentially indicate specific targets for intervention.
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Affiliation(s)
- Olivia T Caruso
- Department of Geography and Environment, Western University, London, Ontario, Canada; Children's Health Research Institute, London, Ontario, Canada
| | - Louise W McEachern
- Department of Geography and Environment, Western University, London, Ontario, Canada; Children's Health Research Institute, London, Ontario, Canada
| | - Leia M Minaker
- School of Planning, University of Waterloo, Waterloo, Ontario, Canada
| | - Jason A Gilliland
- Department of Geography and Environment, Western University, London, Ontario, Canada; Children's Health Research Institute, London, Ontario, Canada; Department of Pediatrics, Western University, London, Ontario, Canada; School of Health Studies, Western University, London, Ontario, Canada; Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada; Lawson Health Research Institute, London, Ontario, Canada.
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Wells G, Trapp G, Wickens N, Heritage B. Powerful promotions: An investigation of the teen-directed marketing power of outdoor food advertisements located near schools in Australia. Health Promot J Austr 2024; 35:144-153. [PMID: 37012612 DOI: 10.1002/hpja.724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 03/15/2023] [Accepted: 03/29/2023] [Indexed: 04/05/2023] Open
Abstract
ISSUE ADDRESSED Adolescents are heavily exposed to unhealthy outdoor food advertisements near schools, however, the marketing power of these advertisements among adolescents has not yet been explored. This study aimed to investigate the teen-directed marketing features present and quantify the overall marketing power of outdoor food advertisements located near schools to explore any differences by content (ie, alcohol, discretionary, core and miscellaneous foods) school type (ie, primary, secondary, K-12) and area-level socio-economic status (SES; ie, low vs high). METHODS This cross-sectional study audited every outdoor food advertisement (n = 1518) within 500m of 64 randomly selected schools in Perth, Western Australia, using a teen-informed coding tool to score the marketing power of each advertisement. RESULTS Outdoor alcohol advertisements around schools had the highest average marketing power score and number of advertising features present. Outdoor advertisements for alcohol and discretionary foods scored significantly higher in marketing power than core food advertisements (P < .001). Outdoor alcohol advertisements around secondary schools scored significantly higher in marketing power than around primary and K-12 schools (P < .001); and outdoor advertisements for discretionary foods in low SES areas scored significantly higher in marketing power than those in high SES areas (P < .001). CONCLUSIONS This study found outdoor advertisements for unhealthy products, such as alcohol and discretionary foods, were more powerful than advertisements for core foods around schools. SO WHAT?: These findings strengthen the need for policies which restrict outdoor advertisements for non-core foods near schools, to reduce adolescents' exposure to powerful alcohol and discretionary food advertisements.
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Affiliation(s)
- Gabriella Wells
- Telethon Kids Institute, The University of Western Australia, West Perth, WA, Australia
| | - Gina Trapp
- Telethon Kids Institute, The University of Western Australia, West Perth, WA, Australia
- School of Population and Global Health, The University of Western Australia, Crawley, WA, Australia
| | - Nicole Wickens
- Telethon Kids Institute, The University of Western Australia, West Perth, WA, Australia
| | - Brody Heritage
- Telethon Kids Institute, The University of Western Australia, West Perth, WA, Australia
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Daly AN, Kearney JM, O'Sullivan EJ. The underlying role of food guilt in adolescent food choice: A potential conceptual model for adolescent food choice negotiations under circumstances of conscious internal conflict. Appetite 2024; 192:107094. [PMID: 37866528 DOI: 10.1016/j.appet.2023.107094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 10/19/2023] [Accepted: 10/20/2023] [Indexed: 10/24/2023]
Abstract
Food choice decisions are challenging to conceptualise, and literature is lacking specific to adolescent food choice decisions. Understanding adolescent nutrition and food choice is becoming increasingly important. This research aims to understand what influences the food choices of Irish adolescents, and the mental negotiations occurring in food-based decisions. Additionally, it aims to develop a holistic conceptual model of food choice, specific to adolescents. A qualitative study was conducted in N = 47 Irish adolescents, via focus group discussions using vignettes to introduce discussion topics around food and eating habits. Data were analysed using reflexive thematic analysis, involving both semantic and latent analysis. Thirteen distinct factors related to adolescent food choices were discussed, forming one main theme and three inter-linking subthemes. The main theme relates to food choice being multi-factorial in nature, needing a balance of priorities through internal negotiations for food choice with the aim of reducing food guilt. This can change depending on the social setting. Social concerns and food guilt appear to play a strong role in adolescent food choice, with adolescents feeling guilty for eating unhealthy food, wasting food, or spending/wasting money on food. A conceptual model for food choice in adolescents was developed, named a "Food Choice Funnel", incorporating a specific "Food Guilt Matrix". While we should encourage healthy eating and a healthy lifestyle, it is important to understand the value placed on the social component to eating among adolescents, since they have increasing social interactions and occasions where choosing health-promoting foods may be more challenging. Healthy eating messages should be designed in a balanced manner to support healthy growth and development, while limiting the potential to induce feelings of guilt among adolescents.
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Affiliation(s)
- Aisling N Daly
- Oxford Brookes Centre for Nutrition and Health, Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK.
| | - John M Kearney
- School of Biological, Health, and Sports Sciences, Technological University Dublin, Dublin, Ireland
| | - Elizabeth J O'Sullivan
- School of Biological, Health, and Sports Sciences, Technological University Dublin, Dublin, Ireland
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Browne S, Mullen A, Mulholland B, Lo C, Ruttledge A. Nutrition quality and food and packaging waste associated with the school food system: A pilot, citizen science study in an Irish secondary school. J Hum Nutr Diet 2023; 36:2310-2322. [PMID: 37501253 DOI: 10.1111/jhn.13220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 07/13/2023] [Indexed: 07/29/2023]
Abstract
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.
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Affiliation(s)
- Sarah Browne
- School of Public Health, Physiotherapy & Sports Science, Belfield, Dublin, Ireland
- Institute of Food & Health, Belfield, Dublin, Ireland
| | - Aoife Mullen
- School of Public Health, Physiotherapy & Sports Science, Belfield, Dublin, Ireland
| | - Beth Mulholland
- School of Public Health, Physiotherapy & Sports Science, Belfield, Dublin, Ireland
| | - Chungwan Lo
- School of Public Health, Physiotherapy & Sports Science, Belfield, Dublin, Ireland
| | - Angela Ruttledge
- Voice of Irish Concern for the Environment, Dublin, Ireland
- FoodCloud, Broomhill Ind Estate, Dublin, Ireland
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Shaw S, Muir S, Strömmer S, Crozier S, Cooper C, Smith D, Barker M, Vogel C. The interplay between social and food environments on UK adolescents' food choices: implications for policy. Health Promot Int 2023; 38:daad097. [PMID: 37647523 PMCID: PMC10468012 DOI: 10.1093/heapro/daad097] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023] Open
Abstract
Factors from social and food environments can influence the food choices of adolescents in ways not experienced during childhood. Evidence suggests these two environments influence adolescents' food choices independently, but there is limited knowledge of how the interplay between these environments influence adolescents' diets. An enhanced understanding of this interplay surrounding adolescent food choice could aid the development of more nuanced interventions and policies. This qualitative study involved 13 online focus groups with adolescents (n = 45) aged 11-18 years, attending secondary school or college in England, UK. Data were analysed using thematic analysis. Social experiences which accompanied eating were perceived as more important than the food itself, and fast-food outlets were described as uniquely suited to facilitating these interactions. Young people wanted to spend their money on foods they considered worthwhile, but this did not always relate to the most affordable foods. Adolescents wanted to put little effort into making food decisions and appreciated factors that helped them make quick decisions such as prominent placement and eye-catching promotions on foods they wanted to buy. Chain food outlets were valued as they offered familiar and frequently advertised foods, which minimized the effort needed for food decisions. Adolescents' sense of autonomy underpinned all themes. Participants described having limited opportunities to make their own food choices and they did not want to waste these buying unappealing 'healthy' foods. Interventions and government policies should align with adolescents' experiences and values relating to food choice to ensure that they are effective with this important age group.
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Affiliation(s)
- Sarah Shaw
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton SO16 6YD, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
| | - Sarah Muir
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton SO16 6YD, UK
| | - Sofia Strömmer
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton SO16 6YD, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
| | - Sarah Crozier
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton SO16 6YD, UK
- NIHR Applied Research Collaboration Wessex, Southampton Science Park, Innovation Centre, 2 Venture Road, Chilworth, Southampton SO16 7NP, UK
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton SO16 6YD, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
| | - Dianna Smith
- Geography and Environmental Science, University of Southampton, Southampton SO17 1BJ, UK
| | - Mary Barker
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton SO16 6YD, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton SO17 1BJ, UK
| | - Christina Vogel
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton SO16 6YD, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
- NIHR Applied Research Collaboration Wessex, Southampton Science Park, Innovation Centre, 2 Venture Road, Chilworth, Southampton SO16 7NP, UK
- Centre for Food Policy, City, University of London, London EC1V 0HB, UK
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Shaw S, Barrett M, Shand C, Cooper C, Crozier S, Smith D, Barker M, Vogel C. Influences of the community and consumer nutrition environment on the food purchases and dietary behaviors of adolescents: A systematic review. Obes Rev 2023; 24:e13569. [PMID: 37081719 PMCID: PMC10909420 DOI: 10.1111/obr.13569] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 02/16/2023] [Accepted: 03/27/2023] [Indexed: 04/22/2023]
Abstract
Adolescence is a period of increased autonomy over decision-making, including food choices, and increased exposure to influences outside the home, including the food environment. This review aims to synthesize the evidence for the influence of community nutrition environments, spatial access to food outlets, and consumer nutrition environments, environments inside food outlets, on adolescent food purchasing and dietary behaviors in high-income countries. Six databases were searched for articles published before January 2023. Results were synthesized using a vote-counting technique and effect direction plots that record the direction of the effect in relation to the anticipated relationship with health. Thirty-four observational and two intervention studies met the inclusion criteria. In the 13 studies assessing adolescent exposure to healthy community nutrition environments, results did not show clear associations with dietary and purchasing outcomes. Thirty studies assessed adolescents' exposure to unhealthy community nutrition environments with the majority (n = 17/30, 57%) reporting results showing that greater exposure to food outlets classified as unhealthy was associated with less healthy food purchases and dietary intakes. Inconsistent results were observed across the seven studies investigating associations with the consumer environment. Further research in these areas, including more high-quality intervention studies, may help to develop policy strategies to improve adolescents' dietary behaviors.
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Affiliation(s)
- Sarah Shaw
- MRC Lifecourse Epidemiology CentreUniversity of SouthamptonSouthamptonSO16 6YDUK
- NIHR Southampton Biomedical Research CentreUniversity of Southampton and University Hospital Southampton NHS Foundation TrustSO16 6YDUK
| | - Millie Barrett
- MRC Lifecourse Epidemiology CentreUniversity of SouthamptonSouthamptonSO16 6YDUK
- NIHR Southampton Biomedical Research CentreUniversity of Southampton and University Hospital Southampton NHS Foundation TrustSO16 6YDUK
- Centre for Food Policy, CityUniversity of LondonNorthampton SquareLondonEC1V0HBUK
| | - Calum Shand
- MRC Lifecourse Epidemiology CentreUniversity of SouthamptonSouthamptonSO16 6YDUK
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology CentreUniversity of SouthamptonSouthamptonSO16 6YDUK
- NIHR Southampton Biomedical Research CentreUniversity of Southampton and University Hospital Southampton NHS Foundation TrustSO16 6YDUK
| | - Sarah Crozier
- MRC Lifecourse Epidemiology CentreUniversity of SouthamptonSouthamptonSO16 6YDUK
- NIHR Southampton Biomedical Research CentreUniversity of Southampton and University Hospital Southampton NHS Foundation TrustSO16 6YDUK
- NIHR Applied Research Collaboration Wessex, Southampton Science Park, Innovation Centre2 Venture Road, ChilworthSouthamptonSO16 7NPUK
| | - Dianna Smith
- NIHR Applied Research Collaboration Wessex, Southampton Science Park, Innovation Centre2 Venture Road, ChilworthSouthamptonSO16 7NPUK
- Geography and Environmental ScienceUniversity of SouthamptonSouthamptonSO17 1BJUK
| | - Mary Barker
- MRC Lifecourse Epidemiology CentreUniversity of SouthamptonSouthamptonSO16 6YDUK
- NIHR Southampton Biomedical Research CentreUniversity of Southampton and University Hospital Southampton NHS Foundation TrustSO16 6YDUK
- School of Health SciencesFaculty of Environmental and Life SciencesUniversity of SouthamptonSouthamptonSO17 1BJUK
| | - Christina Vogel
- MRC Lifecourse Epidemiology CentreUniversity of SouthamptonSouthamptonSO16 6YDUK
- NIHR Southampton Biomedical Research CentreUniversity of Southampton and University Hospital Southampton NHS Foundation TrustSO16 6YDUK
- Centre for Food Policy, CityUniversity of LondonNorthampton SquareLondonEC1V0HBUK
- NIHR Applied Research Collaboration Wessex, Southampton Science Park, Innovation Centre2 Venture Road, ChilworthSouthamptonSO16 7NPUK
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Berhane HY, Tadesse AW, Noor R, Worku A, Shinde S, Fawzi W. Food environment around schools and adolescent consumption of unhealthy foods in Addis Ababa, Ethiopia. MATERNAL & CHILD NUTRITION 2023:e13415. [PMID: 36999963 DOI: 10.1111/mcn.13415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 07/08/2022] [Accepted: 07/18/2022] [Indexed: 04/01/2023]
Abstract
Adolescent diets may be influenced by the retail food environment around schools. However, international research to examine associations between the proximity of retail food outlets to schools and diet provides equivocal support for an association. This study aims to understand the school food environment and drivers for adolescents' consumption of unhealthy foods in Addis Ababa, Ethiopia. Mixed-methods research was conducted, 1200 adolescents (10-14 years) from randomly selected government schools were surveyed, along with vendors within 5-min' walk of the schools and focus group discussions (FGDs) with adolescent groups. Mixed-effect logistic regression investigated the relationship between the number of vendors around the schools and the consumption of selected unhealthy foods. Thematic analysis was used to summarize findings from the FGDs. Consumption of sweets and sugar-sweetened beverages (S-SSB) and deep-fried foods (DFF) at least once a week was reported by 78.6% and 54.3% of the adolescents, respectively. Although all schools were surrounded by food vendors selling DFF and S-SSB, consumption was not associated with the number of vendors available around the school. However, adolescents' awareness and perception of healthy food, and their concerns about the safety of foods in the market, influenced their dietary choices and behaviours. Lack of financial resources to purchase food as desired also played a role in their selection of food and eating habits. Reported unhealthy food consumption is high among adolescents in Addis Ababa. Thus, further research is warranted to come up with school-based interventions that promote access and healthy food choices among adolescents.
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Affiliation(s)
- Hanna Y Berhane
- Nutrition and Behavioural Sciences Department, Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Amare Worku Tadesse
- Nutrition and Behavioural Sciences Department, Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Ramadhani Noor
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
- United Nations Children's Fund, Ethiopia
| | - Alemayehu Worku
- Nutrition and Behavioural Sciences Department, Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Epidemiology and Biostatistics Department, Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | - Sachin Shinde
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Wafaie Fawzi
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
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11
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Ryan D, Holmes M, Ensaff H. Adolescents' dietary behaviour: The interplay between home and school food environments. Appetite 2022; 175:106056. [PMID: 35447162 DOI: 10.1016/j.appet.2022.106056] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 04/05/2022] [Accepted: 04/14/2022] [Indexed: 12/29/2022]
Abstract
In the UK, school food standards have looked to improve the nutritional profile of school food provision and the choices made; however, adolescents' choices tend to bias towards micronutrient poor and energy dense options. This study aimed to explore how adolescents make their school food choices, along with how they engage with their environments whilst selecting food. Seven focus group interviews took place with adolescents (n = 28; 13-14 years) in a secondary school in Northern England. Discussions with participants were audio-recorded, transcribed verbatim and then analysed using an inductive thematic approach. Six themes emerged from the data: (1) parents' and adolescents' roles in the home food environment, (2) burgeoning food autonomy, (3) school food choice factors, (4) social aspects of school food, (5) home versus school, (6) food knowledge & beliefs. Adolescents identified two distinct environments during the focus group discussions: the home and school environments. Adolescents juxtaposed the two, in terms of food provision, food choices, rules and customs surrounding food choice. This juxtaposition emerged as an indirect but important influence on adolescents' school food choices. The school and home environments both (in)directly influence adolescents' school food choices, which involve an integration of multiple, often conflicting influences. Adolescents may adopt a number of unhelpful dietary rationalisations as they try to manage and reconcile these influences. Consultation, together with consideration of relevant food choice models, is required to identify opportunities to influence adolescents' food choices at school.
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Affiliation(s)
- D Ryan
- Nutritional Sciences and Epidemiology, School of Food Science & Nutrition, University of Leeds, Leeds, LS2 9JT, United Kingdom
| | - M Holmes
- Nutritional Sciences and Epidemiology, School of Food Science & Nutrition, University of Leeds, Leeds, LS2 9JT, United Kingdom
| | - H Ensaff
- Nutritional Sciences and Epidemiology, School of Food Science & Nutrition, University of Leeds, Leeds, LS2 9JT, United Kingdom.
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12
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Maneschy I, Moreno LA, Ruperez AI, Jimeno A, Miguel-Berges ML, Widhalm K, Kafatos A, Molina-Hidalgo C, Molnar D, Gottrand F, Donne CL, Manios Y, Grammatikaki E, González-Gross M, Kersting M, Dallongeville J, Gómez-Martinez S, De Henauw S, Santaliestra-Pasías AM. Eating Behavior Associated with Food Intake in European Adolescents Participating in the HELENA Study. Nutrients 2022; 14:nu14153033. [PMID: 35893887 PMCID: PMC9332602 DOI: 10.3390/nu14153033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 07/19/2022] [Accepted: 07/19/2022] [Indexed: 12/10/2022] Open
Abstract
Adolescence is recognized as a time of rapid physiological and behavioral change. In this transition, eating behavior is still being formed and remains an integral part of a person’s lifestyle throughout his or her life. This study aims to assess eating behavior and associations with food intake in European adolescents. We included 2194 adolescents (45.9% boys), aged 12.5 to 17.5 years, from the cross-sectional HELENA study, with two completed 24 h recalls and complete questionnaire data on their eating behavior (Eating Behavior and Weight Problems Inventory for Children- EWI-C). Three subscales of the EWI were evaluated; they measured Strength and motivation to eat (EWI 1), Importance and impact of eating (EWI 2), and Eating as a means of coping with emotional stress (EWI 3). Since these subscales were specially focused on eating behavior, participants were classified as either Low (≤P75) or High (>P75) on each of the subscales. Our results showed a higher consumption of different types of food, in the EWI 1 scales, linked to the hunger and interest in eating, and we observed a relationship with the consumption of energy-dense products. This result was repeated in EWI 3, the subscale linked to emotional eating, where we also found higher consumption of energy-dense products. This study suggests that special features of eating behavior are associated with food intake in adolescents.
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Affiliation(s)
- Ivie Maneschy
- GENUD (Growth, Exercise, Nutrition and Development) Research Group, Facultad de Ciencias de la Salud, Universidad de Zaragoza, 50009 Zaragoza, Spain; (L.A.M.); (A.I.R.); (A.J.); (M.L.M.-B.); (A.M.S.-P.)
- Correspondence:
| | - Luis A. Moreno
- GENUD (Growth, Exercise, Nutrition and Development) Research Group, Facultad de Ciencias de la Salud, Universidad de Zaragoza, 50009 Zaragoza, Spain; (L.A.M.); (A.I.R.); (A.J.); (M.L.M.-B.); (A.M.S.-P.)
- Instituto Agroalimentario de Aragón (IA2), 50013 Zaragoza, Spain
- Instituto de Investigación Sanitaria Aragón (IIS Aragón), 50009 Zaragoza, Spain
- CIBER Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, 28029 Madrid, Spain;
| | - Azahara I. Ruperez
- GENUD (Growth, Exercise, Nutrition and Development) Research Group, Facultad de Ciencias de la Salud, Universidad de Zaragoza, 50009 Zaragoza, Spain; (L.A.M.); (A.I.R.); (A.J.); (M.L.M.-B.); (A.M.S.-P.)
- Instituto Agroalimentario de Aragón (IA2), 50013 Zaragoza, Spain
- Instituto de Investigación Sanitaria Aragón (IIS Aragón), 50009 Zaragoza, Spain
| | - Andrea Jimeno
- GENUD (Growth, Exercise, Nutrition and Development) Research Group, Facultad de Ciencias de la Salud, Universidad de Zaragoza, 50009 Zaragoza, Spain; (L.A.M.); (A.I.R.); (A.J.); (M.L.M.-B.); (A.M.S.-P.)
| | - María L. Miguel-Berges
- GENUD (Growth, Exercise, Nutrition and Development) Research Group, Facultad de Ciencias de la Salud, Universidad de Zaragoza, 50009 Zaragoza, Spain; (L.A.M.); (A.I.R.); (A.J.); (M.L.M.-B.); (A.M.S.-P.)
- Instituto Agroalimentario de Aragón (IA2), 50013 Zaragoza, Spain
- Instituto de Investigación Sanitaria Aragón (IIS Aragón), 50009 Zaragoza, Spain
- CIBER Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, 28029 Madrid, Spain;
| | - Kurt Widhalm
- Division of Clinical Nutrition and Prevention, Department of Pediatrics, Medical University of Vienna, 1090 Vienna, Austria;
| | - Anthony Kafatos
- Faculty of Medicine, University of Crete, GR-71003 Herakleion, Greece;
| | | | - Dénes Molnar
- Department of Pediatrics, Medical School, University of Pécs, H-7624 Pécs, Hungary;
| | - Fréderic Gottrand
- Department of Pediatric Gastroenterology Hepatology and Nutrition, University Lille, Inserm U1286 INFINITE, CHU Lille, F59000 Lille, France;
| | - Cinzia Le Donne
- Council for Agricultural Research and Economics, Research Centre for Food and Nutrition, 00178 Rome, Italy;
| | - Yannis Manios
- Department of Nutrition and Dietetics, Harokopio University, GR-17671 Athens, Greece; (Y.M.); (E.G.)
- Institute of Agri-Food and Life Sciences, Hellenic Mediterranean University Research Centre, GR-71410 Heraklion, Greece
| | - Evangelia Grammatikaki
- Department of Nutrition and Dietetics, Harokopio University, GR-17671 Athens, Greece; (Y.M.); (E.G.)
- Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185, 2 Blok A, B-9000 Ghent, Belgium;
| | - Marcela González-Gross
- CIBER Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, 28029 Madrid, Spain;
- ImFINE Research Group, Department of Health and Human Performance, Faculty of Physical Activity and Sport-INEF, Universidad Politécnica de Madrid, 28040 Madrid, Spain
| | - Mathilde Kersting
- Research Department of Child Nutrition, University Hospital of Pediatrics and Adolescent Medicine, Ruhr-University Bochum, D-44791 Bochum, Germany;
| | - Jean Dallongeville
- Department of Epidemiology and Public Health, Institut Pasteur de Lille, F59000 Lille, France;
| | - Sonia Gómez-Martinez
- Department of Metabolism & Nutrition, Institute of Food Science and Technology and Nutrition (ICTAN)-CSIC, 28040 Madrid, Spain;
| | - Stefaan De Henauw
- Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185, 2 Blok A, B-9000 Ghent, Belgium;
| | - Alba M. Santaliestra-Pasías
- GENUD (Growth, Exercise, Nutrition and Development) Research Group, Facultad de Ciencias de la Salud, Universidad de Zaragoza, 50009 Zaragoza, Spain; (L.A.M.); (A.I.R.); (A.J.); (M.L.M.-B.); (A.M.S.-P.)
- Instituto Agroalimentario de Aragón (IA2), 50013 Zaragoza, Spain
- Instituto de Investigación Sanitaria Aragón (IIS Aragón), 50009 Zaragoza, Spain
- CIBER Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, 28029 Madrid, Spain;
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Adolescents’ School Travel and Unhealthy Snacking: Associations with School Transport Modes, Neighbourhood Deprivation, and Body Weight. SUSTAINABILITY 2022. [DOI: 10.3390/su14127038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Active transport to and/or from school (ATS), alone or combined with motorised transport, provides an opportunity to increase adolescents’ physical activity levels to prevent obesity. However, travel through and exposure to an unhealthy food environment en route to school may have unintended consequences, specifically unhealthy snacking. This study examined the association between adolescents’ unhealthy snack food/soft drink purchases/consumption during the journey to and from school and their school transport modes, neighbourhood deprivation, and body weight. Adolescents (n = 660, age: 15.3 ± 1.3 years, 51.7% female) from 11 schools in the Otago region, New Zealand, completed an online survey and anthropometry. Data were analysed using χ2 test and logistic regression. Overall, 36.7% of adolescents purchased/consumed unhealthy snack foods and 25.9% purchased/consumed soft drinks at least once during their weekly school trips. ATS and mixed transport users reported more frequent unhealthy snack food/soft drinks purchases/consumption on the way to school than motorised transport users. Neighbourhood deprivation, but not body weight, was positively associated with unhealthy snack food/soft drink purchases/consumption during the school journey. Our findings highlight the importance of considering not only travel mode shift but also the obesogenic environment and unhealthy food/drinks purchases/consumption during adolescents’ school journeys, particularly in lower socio-economic areas, to prevent obesity.
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14
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Li X, Braakhuis A, Li Z, Roy R. How Does the University Food Environment Impact Student Dietary Behaviors? A Systematic Review. Front Nutr 2022; 9:840818. [PMID: 35571951 PMCID: PMC9090611 DOI: 10.3389/fnut.2022.840818] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 03/10/2022] [Indexed: 11/13/2022] Open
Abstract
The food environment has been implicated in creating an obesogenic generation; and while previous research has focused on population-wide initiatives, the university population resides in a research gap. To explore detailed components of the university food environment and what shaped dietary behaviors, we retrieved literature from the following databases: ScienceDirect, Scopus, PubMed, Medline, and EMBASE. Eleven studies were identified for qualitative content analysis and study quality assessment identified most of the studies as of good quality (n 8) and some as of fair quality (n 3). The certainty of evidence remained at a low level for all (n 11) studies due to the cross-sectional, observational nature of studies. Three major themes emerged: (1) food environment, (2) student perceptions (SPs), and (3) dietary outcome (DO). In a university food environment, the taste of food was paramount for the food choices of students, followed by the availability of food and the price of food. When university students perceive and choose foods and beverages, they sometimes regard unhealthy foods and beverages as healthy options. The diet quality of university students is more susceptible to living arrangements and socioeconomic status, but higher salt, fat, and added sugar consumption generally resulted in poorer quality of diet on campus. Future research could use novel methods to explore a wider range and deeper level of students' dietary behavior determinants in university food environments.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/, identifier: CRD42021283562.
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Affiliation(s)
- Xingbo Li
- The University of Auckland, Auckland, New Zealand
- The First Hospital of Hebei Medical University, Shijiazhuang, China
| | | | - Zengning Li
- The First Hospital of Hebei Medical University, Shijiazhuang, China
- *Correspondence: Zengning Li
| | - Rajshri Roy
- The University of Auckland, Auckland, New Zealand
- Rajshri Roy
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15
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Abstract
The aim of this review is to summarise the common barriers and motivations for healthy food choice among adolescents, with a specific focus on the Irish context where available. It will also discuss other concerns adolescents have, which may influence their food choices and eating habits. Adolescence represents a period of rapid physical, mental and social development, and many health-related habits developed during adolescence tend to persist into adulthood, making the teenage years an optimal time to encourage healthy eating and health-promoting behaviours. Adolescents are concerned about the health impact of their diet, but their understanding of health is often seen in the context of their physical appearance or body image. Body image concerns are prevalent in adolescents, and this can affect their food choices. Taste, price and convenience are commonly noted factors influencing adolescents' food choices, and as they grow, their level of independence increases and spending more time with their peers means that social desirability and social norms about food become increasingly important factors in adolescent food choice. However, their limited autonomy means their supporting food environment also plays an important role. When developing more targeted interventions in adolescent populations, information on adolescent nutrition needs, their concerns for health and body image, and the barriers and motivations for healthy eating and food choice should be considered. Such a holistic approach should help support healthy eating and the prevention of overweight and obesity in the population, whilst also supporting a healthy relationship with food and their bodies.
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Yeh CW, Lo YTC, Chen YC, Chen WC, Huang YC. Perceived Food Insecurity, Dietary Quality, and Unfavorable Food Intake among Children and Adolescents from Economically Disadvantaged Households. Nutrients 2021; 13:nu13103411. [PMID: 34684412 PMCID: PMC8540399 DOI: 10.3390/nu13103411] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 09/17/2021] [Accepted: 09/25/2021] [Indexed: 11/17/2022] Open
Abstract
Few studies have investigated food security, dietary quality, or unfavorable food intake through self-reports among children and adolescents in Asia. This study assessed the association of perceived food insecurity with dietary quality and unfavorable food intake among 1111 children and 538 adolescents from economically disadvantaged families in Taiwan. Food security status was collected by a validated questionnaire. Dietary quality was examined using a dietary diversity score (DDS). Unfavorable food intake was defined as fried food, bread/cake/pastries, sugar-sweetened beverages, and biscuits/chips. Food-insecure participants had lower DDS, whole grains and protein-rich food intake than food-secure participants. Furthermore, food-insecure children had a higher frequency of unfavorable food consumption. The level of children’s food insecurity was inversely associated with DDS (β: −0.047, 95% CI: −0.085 to −0.009) but positively with bread/pastry (β: 0.103, 95% CI: 0.022–0.184) and sugar-sweetened beverages (β: 0.117, 95% CI: 0.018–0.215) intake. Adolescents who reported food insecurity and not enough money for household expenses had an odds ratio of 2.85 (95% CI: 1.15–7.10) for poor DDS relative to their food-secure and financially able counterparts. We recommended that health policy needs to include diversifying food and nutrition education for vulnerable children and adolescents to improve dietary quality.
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Affiliation(s)
- Chiu-Wen Yeh
- Department of Nutrition, China Medical University, No. 100, Sec. 1, Jingmao Rd., Taichung 406040, Taiwan; (C.-W.Y.); (Y.-C.C.)
| | - Yuan-Ting C. Lo
- Department of Public Health, National Defense Medical Center, No. 161, Sec. 6, Minquan E. Rd., Neihu Dist., Taipei 11490, Taiwan;
| | - Yi-Chieh Chen
- Department of Nutrition, China Medical University, No. 100, Sec. 1, Jingmao Rd., Taichung 406040, Taiwan; (C.-W.Y.); (Y.-C.C.)
| | - Wei-Chih Chen
- Boyo Social Welfare Foundation, No. 131, An 4th St., Puli Township, Nantou County 54547, Taiwan;
| | - Yi-Chen Huang
- Department of Nutrition, China Medical University, No. 100, Sec. 1, Jingmao Rd., Taichung 406040, Taiwan; (C.-W.Y.); (Y.-C.C.)
- Correspondence: ; Tel.: +886-4-22053366 (ext. 7523)
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