Barriers to and motivators for healthful eating as perceived by rural and urban Costa Rican adolescents

Ultra-processed food intake is associated with a displacement of the traditional diet of Costa Rican adolescents

Ultra-processed food (UPF) intake is high among adolescent populations worldwide. This study aimed to characterize the UPF intake and assess its contribution to the traditional diet of Costa Rican adolescents. Using cross-sectional data from 3-day food records obtained from 818 adolescents (13-18 years) from San José, Costa Rica, we calculated the daily % of total energy intake (TEI) from Nova-defined UPF, the Traditional Costa Rica Adolescents Diet Score (TCRAD; higher score reflecting higher traditional adherence), other nutrients, and fiber. The multivariable-adjusted mean UPF intakes were compared across participants' characteristics, mealtime, and days of the week, and assessed for association with TCRAD (continuous score and by adherence categories) and dietary components. UPF intake represented 35.9% of the TEI and was higher on weekdays (vs. weekends), among female adolescents (vs males), urban areas (vs. rural), and higher socioeconomic status. UPF were consumed mostly as snacks (43.5%), in the morning: (58.5%) and afternoon (41.5%). Each 10-percentage-point increase in the total UPF energy contribution was associated with -0.44 (SE = 0.04; P < .0001) lower TCRAD score. UPF was inversely associated with fiber and beneficial micronutrients, and directly associated with added sugars and trans fats. The multivariable-adjusted UPF intake was lower at moderate (38.5%, P < .0001) and high (29.9%, P < .0001) adherence to the TCRAD, compared with low adherence (43.9%). Our results support widespread trends of UPF displacing healthy diets. Strategies to reduce UPF consumption, especially during school hours, and encourage healthy traditional diets, are needed for Costa Rican adolescents.

Primary-school-aged children inspire their peers and families to eat more vegetables in the KiiDSAY project: a qualitative descriptive study

BACKGROUND

While vegetable intakes in Australia remain sub-optimal across all age groups, children are rarely consulted about their ideas on how to increase consumption. Qualitative research involving children provides an opportunity to consider their views. The aim of the Kids initiative inspires Dietary Success in Adults and Youth (KiiDSAY) project was to explore the views of school-aged children, who had participated in a school-based nutrition education program, about inspiring their peers and families to eat more vegetables.

METHODS

A total of 26 children (15 boys) aged 10-12 years from four primary schools in New South Wales, Australia, participated in seven focus group interviews. Purposeful sampling was used to recruit participants. The study involved open-ended semi-structured questions conducted via Zoom that were audio-recorded, transcribed verbatim and analysed using thematic analysis with deductive and inductive coding in NVivo.

RESULTS

Four major themes emerged: (i) taste; (ii) family environment; (iii) healthy eating; and (iv) change makers; with subthemes that were embedded within Social Cognitive Theory and Ecological Model of Health Behaviour theoretical frameworks.

CONCLUSIONS

Children's inputs hold great potential for informing future interventions, particularly when designing or refining school-based nutrition programs. Children offered suggestions on how to inspire increased vegetable consumption among their peers and families that could be taken into consideration for future research and practice. These included: cooking activities in the home and school settings using recipes that creatively hide/mask/enhance the flavour of vegetables, involving positive role models and supportive school environments. Additionally, children recommended a sequential approach to the delivery of recipes starting from fruit-based and transitioning to vegetable-based recipes. Given the challenges faced in increasing children's vegetable consumption, particular focus on future research in this area is warranted.

TRIAL REGISTRATION

FEAST Trial registered 14th December 2020 with the Australian and New Zealand Clinical Trials Registry (ACTRN12620001347954).

Exploring Adolescent girls' Food-Talk in Kathmandu Valley, Nepal: A Qualitative Study

This study aimed to analyze how adolescent girls residing in Kathmandu valley, Nepal, talk about food within the context of their everyday experiences. We conducted 10 in-depth and four focus group interviews. Qualitative thematic analysis based on the constructivist paradigm was used to organize the interviews. The Utilitarian domain contained health statements using biomedical language and lay theories on health. Hedonic talk emphasized the taste of food, but notions about enjoyment were limited. Collective talk constructed an ideal family. In agency talk, the interviewees described their active role in achieving a slim body. Participants were not concerned about food insecurity but about eating too much.

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.

Chrononutrition behavior during the COVID-19 pandemic and its relationship with body weight among college students

Introduction

Students in colleges are exposed to unhealthy lifestyles and poor dietary choices. They are at risk of being overweight, skipping meals, and developing eating disorders. However, there is a paucity of information on their chrononutrition behavior, which is very important, especially concerning the timing of food consumption across the day. Therefore, the present study aimed to investigate chrononutrition behavior and its potential association with body weight status among college students in Malaysia.

Methods

This cross-sectional study was conducted on 409 college students aged above 18 in Malaysia. The chrononutrition behavior was assessed using the validated Chrononutrition Profile Questionnaire (CP-Q). The questionnaire was distributed using an online platform. Participants self-reported their body weight and height, and the Body Mass Index (BMI) was computed. Data were analyzed using the SPSS software.

Results

A total of 409 participants were recruited, with a mean age of 21.5 ± 2.2 years. The prevalence of underweight, normal, and overweight was 24.7, 49.4, and 25.9%, respectively. The chrononutrition behavior revealed that participants ate breakfast about four times/week (mean 4.27 ± 2.43 days), and only 135 (33.0%) consumed breakfast daily. The largest meal consumed was during lunch (75.8%), and the mean of snacking after the last meal was 3.23 ± 2.01 days. The prevalence of night eating was low, and most participants (70.9) did not wake up at night to eat. The frequency, however, was significantly higher in the underweight group compared to the normal weight group (p < 0.05). We observed a significant association between BMI and eating window, evening latency, evening eating, and night eating. It was found that the underweight had a poor eating window (p < 0.01), poor evening latency (p < 0.01), poor evening eating (p < 0.01), and poor night eating (p < 0.05) compared to those with normal and overweight BMI groups. In contrast to predictions, poor chrononutrition behavior was more likely to predict being underweight compared to normal (p < 0.05).

Conclusion

Underweight young adults are more likely to have poor chrononutrition behavior. The results of the present study suggest that future nutrition education should also focus on the chrononutrition behavior of college students.

Psychosocial aspects related to fruit and vegetable consumption in adolescents

This study aimed at assessing the association between psychosocial aspects and fruit and vegetable consumption in adolescents. Cross-sectional study developed with 327 adolescents from a public school in Brazil. A questionnaire developed for adolescents was applied to assess the influence of self-efficacy, family, peers, and body image on the consumption of fruits and vegetables. Specific questions assessed the intake frequency of fruits and vegetables, and the mean consumption was estimated using two 24-hour recalls. Scores related to psychosocial aspects were described as mean and median and the weight status was classified based on the body mass index. The average daily consumption of fruits and vegetables was 36.2 g and 45.4 g, respectively. Self-efficacy and the influence of peers were associated with an increase in the amount and frequency of fruits and vegetables consumption. Adolescents with higher scores of self-efficacy had greater average consumption of fruits and vegetables when compared to those with lower scores. The same was observed for the influence of peers. Self-efficacy and the influence of peers were the factors that most influenced the consumption of fruits and vegetables in adolescents.

Exploring barriers to diversified dietary feeding habits among adolescents in the agrarian community, North West Ethiopia

Introduction

Adolescence is a critical and neglected age group of the population in any form of nutritional intervention. A comprehensive study that assesses barriers that influence their diversified feeding habit is not well investigated in qualitative approaches. Therefore, this study was conducted to fill this gap by providing evidence on exploring barriers to diversified feeding habits of adolescents in the agrarian community, North West Ethiopia.

Objective

The aim of the study was to explore barriers to diversified feeding habits of adolescents in the agrarian community, North West Ethiopia.

Methods

A phenomenological qualitative study design was conducted among adolescents in the age group of 10-19 years, and adults in the age range of 25 to 64 years (representatives of farmers, agricultural, health, and education sectors). We conducted 24 in-depth interviews (12- adolescents, 4-health, 2- agricultural extension, 3-education, and 3-farmer representative) among purposively selected community groups. In-depth interview guides and observation checklist were utilized for data collection. The audio-recorded qualitative data were transcribed word by word into English. Finally, the translated data were exported to ATLAS ti version 7.1 software for thematic analysis based on inductive content analysis. All coded quotations, including memos written throughout the coding process, were then analyzed to identify themes inductively.

Results

Dietary habit of adolescents in the study area was predominantly plant-based cereals with low protein, vitamins, and mineral contents. Adolescents have limited consumption of fruits, vegetables, and animal source foods. Adolescents with these feeding habits had suboptimal intake of micronutrients and proteins, which are crucial for their rapid growth stage. Individual-level barriers, family-level influence, dietary tradition of community, agricultural practice (poor agroforestry practice of the community, and poor agricultural practice to produce year-round diverse food items), and week multi-sectorial collaboration for nutritional intervention all influenced adolescent dietary habits.

Conclusion

Multiple layers of barriers influenced the diverse dietary habits of adolescents in the study setting. These multiple and interconnected influences ranged from individual level to multi-sectorial collaboration. Nutritional interventions should be implemented at the individual, family, agricultural, and multi-sectorial levels to improve adolescents' diverse dietary habits.

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.

Factors influencing obesogenic behaviours of adolescent girls and women in low- and middle-income countries: A qualitative evidence synthesis

This systematic review synthesized the qualitative evidence on factors influencing obesogenic behaviours in adolescent girls and women of reproductive age in low- and middle-income countries (LMICs). This qualitative evidence synthesis followed the framework synthesis approach to extract, analyse and synthesize data. Electronic searches were conducted in the Web of Science, SCOPUS, CABI Abstracts, MEDLINE, PsycINFO and Google Scholar. Studies were eligible if they were conducted in LMICs, of qualitative nature, and reported obesogenic behaviours of female adolescents (10-19 years of age) or women of reproductive age (15-49 years of age). The review resulted in 71 included studies from 27 different countries. Thirty-two studies focused on dietary behaviours, 17 on physical activity and 22 on both behaviours. Gender norms and failures to recognize the importance of healthy behaviours across the life cycle were important factors. The abundance and promotion of affordable but unhealthy food, food safety concerns, taste preferences and social desirability of foods drive consumption of unhealthy foods. Busy lives and limited exercise spaces keep girls and women from being physically active. Obesogenic behaviours of adolescent girls and women of reproductive age are influenced by factors at individual, social, physical and environmental levels and require diverse solutions to address these factors in LMICs.

Determinants of health and well-being in adolescents : Review of sex differences with a focus on boys

A wide variety of variables determine health and well-being in adolescence. How these variables may differ in relation to gender or sex is often not clear. In addition, research on sex differences often focuses on females rather than males. This review gives an overview on the literature with respect to possible gender/sex-specific determinants and correlates of health and well-being in adolescent boys. The search strategy used the approach of a narrative review, which led to 17 papers being included. The data synthesis employed a qualitative and descriptive analysis approach. We found sex differences in three categories: clinical symptoms, health and well-being, and risk behavior. The results show a variety of determinants that lead to sex differences in health outcomes, such as peer relations, social economic status, physical activity and coping styles. Strengths and limitations of the literature and implications for future research are discussed.

Changes in Dietary Intake of Major Nutrients and Food Sources among Costa Rican Adolescents in the Last 20 Years

BACKGROUND

Adolescence offers a window of opportunity to prevent adult obesity and noncommunicable disease risk factors. With the rising prevalence of adolescent obesity over the last 20 y, identifying any changes in dietary risk factors is crucial.

OBJECTIVES

We aimed to assess the dietary intake of major nutrients and their food sources in Costa Rican adolescents from 1996 to 2017.

METHODS

Means from 3-d food records from adolescents (ages 13-18 y) living in San José (the province with the highest concentration of adolescents in Costa Rica) were obtained in 1996 (n = 276), 2006 (n = 133), and 2017 (n = 818). Differences in consumption of major nutrients and selected food groups by sex and survey period were tested using age- and area-adjusted ANOVAs.

RESULTS

In 2017, adolescents consumed significantly (P < 0.05) less saturated and trans fats [saturated: -3.2% of total energy (TE); trans: -1.4% TE], vegetables (-24 g/d), beans (-42 g/d), and white rice (22 g/d) than in 1996. The 2017 adolescents also reported significantly higher consumption of unsaturated fatty acids (MUFAs: up from 8.2% to 15.3% TE; PUFAs: up from 5.5% to 9.5% TE; P < 0.05), sugary drinks (+134 g/d), pastries/desserts (+55 g/d), other refined starchy foods (+36 g/d), and snacks/fast foods (+26 g/d) than their 1996 counterparts. In 1996 and 2006, the main source of calories was white rice, whereas in 2017, it was sugary drinks (12% TE and 15% TE, respectively; P < 0.05). The intake ratio of beans to white rice was significantly higher in 1996 (1:1.6) than in 2017 (1:3.5).

CONCLUSIONS

The changes in the intake of major nutrients and food sources of Costa Rican adolescents present new public health challenges for cardiometabolic risk prevention. Costa Rica should prioritize the design of comprehensive strategies that target added sugar intake while simultaneously increasing access to and promotion of healthful items.

Malaysian adolescents' perceptions of healthy eating: a qualitative study

OBJECTIVE

To explore the concepts of healthy eating and to identify the barriers and facilitating factors for dietary behaviour change in adolescents.

DESIGN

A qualitative study involving twelve focus groups.

SETTING

Two secondary schools in the district of Hulu Langat in Selangor, Malaysia.

PARTICIPANTS

Seventy-two adolescents aged 13-14 years.

RESULTS

Adolescents had some understanding regarding healthy eating and were able to relate healthy eating with the concepts of balance and moderation. The adolescents' perceptions of healthy and unhealthy eating were based on food types and characteristics, cooking methods and eating behaviours. Facilitators for healthy eating were parents' control on adolescents' food choices, feeling concern about own health and body, being influenced by other's health condition, and knowledge of healthy or unhealthy eating. On the other hand, barriers for healthy eating were the availability of food at home and school, taste and characteristics of foods, and lack of knowledge on healthy or unhealthy foods.

CONCLUSIONS

The findings contribute to a better understanding of the adolescents' concept of healthy eating, as well as the facilitators and barriers to practising healthy eating. Future interventions should include a method of promoting the immediate benefits of healthy eating, the way to cope with environmental barriers for healthy eating, and increasing the availability of healthy food choices at home and in the school environment. The health and nutrition education programmes should also focus on educating parents, as they can be role models for adolescents to practise more healthful behaviours.

Vegetable intake in Australian children and adolescents: the importance of consumption frequency, eating occasion and its association with dietary and sociodemographic factors

OBJECTIVE

We aimed to profile vegetable consumption and its association with dietary and sociodemographic factors.

DESIGN

Secondary analysis of a nationally representative nutrition survey. 'Vegetables' refers to non-discretionary 'vegetables and legumes/beans' as defined by the Australian Dietary Guidelines (ADG). Prevalence of vegetable consumption, frequency of intake, proportion meeting ADG recommendations, most popular food groups, intake at each reported eating occasion, and the profile of high and low vegetable consumers (based on the median servings) were determined.

SETTING

Australian 2011-2012 National Nutrition and Physical Activity Survey.

PARTICIPANTS

Children and adolescents aged 2 to 18 years (n 2812).

RESULTS

Vegetables were consumed by 83·0% (95% CI 81·6, 84·4%) of participants, but the median vegetable servings was less than a third of the ADG recommendations. 'Leaf and stalk vegetables' and 'potatoes' were the most popular vegetable-dense food groups at lunch and dinner, respectively. Sixty-four percent had vegetables once a day, and predominantly at dinner. Vegetable frequency was positively associated with daily vegetable servings and variety. Participants who consumed vegetables twice a day generally had vegetables at both lunch and dinner and had nearly double the servings (2·6, sd 1·9) of those who consumed them once (1·5, sd 1·5). High vegetable consumers were older, had higher total energy, but lower discretionary energy intake and were less likely to be at risk of metabolic complications.

CONCLUSION

Increasing the frequency of vegetable consumption may assist with increasing daily vegetable servings. A focus on consuming vegetables at lunch may assist with increasing both total servings and variety.

Mediation of psychosocial determinants in the relation between socio-economic status and adolescents' diet quality

PURPOSE

To examine the underlying reasons for the positive relation between socio-economic status (SES) and the diet quality of adolescents.

METHODS

In 2081 adolescents (12.5-17.5 years) of the European HELENA study, a continuous variable on diet quality via 2-day 24-h recalls was available. SES was reflected by parental education, parental occupation and family affluence. Mediation by several psychosocial determinants was tested: self-efficacy, availability at school and home, social support, barriers, benefits, awareness and some self-reported influencers (parents, school, taste, health, friends, food readily available, easy preparation, hunger, price and habits). Multiple mediation analyses were adjusted for age, sex and country.

RESULTS

The availability of soft drinks and fruit at home, social support, parental influence, barriers, price influence, taste influence, health influence and food being readily available were significant mediators. The multiple mediation indirect effect accounted for 23-64% of the total effect. Both occupation and education and both maternal and paternal factors could be explained by the mediation. The unavailability of soft drinks was the strongest mediator (17-44% of the total effect).

CONCLUSION

Up to 64% of the positive relation between SES and the diet quality in adolescence could be explained by several healthy eating determinants. Focusing on these factors in low-SES populations can minimize social inequalities in diet and health by improving the diet of these specific adolescents.

Perceived barriers to achieving a healthy weight: a qualitative study using focus groups at public and private schools in Guatemala City

BACKGROUND

Overweight prevalence among Guatemalan girls is higher in public than in private schools. Little is known about adolescent girls' perceptions of the right ways to achieve a healthy weight. This study examines public and private school adolescent girls' perceptions of a "healthy weight," and barriers and facilitators to achieving it.

METHODS

We conducted 4 focus groups in public and private schools in Guatemala City with girls from 13 to 15 years old. The discussion guide included open-ended questions and activities aimed at examining perceptions of "healthy weight" and barriers and motivators to achieving it within the school environment. Focus groups were audio-recorded and transcribed. Data analyses followed established methods of content analysis.

RESULTS

Twenty-eight girls (private school, n = 12; public school, n = 16) of ages ranging from 13.1 to 15.9 years (median, 14, IQR, 13.6-14.9) participated in the study. Girls identified images of thin and fit women as healthy. They cited healthy eating and physical activity as ways to achieve a healthy weight. Within the school environment, barriers to maintaining a healthy weight included a lack of healthy food options and the prioritization of sports for boys over girls. In public schools, facilities were less than optimal; in private schools, girls' access to facilities was limited. Public school girls stated that their uniforms were inappropriate for exercising.

CONCLUSION

Our findings support the need to provide more healthy food options in Guatemalan schools. In addition, physical activity for girls should be promoted and facilities made available for their use.

Predictors of college-student food security and fruit and vegetable intake differ by housing type

OBJECTIVE

We assessed whether college-student characteristics associate with food security and fruit and vegetable (FV) intake and whether these associations differ in students in housing with and without food provision.

PARTICIPANTS

514 randomly-sampled students from a large, Midwestern, public university in 2012 and 2013 METHODS: Ordered logistic regression tested how student characteristics associate with food security. Linear regression tested how student characteristics associate with FV intake. Analyses were stratified by housing type - that is, housing with food provision (dormitory, fraternity/sorority house, cooperative) vs. housing without food provision.

RESULTS

Only among those living in housing without food provision, males (p = 0.04), students without car access (p = 0.005), and those with marginal (p = 0.001) or low (p = 0.001) food security demonstrated lower FV intake.

CONCLUSIONS

Housing with food provision may buffer the effects of student characteristics on food.

Influence of school architecture and design on healthy eating: a review of the evidence

We examined evidence regarding the influence of school physical environment on healthy-eating outcomes. We applied a systems perspective to examine multiple disciplines' theoretical frameworks and used a mixed-methods systematic narrative review method, considering both qualitative and quantitative sources (published through March 2014) for inclusion. We developed a causal loop diagram from 102 sources identified. We found evidence of the influence of many aspects of a school's physical environment on healthy-eating outcomes. The causal loop diagram highlights multilevel and interrelated factors and elucidates the specific roles of design and architecture in encouraging healthy eating within schools. Our review highlighted the gaps in current evidence and identified areas of research needed to refine and expand school architecture and design strategies for addressing healthy eating.

The influence of gender stereotypes on eating habits among Costa Rican adolescents

PURPOSE

To identify the influence of gender stereotypes on eating habits among Costa Rican adolescents.

DESIGN

Qualitative, descriptive research was used in this study.

SETTING

Adolescents and parents were recruited from socioeconomically diverse populations in rural and urban areas of San José, Costa Rica.

SUBJECTS

Subjects were 92 adolescents (14 to 17 years old) and 48 parents.

METHODS

Focus group data were transcribed and entered into the qualitative data analysis software Atlas.ti version 5.0. Analyses were grounded on the social cognitive theory.

RESULTS

Five themes emerged from the focus group discussions: (1) Costa Rican adolescents associate the consumption of moderate quantities of healthy foods with femininity and male homosexuality. (2) The consumption of hearty portions of nonhealthy foods was associated with masculinity and male heterosexuality. (3) There is an emerging view that it is acceptable for heterosexual male adolescents to take care of their bodies through healthy eating. (4) Body care among female adolescents is an element of femininity and body image. (5) Parents reinforce their daughters' persistent concern with weight control because they perceive it as feminine behavior.

CONCLUSION

Health promoters should be aware of the existing and changing food stereotypes around gender as an avenue for the promotion of healthy eating.

Formative research to develop a community-based intervention for chronic disease prevention in Guatemalan school-age children

Background

Noncommunicable diseases (NCD) are the most common causes of morbidity and mortality worldwide, even in low- and middle-income countries (LMIC). Recent trends in health promotion emphasize community-based interventions as an important strategy for improving health outcomes. The aim of this study was to conduct formative research regarding the perceptions of NCD risk factors, their influencing factors, and community resources available to aid the development and implementation of a community-based intervention with school-age children.

Methods

Focus group discussions (n = 18), home visits (n = 30), and individual semi-structured interviews (n = 26) were conducted in three urban communities in Guatemala with school-age children (10–12 years of age), teachers, parents, and local community members (i.e., school principals, school food kiosk vendors, religious leaders, authority representatives). All focus groups and interviews were transcribed verbatim for thematic analysis.

Results

Children, parents, and teachers have general knowledge about modifiable risk factors. Adults worried more about tobacco use, as compared to unhealthy diet and physical inactivity in children. Participants identified features at the intrapersonal (e.g., negative emotional state), interpersonal (e.g., peers as role models), and organizational and community levels (e.g., high levels of crime) that influence these risk factors in children. School committees, religious leaders, and government programs and activities were among the positive community resources identified.

Conclusions

These findings should help researchers in Guatemala and similar LMIC to develop community-based interventions for NCD prevention in school-age children that are effective, feasible, and culturally acceptable.

Die Wahrnehmung von Esser-Prototypen als Erklärung von Geschlechterunterschieden im Ernährungsverhalten unter Berücksichtigung des Alters

Jungen ernähren sich nachweislich ungünstiger als Mädchen. Die vorliegende Studie untersucht die Prototypen-Wahrnehmung als Erklärung für Geschlechterunterschiede im Ernährungsverhalten von Jugendlichen unter Berücksichtigung des Alters. Angenommen wird, dass die Wahrnehmung des typischen ungesunden und gesunden Essers die Geschlechterunterschiede im Ernährungsverhalten mediiert. Weiterhin wird im Sinne einer moderierten Mediation postuliert, dass das Alter den Zusammenhang zwischen Prototypen-Wahrnehmung und Ernährungsverhalten moderiert. Befragt wurden 340 SchülerInnen an Haupt- und Werkrealschulen im Alter von 10 – 17 Jahren zu Ernährungsverhalten und Wahrnehmung von Esser-Prototypen. Im Ergebnis hatten die Jungen ein signifikant ungünstigeres Ernährungsmuster als die Mädchen und sahen den ungesunden Esser positiver sowie den gesunden Esser negativer. Dieser Geschlechterunterschied im Ernährungsverhalten wurde partiell durch die Prototypen-Wahrnehmung mediiert. Dabei wurde der Zusammenhang zwischen der Prototypen-Wahrnehmung des ungesunden Essers und des Ernährungsverhaltens durch das Alter moderiert: Bei älteren Jugendlichen hing die Wahrnehmung des ungesunden Essers stärker mit dem Ernährungsverhalten zusammen als bei jüngeren Jugendlichen. Die Ergebnisse zeigen, wie wichtig es ist, vor allem bei älteren Jungen eine negative Wahrnehmung des ungesunden Essers zu fördern, mit dem Ziel das Ernährungsverhalten im Jugendalter zu verbessern.

Exploratory research to design a school nurse-delivered intervention to treat adolescent overweight and obesity

OBJECTIVE

In preparation for a pilot study to evaluate the efficacy of a school nurse-delivered intervention, focus groups were conducted to gain insight into the perceptions of stakeholders regarding the design and implementation of the intervention.

SETTING AND PARTICIPANTS

Fifteen focus groups at participating schools. One hundred subjects, including overweight and obese high school students, parents, high school nurses, and staff.

MAIN OUTCOME MEASURE

Stakeholders' perceptions.

ANALYSIS

Focus groups were audiotaped and transcribed verbatim. Theme instances related to the research aim were identified, coded, and sorted into theme categories.

RESULTS

Major topics discussed included teen issues, family support, intervention implementation-related concerns, and curriculum content. Teen issues included dealing with peer pressure, avoiding emotional eating, and support from friends. Many participants thought it should be the teen's choice to involve parents. Confidentiality was the most commonly identified potential barrier to implementation. Recommendations for nutrition and physical activity curriculum content focused on concrete, practical strategies.

CONCLUSIONS AND IMPLICATIONS

Results of this research provided insight into stakeholder's needs and perceptions regarding the content and structure of a school nurse-delivered intervention to treat adolescent overweight and obesity. Findings were used in the design and implementation of intervention protocols and materials.

Associação entre comportamentos de risco à saúde de pais e adolescentes em escolares de zona rural de um município do Sul do Brasil

Objetivou-se avaliar a associação entre comportamentos de risco à saúde dos pais e adolescentes escolares de zona rural. Participaram 377 escolares entre 10 e 18 anos e 338 pais. Foram analisados: nível de atividade física no lazer e deslocamento, hábitos de alimentação inadequados, excesso de peso, uso de cigarros e consumo de bebidas alcoólicas. A prevalência de relato de uso de cigarro e álcool nos últimos 30 dias entre os jovens foi de 6,7% e 27%, respectivamente. Quarenta e cinco por cento dos adolescentes não atingiram o escore de atividade física. A adesão aos passos para uma alimentação saudável foi baixa. A atividade física dos adolescentes esteve relacionada de forma positiva com a dos pais, e o consumo de álcool da mãe se associou de forma positiva com o consumo do adolescente. Para os outros comportamentos, não houve associação significativa. Na análise estratificada por sexo, o nível de atividade física do pai se associou ao nível de atividade física das meninas. O comportamento de risco à saúde dos pais associa-se ao mesmo comportamento dos adolescentes de zona rural.

Determinants of fruit and vegetable consumption among children and adolescents: a review of the literature. Part II: qualitative studies

Background

Large proportions of children do not fulfil the World Health Organization recommendation of eating at least 400 grams of fruit and vegetables (FV) per day. To promote an increased FV intake among children it is important to identify factors which influence their consumption. Both qualitative and quantitative studies are needed. Earlier reviews have analysed evidence from quantitative studies. The aim of this paper is to present a systematic review of qualitative studies of determinants of children's FV intake.

Methods

Relevant studies were identified by searching Anthropology Plus, Cinahl, CSA illumine, Embase, International Bibliography of the Social Sciences, Medline, PsycINFO, and Web of Science using combinations of synonyms for FV intake, children/adolescents and qualitative methods as search terms. The literature search was completed by December 1st 2010. Papers were included if they applied qualitative methods to investigate 6-18-year-olds' perceptions of factors influencing their FV consumption. Quantitative studies, review studies, studies reported in other languages than English, and non-peer reviewed or unpublished manuscripts were excluded. The papers were reviewed systematically using standardised templates for summary of papers, quality assessment, and synthesis of findings across papers.

Results

The review included 31 studies, mostly based on US populations and focus group discussions. The synthesis identified the following potential determinants for FV intake which supplement the quantitative knowledge base: Time costs; lack of taste guarantee; satiety value; appropriate time/occasions/settings for eating FV; sensory and physical aspects; variety, visibility, methods of preparation; access to unhealthy food; the symbolic value of food for image, gender identity and social interaction with peers; short term outcome expectancies.

Conclusions

The review highlights numerous potential determinants which have not been investigated thoroughly in quantitative studies. Future large scale quantitative studies should attempt to quantify the importance of these factors. Further, mechanisms behind gender, age and socioeconomic differences in FV consumption are proposed which should be tested quantitatively in order to better tailor interventions to vulnerable groups. Finally, the review provides input to the conceptualisation and measurements of concepts (i.e. peer influence, availability in schools) which may refine survey instruments and theoretical frameworks concerning eating behaviours.

Teenage Diet: Context and Companions Determine Eating Habits

Objetivo: presentar los significados de la alimentación y las prácticas relacionadas de un grupo de adolescentes escolarizados del colegio Nuestra Señora de Guadalupe, de Cali, Colombia. Método: estudio con abordaje cualitativo de tipo exploratorio, orientado por la hermenéutica dialéctica, utilizando como técnica el análisis de contenido. Se tuvieron en cuenta los espacios familiares, escolares y de la calle, donde los adolescentes interactúan con sus pares o amigos. Participaron 31 adolescentes (17 mujeres y 14 hombres), 10 familiares (6 madres, 2 padres y 2 abuelas), 3 profesores y la administradora de la cafetería. Resultados: de acuerdo con el espacio y la compañía se establecieron subcategorías que determinan e influyen en el tipo de alimentos que consumen los adolescentes, así: en la familia, las tradiciones; en el colegio, la autonomía, la disponibilidad económica, las preferencias del grupo y la oferta de alimentos en la cafetería; en la calle, el género, la amistad y el amor inciden en la elección e ingesta de alimentos. Conclusiones: el espacio y la compañía determinan el tipo y la calidad de los alimentos ingeridos por los adolescentes.

A alimentação saudável na ótica dos adolescentes: percepções e barreiras à sua implementação e características esperadas em materiais educativos

Este estudo visou avaliar percepções, barreiras e características de materiais educativos de promoção de alimentação saudável descritas por adolescentes. Realizaram-se quatro grupos focais com 25 adolescentes com perguntas sobre: percepção e motivação para modificar a dieta; conceito de alimentação saudável e barreiras para sua adoção; e características de impressos para a promoção de práticas alimentares saudáveis. Observou-se uma freqüente indecisão quanto a classificar a dieta como saudável. Os adolescentes referiram não se sentir confiantes para modificar a dieta, mas relataram conceitos adequados sobre alimentação saudável. As principais barreiras citadas foram focadas em aspectos pessoais e sociais, como: a tentação, o sabor dos alimentos, a influência dos pais e a falta de tempo e de opções de lanches saudáveis na escola. Para os jovens, materiais educativos de promoção de alimentação saudável devem reforçar seus benefícios imediatos e destacar mensagens alarmantes sobre os riscos à saúde advindos de uma alimentação inadequada.

Gaining children's perspectives: a multiple method approach to explore environmental influences on healthy eating and physical activity

In order to inform local action for health improvement, this pilot study used multiple methods to explore children's perspectives of environmental influences on their eating and physical activity. Thirty-nine children aged 9-11 years from a North London local authority took photos, drew maps, and attended focus groups. We found that the approach engaged children and that each of the methods returned useful, complementary information. The results highlighted a number of areas for local policymakers and practitioners to consider when developing work to prevent childhood obesity. We conclude that these methods of gaining children's views should be further developed and tested.

Barriers to and suggestions for a healthful, active lifestyle as perceived by rural and urban Costa Rican adolescents

OBJECTIVE

To assess the perceptions of rural and urban Costa Rican adolescents regarding which barriers and motivators affect their adoption of an active lifestyle.

DESIGN

Data were collected in focus group discussions.

PARTICIPANTS

108 male and female adolescents aged 12 to 18 from the 7th to 11th grades.

SETTING

Two urban and 1 rural high school in San José, Costa Rica.

PHENOMENA OF INTEREST

Active lifestyle; barriers and motivators for active life.

ANALYSIS

Data were reviewed for emerging themes, and themes were coded using content analysis procedures.

RESULTS

Major barriers: (a) physical education curriculum was focused on competitive sports; (b) lack of facilities in the school and community environments; (c) family did not provide good role models and reinforced the socially expected gender roles. Key motivators: (a) changed the physical education curriculum to focus on leisure and recreational activities; (b) increased the availability of facilities both in the school and in the community; and (c) provided a strong social support network.

CONCLUSIONS AND IMPLICATIONS

The school, community, and family environments are potential targets for physical activity interventions for adolescents. Future studies should explore in depth the influence of adolescent socialization patterns (particularly for females) in the establishment of an active lifestyle.

Examining an integrative model of physical activity and healthy eating self-perceptions and behaviors among adolescents

PURPOSE

This study tested a comprehensive model of physical activity and healthy eating behavior.

METHODS

A sample of older adolescents (boys n = 206, girls n = 326) volunteered to complete a scientifically supported questionnaire assessing physical activity and healthy eating perceptions of competence, values, and behaviors once during class time.

RESULTS

Confirmatory factor analysis suggested the data fit the model well. Tests of group differences supported factorial invariance, and revealed higher physical activity perceptions of competence, value, and behavior as well as lower healthy diet value and behavior for adolescent boys compared with girls. Perceptions of competence for healthy diet were also higher among boys. Path modeling demonstrated a good model fit, whereby behavior-specific perceptions of competence and values were significant correlates of physical activity for the total sample and subsamples of boys and girls (R(2) = .41-.53). Perceptions of competence and values were also significant correlates of healthy diet for the total sample (R(2) = .34) and boys (R(2) = .42). Subjective values were significant correlates of healthy diet for girls (R(2) = .30). Structural invariance suggested that the models were not significantly different for adolescent boys and girls.

CONCLUSIONS

These results demonstrate the saliency of the comprehensive model in understanding physical activity and healthy eating behaviors among older adolescents. Further tests of the model are needed to advance theory exploring both physical activity and healthy eating behaviors, and to inform intervention strategies targeting adolescent health.