Nutritional issues for adolescents

Minimum diet diversity-women score and predictors of school adolescent girl stunting and thinness in Northwest Ethiopia

BACKGROUND

Limited data exist on adolescent nutrition. This school-based cross-sectional study aimed to assess dietary practices, nutritional status, and associated factors among adolescent girls.

METHODS

Two hundred seventy-nine primary and secondary school girls were selected via multistage sampling. A pretested questionnaire and 24-h recall method were employed to gather data on background characteristics and dietary practices. The questionnaire was pretested with 20 adolescents from nonparticipating schools to assess clarity and reliability. Feedback from the pretest was used to refine the questionnaire. The minimum dietary diversity for women (MDD-W) was used as an indicator of diet quality, where women were considered to have adequate dietary diversity if they consumed at least five of ten food groups in the past 24 h. Key informant interviews were used to explore nutritional problems, while anthropometric measurements were taken to assess nutritional status. Height and weight, combined with age, were used to calculate height-for-age and BMI-for-age z scores via WHO AnthroPlus software. Nutritional status was categorized as stunted (< -2SD), thin (< -2SD), normal (-2SD to + 2SD), or overweight (> + 2SD). A multivariate binary logistic regression model identified predictors of nutritional status. The quantitative data were analyzed via SPSS, and the qualitative data were analyzed via ATLAS.ti.

RESULTS

Only 24% of the students met the MDD-W. Predominant consumption of plant-source foods (100%) and low animal-source food intake (< 20%) were observed. Environmental, social, and cultural factors are barriers to nutrition, whereas cultural food preferences act as reinforcing factors. The prevalence rates of thinness, stunting, and overweight were 7.2%, 6.4%, and 5.7%, respectively, with undernutrition being more prevalent in younger adolescents (10-14 years). Adolescents with low fast food consumption and those in late adolescence were less likely to be stunted or thin.

CONCLUSION

Poor dietary practices and undernutrition, particularly among younger adolescents, were observed. Comprehensive programs addressing environmental, social, and cultural barriers are needed to improve adolescent nutrition.

Cross-sectional study on behavioural determinants associated with sugary foods and beverages and their correlates with body mass index among adolescents in Nagarjun municipality, Nepal

OBJECTIVES

This study was conducted to determine the status of and factors associated with behavioural determinants (knowledge, attitude and practice) of sugary foods and beverages among adolescents in Kathmandu, Nepal.

DESIGN

Cross-sectional study.

SETTING

The study was done at educational institutions located in Nagarjun municipality, Kathmandu, Nepal.

PARTICIPANTS

In this study, 768 adolescents from grades 8, 9 and 10 were selected using a multistage random sampling technique.

PRIMARY AND SECONDARY OUTCOME MEASURES

Knowledge regarding sugary foods and beverages was assessed using 9 questions, attitude was measured through 13 Likert scale statements and consumption was assessed using 9 questions through a semi-structured questionnaire. Body mass index (BMI) was calculated based on anthropometric measurements. Pearson's χ2 test and logistic regression were used to assess factors associated with those behavioural determinants, along with their correlates with BMI. A p value of <0.05 was considered statistically significant.

RESULT

Adequate level of knowledge was found among 84.11% (95% CI: 81.52% to 86.70%) of the adolescents. Awareness of the health risks and inclination to adopt healthier behaviours was seen among 60% of the adolescents (95% CI: 56.55% to 63.49%). The percentage of adolescents consuming sugary foods and beverage items was 84.50% (95% CI: 81.94% to 87.07%). The odds of having adequate knowledge among respondents was twice (adjusted OR (AOR)=2.05, 95% CI: 1.12 to 3.76) more likely for those who were living with their parents. Female adolescents (AOR=2.51, 95% CI: 1.61 to 3.89), whose mothers are homemakers (AOR=1.99, 95% CI: 1.04 to 3.58) and fathers are engaged in foreign employment (AOR=2.09, 95% CI: 1.04 to 4.21), were more likely to consume sugary items. Prevalence of overweight and obesity was seen among 6.38% (95% CI: 4.64% to 8.11%) of respondents. Consumption was seen to be significant to the model overweight/obesity versus normal (OR=11.95 (95% CI: 1.61 to 88.42)).

CONCLUSION

Adequate knowledge alone was insufficient for influencing food selection and choices. Family-indulged interventions can be useful as familial factors seem to be impacting behavioural characteristics. Sugary foods and beverages consumption was linked to being overweight/obese, highlighting the importance of dietary discipline in reducing this risk.

Exploring the relationship between the food environment and preferences among schoolchildren in a low socioeconomic community in Sri Lanka: A GIS-based assessment

The food environment in school neighborhoods plays a crucial role in manipulating the food choices of schoolchildren. This study investigated the relationship between the food environment in neighborhoods and the dietary practices of government school students in a low socioeconomic setting in Sri Lanka. This cross-sectional study surveyed the neighborhood food environment of selected schools (n = 30) in the Monaragala District, Sri Lanka, using geographical information system (GIS) data and collected dietary information from a representative sample of schoolchildren (n = 603). Chi-square and Spearman correlation tests were performed using SPSS version 23.0 to estimate the associations between the food environment and BMI, while ArcGIS 10.4.1 was used to analyze the GIS data. The majority of the students (35.5%) were 15 years old, and approximately 51% were females. The mean BMI of the study participants was 18.14 (±3.28). More than 90% of outlets within proximity sold unhealthy foods. Consumption of confectionaries was 72.3% of the students, whereas healthy food choices ranged from 5% to 12%. A positive correlation between consuming unhealthy food and distance to outlets from school was observed (p<0.05). The risk of consuming low-nutrition food doubled (OR = 2.47, 95% CI: 1.52-3.89) among the students studying in schools where a larger proportion of energy-dense food was sold in closer proximity. In conclusion, the density and proximity of outlets that sell food with low nutrients in the school neighborhood environment were positively associated with students' unhealthy food item choices.

Prevalence of problematic eating behavior and assessment of awareness on eating disorder among medical students

Background

There are few studies that highlight the problematic eating behavior of college students; however, similar data on the medical undergraduate population is sparse, especially in India. Awareness among medical students would be considered different compared to other students, owing to their training and education.

Aim

To know the prevalence of problematic eating behavior in medical undergraduate students and to measure the extent of awareness regarding problematic eating behavior present amongst the students.

Materials and Methods

The present study was a cross-sectional study conducted over 2 months that included students (1st -4th year and interns) aged 17-30 years, studying MBBS. Ethical approval to do the study was taken from the Institutional Ethics Committee. Purposive sampling was done. Those students who gave informed consent to be a part of this study and were not diagnosed with any severe mental and physical illness were included in this study. Socio-demographic data was collected in a semi-structured proforma. The questionnaire was given to the students to fill up. The questionnaire included EAT-26 (Eating Attitudes Test-26) score for screening the students for problematic eating behavior. For objectively assessing awareness amongst the students regarding the same, a few questions of knowledge, attitude, and practice (KAP) on problematic eating were included in the form. The result was analyzed using SPSS- 25 (Statistical Package for Social Sciences) and appropriate statistical tests.

Results

Among Medical undergraduates, 19.9% had EAT-26 score more than or equal to 20, suggesting some problematic eating behavior. A total of 36.7% of students were obese, while 5.6% were underweight. Gender and background do not play any role in the causation of Problematic Eating Behaviour (PEB). There was a significant difference in the EAT score with respect to the education of the head of the family (P < 0.01), positive history of mental illness in the family (P = 0.01), positive history of childhood obesity (P < 0.01), and positive history of bullying (P < 0.01). Awareness or knowledge about eating disorders is high among MBBS graduates, which could be a protective factor in general.

Conclusion

Obesity is a more concerning issue in the medical undergraduate population rather than underweight. Childhood obesity and bullying emerge as important factors affecting the eating attitudes and behavior among medical graduates.

Applying the Integrated Sustainability Framework to explore the long-term sustainability of nutrition education programmes in schools: a systematic review

OBJECTIVE

This review aimed to identify and synthesise the enablers and barriers that influence the long-term (≥ 2 years) sustainment of school-based nutrition programmes.

DESIGN

Four databases (PubMed, Cochrane Library, Embase and Scopus) were searched to identify studies reporting on the international literature relating to food and nutrition programmes aimed at school-age (5-14 years) children that had been running for ≥ 2 years (combined intervention and follow-up period). Eligible studies were analysed using the Integrated Sustainability Framework (ISF), which involved deductive coding of programme enablers and barriers. A quality assessment was completed, using the Mixed-Methods Appraisal Tool and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

SETTING

International school-based nutrition programmes.

SUBJECTS

Individuals involved with the implementation of school-based nutrition programmes.

RESULTS

From the 7366 articles identified, thirteen studies (seven qualitative, five mixed methods and one quantitative descriptive) were included, from which the enablers and barriers of eleven different nutrition-related programmes were analysed. Thirty-four factors across the five domains of the ISF were identified that influenced the sustained implementation of programmes. The most common barrier was a lack of organisational readiness and resources, whereas the most common enabler was having adequate external partnerships and a supportive environment.

CONCLUSIONS

These findings have application during the initiation and implementation phases of school-based nutrition programmes. Paying attention to the 'outer contextual factors' of the ISF including the establishment and maintenance of robust relationships across whole of government systems, local institutions and funding bodies are crucial for programme sustainment.

The Study of Nutrient Intake and Adolescent Girls' Quality of Life in a Rural Area of Indonesia

An inadequate nutrient intake correlates with malnutrition, a problem affecting many adolescents worldwide. Nutrient intake is associated with quality of life (QoL). Our study analyzed the relationship between nutrient intake and adolescents’ QoL. We conducted a cross-sectional study. Through simple random sampling, 157 adolescent girls were selected. Nutrition status was assessed using anthropometric measurements. Nutrient intake was collected using the food frequency questionnaire (FFQ). WHOQOL BREF was used to explore adolescent girls’ quality of life. The median of nutrient intake: energy (908.25 kcal); protein (24.16 g); carbohydrate (128.89 g); fat (21.89 g); vitamin A (77.10 mg); vitamin E (1.40 mg); vitamin B1 (0.19 mg); vitamin B2 (0.29 mg); vitamin B6 (0.45 mg); folic acid (35.13 mg); vitamin C (12.60 mg); calcium (197.46 mg); magnesium (93.72 mg); iron (2.64 mg); and zinc (2.09 mg). The adolescents’ QoL scores were physical health 44 (25–81), psychological domain 56 (19–94), social relationships 56 (19–94), and environmental domain 56 (31–100). The strongest correlations were between (1) physical health with carbohydrates, vitamin C, and fat; (2) psychological domain with calcium; (3) social relationships with carbohydrates and vitamin C; and (4) environmental domain with BMI and zinc. There was a significant positive correlation between the intake of some nutrients and adolescents’ QoL, despite the observation of some significant negative correlations. The findings of this study indicate that more attention should be focused on adolescents’ nutrient intake in order to improve their QoL.

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

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

Promoting Healthy Eating among Young People-A Review of the Evidence of the Impact of School-Based Interventions

Intro: Globally, the prevalence of overweight and obesity is increasing among children and younger adults and is associated with unhealthy dietary habits and lack of physical activity. School food is increasingly brought forward as a policy to address the unhealthy eating patterns among young people. Aim: This study investigated the evidence for the effectiveness of school-based food and nutrition interventions on health outcomes by reviewing scientific evidence-based intervention studies amongst children at the international level. Methods: This study was based on a systematic review using the PRISMA guidelines. Three electronic databases were systematically searched, reference lists were screened for studies evaluating school-based food and nutrition interventions that promoted children’s dietary behaviour and health aiming changes in the body composition among children. Articles dating from 2014 to 2019 were selected and reported effects on anthropometry, dietary behaviour, nutritional knowledge, and attitude. Results: The review showed that school-based interventions in general were able to affect attitudes, knowledge, behaviour and anthropometry, but that the design of the intervention affects the size of the effect. In general, food focused interventions taking an environmental approach seemed to be most effective. Conclusions: School-based interventions (including multicomponent interventions) can be an effective and promising means for promoting healthy eating, improving dietary behaviour, attitude and anthropometry among young children. Thus, schools as a system have the potential to make lasting improvements, ensuring healthy school environment around the globe for the betterment of children’s short- and long-term health.

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

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

Salt Reduction Strategies in Portuguese School Meals, from Pre-School to Secondary Education-The Eat Mediterranean Program

High sodium (salt) consumption is associated with an increased risk of developing non-communicable diseases. However, in most European countries, Portugal included, sodium intake is still high. This study aimed to assess the sodium content of school meals before and after the Eat Mediterranean (EM) intervention—a community-based program to identify and correct nutritional deviations through the implementation of new school menus and through schools’ food handlers training. EM (2015–2017) was developed in 25 schools (pre to secondary education) of two Portuguese Municipalities, reaching students aged 3–21 years old. Samples of the complete meals (soup + main course + bread) from all schools were collected, and nutritional quality and laboratory analysis were performed to determine their nutritional composition, including sodium content. Overall, there was a significant decrease (−23%) in the mean sodium content of the complete school meals, which was mainly achieved by the significant reduction of 34% of sodium content per serving portion of soup. In conclusion, EM had a positive effect on the improvement of the school meals’ sodium content, among the participant schools. Furthermore, school setting might be ideal for nutrition literacy interventions among children, for flavors shaping, and for educating towards less salty food acceptance.

Effect of implementing school meals compared with packed lunches on quality of dietary intake among children aged 7-13 years

Strategies are needed to improve the dietary habits of children. The aim of the present study was to evaluate the effect of implementing a school food programme on the dietary quality of lunches consumed by school children aged 7–13 years compared with packed lunches brought from home. A secondary objective was to investigate if a possible effect would differ between the younger children and the older. A quasi-experimental study design with four intervention schools and four matched control schools was conducted. In total, 984 school children participated. Data on packed lunches were collected at baseline. At the 1st follow-up the children in the intervention schools were offered free school meals and at the 2nd follow-up children paid for their school meals. The control group had packed lunches at all measurements. A digital photographic method combined with a Meal Index of dietary Quality (Meal IQ) was used for dietary assessment. Multilevel modelling was employed for data analyses. The quality of dietary intake was improved when free school meals were offered (P = 0·004); if the school meals were paid for the use was limited and no difference in change in dietary quality was found (P = 0·343). The school food programme had no difference in effect according to age (P = 0·083). In conclusion, offering a free school meal had a positive effect on dietary quality of the lunches consumed by school children aged 7–13 years. No effect was measured when the school meals were not provided for free. The dietary effect did not depend on age.

How family socioeconomic status, peer behaviors, and school-based intervention on healthy habits influence adolescent eating behaviors

Psychologists in schools can play an important role in developing policies and programs to promote healthy eating habits. This study analyses the contributions of family socioeconomic status, peer influence (schoolmates’ food consumption), and school-based nutrition interventions to explain adolescent eating behaviors. Data were obtained from the 2014 Health behaviour in school-aged children survey in Spain, with a sample of 6,851 adolescents (11- to 16-years-old). The results suggest that school-based healthy-eating programs could improve by considering parental education level and by implementing interventions focused on the peer social network. Policies that limit access to unhealthy products in schools – rather than simply offering healthy foods alongside unhealthy products – could be more effective.

Comparing Diet and Exercise Monitoring Using Smartphone App and Paper Diary: A Two-Phase Intervention Study

Background

There is increasing recognition that personalized approaches may be more effective in helping people establish healthier eating patterns and exercise more, and that this approach may be particularly effective in adolescents.

Objective

The objective of this study was to investigate the use of a smartphone app (FoodWiz2) in supporting healthy lifestyle choices in adolescence.

Methods

Participants (N=34: 11 male, 23 female) aged 16-19 years in full- or part-time education were recruited from sixth form colleges, schools, and other further education establishments in Norfolk and Suffolk, United Kingdom, between February and May 2015. Participants recorded food intake and exercise using a paper diary for 4-5 weeks and then used the app for the same duration. Initial nutrition education and general support were provided during the paper diary use, but the app included personalized messages sent in response to app activity. At the end of each study phase, participants completed an online questionnaire to describe their experience of using the paper diary and app.

Results

Record completion declined throughout the study, possibly affected by examination pressure. Food intake data showed increased fruit consumption and significantly reduced consumption of chocolate snacks (P=.01) and fizzy drinks (P=.002) among participants using the app. Questionnaire responses indicated that the app was generally preferred to the paper diary, in particular, the app was seen as less boring to use (P=.03) and more acceptable in social settings (P<.001).

Conclusions

This app-based approach has shown the potential for a more effective approach to improving adolescent diet and exercise levels.

Dietary intake of adolescents compared with the Brazilian Food Guide and their differences according to anthropometric data and physical activity

OBJECTIVE

To assess the dietary intake of adolescents compared with the Brazilian Food Guide and to explore their differences according to anthropometric data and physical activity.

METHODS

A total of 476 adolescents from public schools of Piracicaba, SP, Brazil participated in this study. A semi-quantitative food frequency questionnaire was used to estimate food group intake of adolescents. Height, weight and waist circumference of all participants were measured. Physical activity pattern was determined by questioning about participation in regular sport activities.

RESULTS

The prevalence of overweight was 36.1% and 60% were not physically active. 7.8, 7.1, 6.3, and 0.2% of adolescents consumed vegetables, fruits, milk and derivatives, and cereals, respectively, according to recommendations. About 55 and 79% of adolescents consumed excessively oils/fats and sugar/sweets, respectively. Physically active adolescents consumed more cereals, fruits, vegetables, milk and derivatives, and meats and eggs.

CONCLUSION

Most adolescents did not follow the food group recommendations and those who were physically active have healthier food habits.

Nutrient intake of European adolescents: results of the HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescence) Study

OBJECTIVE

An adequate nutritional intake in childhood and adolescence is crucial for growth and the prevention of youth and adult obesity and nutrition-related morbidities. Improving nutrient intake in children and adolescents is of public health importance. The purpose of the present study was to describe and evaluate the nutrient intake in a European sample using the D-A-CH nutrient intake recommendations and the Nutritional Quality Index (NQI).

DESIGN

The HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescence) Study is a cross-sectional study, the main objective of which is to obtain comparable data on a variety of nutritional and health-related parameters in adolescents aged 12·5-17·5 years.

SETTING

Eight cities in Europe.

SUBJECTS

The initial sample consisted of 3528 European adolescents. Among these, 1590 adolescents (54% female) had sufficient and plausible dietary data on energy and nutrient intakes from two 24 h recalls using the HELENA-DIAT software.

RESULTS

The intakes of most macronutrients, vitamins and minerals were in line with the D-A-CH recommendations. While the intakes of SFA and salt were too high, the intake of PUFA was too low. Furthermore, the intakes of vitamin D, folate, iodine and F were less than about 55% of the recommendations. The median NQI was about 71 (of a maximum of 100).

CONCLUSIONS

The intakes of most nutrients were adequate. However, further studies using suitable criteria to assess nutrient status are needed. Public health initiatives should educate children and adolescents regarding balanced food choices.

Academic stress levels were positively associated with sweet food consumption among Korean high-school students

OBJECTIVE

The objectives of the present study were to identify the association among levels of persistent academic stress, appetite, and dietary habits and to determine the specific types of sweet foods consumed by Korean high-school students according to their academic stress levels.

METHODS

The study participants included 333 high-school students in the 10th to 12th grades in Kyunggi Province, Korea. The level of academic stress was scored with a 75-item academic stress scale and was categorized as high, medium, or low. A food-frequency questionnaire was used to measure the sugar intake from sweet foods.

RESULTS

Korean high-school students with a high academic stress level had larger meals than the other students. Compared with students with low academic stress, the students with high academic stress had a higher frequency of sugar intake from the following food types: confectionaries, candies and chocolates, breads, and flavored milk. Moreover, compared with students with low academic stress, the students with high academic stress had a higher total intake of sugar from the following food types: confectionaries, candies, chocolates, flavored milk, traditional Korean beverages, and spicy, sweet, and fried rice cakes.

CONCLUSION

Unhealthy stress-related food choices may compromise high-school students' health and contribute to their morbidity. The findings of the present study could be used to help nutritionists develop effective strategies for nutritional education and counseling to improve adolescent health.

Community-based interventions for enhancing access to or consumption of fruit and vegetables among five to 18-year olds: a scoping review

BACKGROUND

Low fruit and vegetable ( FV) consumption is a key risk factor for morbidity and mortality. Consumption of FV is limited by a lack of access to FV. Enhanced understanding of interventions and their impact on both access to and consumption of FV can provide guidance to public health decision-makers. The purpose of this scoping review is to identify and map literature that has evaluated effects of community-based interventions designed to increase FV access or consumption among five to 18-year olds.

METHODS

The search included 21 electronic bibliographic databases, grey literature, targeted organization websites, and 15 key journals for relevant studies published up to May 2011. Retrieved citations were screened in duplicate for relevance. Data extracted from included studies covered: year, country, study design, target audience, intervention setting, intervention strategies, interventionists, and reported outcomes.

RESULTS

The search located 19,607 unique citations. Full text relevance screening was conducted on 1,908 studies. The final 289 unique studies included 30 knowledge syntheses, 27 randomized controlled trials, 55 quasi-experimental studies, 113 cluster controlled studies, 60 before-after studies, one mixed method study, and three controlled time series studies. Of these studies, 46 included access outcomes and 278 included consumption outcomes. In terms of target population, 110 studies focused on five to seven year olds, 175 targeted eight to 10 year olds, 192 targeted 11 to 14 year olds, 73 targeted 15 to 18 year olds, 55 targeted parents, and 30 targeted teachers, other service providers, or the general public. The most common intervention locations included schools, communities or community centres, and homes. Most studies implemented multi-faceted intervention strategies to increase FV access or consumption.

CONCLUSIONS

While consumption measures were commonly reported, this review identified a small yet important subset of literature examining access to FV. This is a critically important issue since consumption is contingent upon access. Future research should examine the impact of interventions on direct outcome measures of FV access and a focused systematic review that examines these interventions is also needed. In addition, research on interventions in low- and middle-income countries is warranted based on a limited existing knowledge base.

Changes in dietary behavior among adolescents and their association with government nutrition policies in Korea, 2005-2009

OBJECTIVES

This study was conducted to observe recent changes in adolescents' dietary behavior and indirectly evaluate the effects of the government's nutritional policies in Korea.

METHODS

We analyzed the secular trends in seven dietary behaviors using the Korea Youth Risk Behavior Web-based Survey data from 2005 to 2009. Through literature review, we included the policies implemented for the improvement of adolescents'dietary behaviors during the same periods.

RESULTS

The significant linear trends were observed in all dietary behaviors (p<0.05). Overall, all behaviors except the fruit intake rate were desirably changed during five years but undesirable changes were observed between 2008 and 2009 in all behaviors. Within those periods, several policies were implemented including 'Ban on carbonated-beverages in school', 'Green Food Zone', etc. Despite confirmed evidence of their effects, the policies on individual behavior such as nutrition education didn't influence the prevalence of dietary behaviors because they were conducted to too limited persons. Policies on the school environmental improvement, such as ban on carbonated beverage in school, were more effective because they decreased the exposure of undesirable food environment. However, for effect of Green Food Zone improving community environment we couldn't come to a conclusion because of too short period after full implementation.

CONCLUSIONS

Among government nutrition policies conducted from 2005 to 2009, those on environmental improvement, especially in school, were more effective than those on individual behavior. Therefore, the development and implement of policies on school environmental improvement are needed in Korea.

Food intake of European adolescents in the light of different food-based dietary guidelines: results of the HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescence) Study

Objective

Since inadequate food consumption patterns during adolescence are not only linked with the occurrence of obesity in youth but also with the subsequent risk of developing diseases in adulthood, the establishment and maintenance of a healthy diet early in life is of great public health importance. Therefore, the aim of the present study was to describe and evaluate the food consumption of a well-characterized sample of European adolescents against food-based dietary guidelines for the first time.

Design

The HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescence) Study is a cross-sectional study, whose main objective was to obtain comparable data on a variety of nutritional and health-related parameters in adolescents aged 12·5–17·5 years.

Setting

Ten cities in Europe.

Subjects

The initial sample consisted of more than 3000 European adolescents. Among these, 1593 adolescents (54 % female) had sufficient and plausible dietary data on energy and food intakes from two 24 h recalls using the HELENA-DIAT software.

Results

Food intake of adolescents in Europe is not optimal compared with the two food-based dietary guidelines, Optimized Mixed Diet and Food Guide Pyramid, examined in this study. Adolescents eat half of the recommended amount of fruit and vegetables and less than two-thirds of the recommended amount of milk (and milk products), but consume much more meat (and meat products), fats and sweets than recommended. However, median total energy intake may be estimated to be nearly in line with the recommendations.

Conclusion

The results urge the need to improve the dietary habits of adolescents in order to maintain health in later life.

Pilot evaluation of the HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescence) Food-O-Meter, a computer-tailored nutrition advice for adolescents: a study in six European cities

OBJECTIVE

To investigate the feasibility and impact of the Food-O-Meter, an Internet-based computer-tailored nutrition intervention in adolescents.

DESIGN

Participants in the intervention condition received the computer-tailored advice at baseline and at 1 month, those in the control condition received standardised advice. Effects were evaluated at 1 month (n 621) and at 3 months (n 558) using multi-level modelling.

SETTING

Secondary schools in six European cities. Adolescents accessed the intervention in the school computer room under the supervision of teachers.

SUBJECTS

Classes with students aged 12-17 years in the schools participating in the HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescence) cross-sectional study were randomised into intervention and control schools.

RESULTS

In most participating centres the intervention was feasible and generally well appreciated, especially by girls. Technical problems and lack of motivation of the teachers hindered implementation in some centres. Overweight adolescents had higher scores for reading and using the advice than normal weight adolescents. After 1 month adolescents receiving the standardised advice reported an increase in fat intake, while fat intake in the intervention condition was stable (F = 4·82, P < 0·05). After 3 months, there was a trend in the total group for an intervention effect of the tailored advice on fat intake (F = 2·80, P < 0·10). In the overweight group there was a clear positive effect (F = 5·76, P < 0·05).

CONCLUSIONS

The Food-O-Meter should be developed further. The results were modest but clear for percentage energy from fat, specifically in the overweight group. Adaptations based on new research are needed to enhance the reliability and effectiveness of the intervention.

Trends in dietary carbohydrate quality during puberty from 1988 to 2007: a cause for concern?

The extent to which the quality of dietary carbohydrates (CHO) changes throughout puberty is not known. We analysed trends in the quantity and quality of CHO intake among German adolescents by separately examining trends during puberty (pubertal trends) and trends in CHO intake from 1988 to 2007 (secular trends). Linear mixed-effects regression analyses were performed in 216 participants of the Dortmund Nutritional and Anthropometric Longitudinally Designed Study who had provided weighed 3 d dietary records at the onset of the pubertal growth spurt (defined by age at take-off) and over the subsequent 4 years. Over the course of puberty, CHO quality changed little: added sugar intake from beverages increased in girls (0·25 (se 0·12) % energy (% E)/year, P = 0·04) and added sugar intake from sweets decreased in both sexes (boys: - 0·22 (se 0·11) % E/year, P = 0·049; girls: - 0·20 (se 0·10) % E/year, P = 0·04). For both sexes, significant upward secular trends were observed for CHO (% E), glycaemic load (g/MJ) and added sugar intakes from sources other than sweets and soft drinks (% E), while absolute fibre intake (g/d) decreased (P ≤ 0·04). Concomitant increases in total added sugar intake (% E) and decreases in fibre and whole-grain densities (g/MJ) (P = 0·001-0·02) were confined to boys only. The quality of dietary CHO consumed by healthy German adolescents shows notable secular declines, but does not change markedly during puberty. Public health initiatives should be tailored to improve the overall quality of CHO nutrition.

Who eats healthily? A population-based study among young Swiss residents

OBJECTIVE

To assess whether Swiss residents aged 15-24 years follow current nutritional guidelines and whether differences exist according to gender and weight status.

DESIGN

Cross-sectional national survey.

SETTING

Switzerland.

SUBJECTS

The 1786 participants (48·4 % women) were divided into overweight, normal weight and underweight. We used traditional BMI cut-offs for people ≥18 years of age (underweight = BMI < 18·5 kg/m2, normal weight = BMI ≥ 18·5 kg/m2 and <25 kg/m2, overweight = BMI ≥ 25 kg/m2) and age- and gender-appropriate tables for people aged <18 years, with BMI calculated from self-reported weight and height. We performed bivariate analyses by gender, and then bivariate and multivariate analyses comparing overweight to normal weight people (excluding underweight, n 129, 71·6 % women) regarding adherence to recommendations for fruit, vegetables, meat, fish and dairy products; physical activity; attitude towards body weight; depression, smoking and alcohol consumption.

RESULTS

Overall, adherence to nutritional guidelines was low, particularly for vegetables and dairy products. Women had a higher adherence than men except for fish and dairy products. In the multivariate analyses, overweight women had a lower vegetable intake, were less satisfied with body weight and had more often been on a diet, whereas overweight men were less satisfied with body weight and wanted to lose weight more often than their normal weight peers. There were no significant differences for physical activity.

CONCLUSIONS

Overweight prevention programmes should target youth specifically by gender and promote an appropriate self-perception. Overweight women should be encouraged to eat more vegetables and men to be more sensitised on healthy food. Further research is needed to assess how to make nutritional guidelines more adaptable to young people's daily life.

Dietary habits of Palestinian adolescents and associated sociodemographic characteristics in Ramallah, Nablus and Hebron governorates

OBJECTIVE

To describe food habits and associated sociodemographic factors.

DESIGN

Cross-sectional survey in 2005.

SETTING

Ninety-six school classes in Ramallah, Nablus and Hebron governorates, Occupied Palestinian Territory.

SUBJECTS

Grade 8 and 9 students aged 13-15 years (n 2952).

METHODS

Self-administered student and parent questionnaires.

RESULTS

High standard of living (STL) index and residence in Ramallah were positively associated with intake of animal foods, Western-style foods, dairy products, fruits and vegetables, sweets and salty snacks. Only 26.1 % of the students ate three main meals daily; 26.2 % of the boys and 51.0 % of the girls had breakfast one to two times per week or less often (P < 0.001). Only one-quarter of students drank milk daily (32.9 % of boys and 18.3 % of girls, P < 0.001). The majority of students, boys and girls in similar proportions, consumed vegetables daily (72.8 % v. 73.8 %, respectively). Daily fruit consumption was also equally common among boys and girls (58.9 % v. 55.2 %, respectively), but with clear differences by STL, region and parents' education. Daily intake of sweets and salty snacks was common among girls, and daily intake of soft drinks was common among boys.

CONCLUSIONS

Irregular meal patterns were common among Palestinian adolescents. High STL and residence in Ramallah were associated with frequent intake of foods high in sugar and fat, but also with frequent intake of fruits and vegetables. Effective interventions are needed to establish healthy dietary habits.

Effectiveness of school-based interventions in Europe to promote healthy nutrition in children and adolescents: systematic review of published and ‘grey’ literature

The objective of the present review was to summarise the existing European published and ‘grey’ literature on the effectiveness of school-based interventions to promote a healthy diet in children (6–12 years old) and adolescents (13–18 years old). Eight electronic databases, websites and contents of key journals were systematically searched, reference lists were screened, and authors and experts in the field were contacted for studies evaluating school-based interventions promoting a healthy diet and aiming at primary prevention of obesity. The studies were included if they were published between 1 January 1990 and 31 December 2007 and reported effects on dietary behaviour or on anthropometrics. Finally, forty-two studies met the inclusion criteria: twenty-nine in children and thirteen in adolescents. In children, strong evidence of effect was found for multicomponent interventions on fruit and vegetable intakes. Limited evidence of effect was found for educational interventions on behaviour, and for environmental interventions on fruit and vegetable intakes. Interventions that specifically targeted children from lower socio-economic status groups showed limited evidence of effect on behaviour. In adolescents, moderate evidence of effect was found for educational interventions on behaviour and limited evidence of effect for multicomponent programmes on behaviour. In children and adolescents, effects on anthropometrics were often not measured, and therefore evidence was lacking or delivered inconclusive evidence. To conclude, evidence was found for the effectiveness of especially multicomponent interventions promoting a healthy diet in school-aged children in European Union countries on self-reported dietary behaviour. Evidence for effectiveness on anthropometrical obesity-related measures is lacking.

Parents' and teachers' opinions about the school food policy in Belgian Flemish nursery schools

The partnership of parents, teachers, and schools is necessary to develop effective school food interventions. To gather parents' and teachers' opinions and perceptions about the school food policy, 884 parents and 70 teachers of preschoolers completed a questionnaire. School food policy is an issue of importance for parents and teachers: the majority agrees that schools should restrict the availability of snacks and soft drinks; however, to replace fruit juice and sugared milk drinks with sugarless alternatives will take special effort. Fruit is not always available at school, although parents would appreciate it. Parents of lower educational level are in general more permissive.

Relative validity of a semiquantitative food frequency questionnaire designed for schoolchildren in western Greece

Background

The use of food frequency questionnaires (FFQs) has become increasingly important in epidemiologic studies. During the past few decades, a wide variety of nutritional studies have used the semiquantitative FFQ as a tool for assessing and evaluating dietary intake. One of the main concerns in a dietary analysis is the validity of the collected dietary data.

Methods

This paper discusses several methodological and statistical issues related to the validation of a semiquantitative FFQ. This questionnaire was used to assess the nutritional habits of schoolchildren in western Greece. For validation purposes, we selected 200 schoolchildren and contacted their respective parents. We evaluated the relative validity of 400 FFQs (200 children's FFQs and 200 parents' FFQs).

Results

The correlations between the children's and the parents' questionnaire responses showed that the questionnaire we designed was appropriate for fulfilling the purposes of our study and in ranking subjects according to food group intake.

Conclusion

Our study shows that the semiquantitative FFQ provides a reasonably reliable measure of dietary intake and corroborates the relative validity of our questionnaire.

Food consumption among preschoolers. Does the school make a difference?

Few preschool children have a diet in line with nutrition recommendations. The school food policy is one of the factors that can influence children's eating habits. Multilevel regression analyses were carried out to test the potential influence of a school's food policy (N=50) on the children's (N=1678; ages 2.5-6.5 year) consumption of fresh fruit, snacks, water, fruit juice, milk, sugared milk drinks and sugared soft drinks. Between-school variation remained significant after controlling for individual level characteristics for fruit juice, sugared milk drinks and fruit. Significant school level variables were availability of sugared milk drinks and having food rules in the school policy.

A computer-tailored dietary fat intake intervention for adolescents: results of a randomized controlled trial

BACKGROUND

The positive effects of computer-tailored dietary fat intake interventions have been demonstrated in adults, but few studies have investigated the impact on adolescents.

PURPOSE

The purpose is to evaluate the acceptability, feasibility and effectiveness of a computer-tailored dietary fat intake education program for adolescents.

METHODS

A random sample of 10 schools, 5 with general and 5 with technical-vocational education programs, were selected to participate. In each of the 10 schools, 2 classes of 7th graders were randomly assigned to the intervention (n = 153) or control (no-intervention, n = 151) condition. Students were exposed once in class to a 50-min theory-based computer-tailored dietary fat intake intervention. Questionnaires were completed 1 week before (food frequency questionnaire for dietary fat intake + psychosocial determinants) and 3 months after (process evaluation + food frequency questionnaire for dietary fat intake + psychosocial determinants) the intervention.

RESULTS

About one in three students evaluated the intervention as interesting (34%), novel (38%), personally relevant (26%), credible (34%), and correct (38%). Half of the students evaluated the intervention messages to be too long, and one fourth did not read the intervention messages. A decrease in dietary fat consumption was shown in girls enrolled in technical-vocational schools (F = 3.5, p < or = .05) and in boys and girls undertaking general education who reported to have read the intervention messages (F = 3.6, p < or = .05); however, no intervention effects were detected for the total sample.

CONCLUSIONS

Further improvements to the intervention for use in adolescents should be evaluated. Given that a positive impact was shown in most adolescents and that a computer-tailored dietary fat intake education program has the capability of reaching large groups at low cost, this study shows that using such interventions in adolescents has potential.

Secular trends in fruit intake among Danish schoolchildren, 1988 to 2006: changing habits or methodological artefacts?

BACKGROUND

Intermittent monitoring of fruit and vegetable intake at the population level is essential for the evaluation and planning of national dietary interventions. Yet, only a limited number of studies on time trends in fruit and vegetable intake among children and adolescents have been published internationally. In Denmark, national comprehensive campaigns to enhance fruit and vegetable consumption were initiated in 2001. This paper describes secular trends in fruit intake among Danish adolescents by six comparable school surveys from 1988 to 2006. The paper demonstrates and discusses the consequences of measurement changes introduced in long-term trend analyses.

METHODS

We used Danish data from the international Health Behaviour in School-aged Children (HBSC) study collected in 1988, 1991, 1994, 1998, 2002 and 2006. Analyses were conducted on comparable questionnaire-based data from students aged 11, 13 and 15 total (n = 23,871) from a random sample of schools. Data on fruit intake were measured by a food frequency questionnaire. Due to changes in number of response categories beween surveys, different cut-points were analysed.

RESULTS

The prevalence of students eating fruit at least once daily ranged from 78.3% among 13-year-old girls in 1988 to 17.3% among 15-year-old boys in 2002. Based on the six data collections, analyses of trends showed a significant decrease in prevalence of students eating fruit at least once daily from 1988 to 2002 (all p-values < 0.0001). In all age and gender groups, a significant increase in intake occurred between 2002 and 2006 (all p-values < 0.0065). Analyses of alternative cut-points revealed similar results.

CONCLUSION

Fruit consumption among Danish schoolchildren decreased from 1988 to 2002 with an increase since 2002. We suggest that the increase may be attributable to a nation-wide initiative conducted in Denmark since 2001 to increase the intake of fruit and vegetables in the population. Still, the results imply that a substantial proportion of Danish schoolchildren do not meet the nationally recommended daily intake of fruit. Our analyses indicate that the observed trends are not solely caused by methodological biases related to changes in measurements.

The health benefits of calcium citrate malate: a review of the supporting science

There has been considerable investigation into the health benefits of calcium citrate malate (CCM) since it was first patented in the late 1980s. This chapter is a comprehensive summary of the supporting science and available evidence on the bioavailability and health benefits of consuming CCM. It highlights the important roles that CCM can play during various life stages. CCM has been shown to facilitate calcium retention and bone accrual in children and adolescents. In adults, it effectively promotes the consolidation and maintenance of bone mass. In conjunction with vitamin D, CCM also decreases bone fracture risk in the elderly, slows the rate of bone loss in old age, and is of benefit to the health and well-being of postmenopausal women. CCM is exceptional in that it confers many unique benefits that go beyond bone health. Unlike other calcium sources that necessitate supplementation be in conjunction with a meal to ensure an appreciable benefit is derived, CCM can be consumed with or without food and delivers a significant nutritional benefit to individuals of all ages. The chemistry of CCM makes it a particularly beneficial calcium source for individuals with hypochlorydia or achlorydia, which generally includes the elderly and those on medications that decrease gastric acid secretion. CCM is also recognized as a calcium source that does not increase the risk of kidney stones, and in fact it protects against stone-forming potential. The versatile nature of CCM makes it a convenient and practical calcium salt for use in moist foods and beverages. The major factor that may preclude selection of CCM as a preferred calcium source is the higher cost compared to other sources of calcium commonly used for fortification (e.g., calcium carbonate and tricalcium phosphate). However, formation of CCM directly within beverages or other fluid foods and/or preparations, and the addition of a concentrated CCM solution or slurry, are relatively cost-effective methods by which CCM can be incorporated into finished food and beverage products.

The effects of a middle-school healthy eating intervention on adolescents' fat and fruit intake and soft drinks consumption

OBJECTIVES

To evaluate the effects of a middle-school healthy eating promotion intervention combining environmental changes and computer-tailored feedback, with and without an explicit parent involvement component.

DESIGN

Clustered randomised controlled trial.

SETTING

Fifteen West-Flemish (Belgian) middle schools.

SUBJECTS

A random sample of 15 schools with 2991 pupils in 7th and 8th grades was randomly assigned to an intervention group with parental support (n = 5), an intervention group without parental support (n = 5) and a control group (n = 5). In these 15 schools an intervention combining environmental changes with computer-tailored feedback was implemented. Fat and fruit intake, water and soft drinks consumption were measured with food-frequency questionnaires in the total sample of children.

RESULTS

In girls, fat intake and percentage of energy from fat decreased significantly more in the intervention group with parental support, compared with the intervention alone group (all F>3.9, P < 0.05) and the control group (all F>16.7, P < 0.001). In boys, there were no significant decreases in fat intake (F = 1.4, not significant (NS)) or percentage of energy from fat (F = 0.7, NS) as a result of the intervention. No intervention effects were found in boys or in girls for fruit (F = 0.5, NS), soft drinks (F = 2.6, NS) and water consumption (F = 0.3, NS).

CONCLUSIONS

Combining physical and social environmental changes with computer-tailored feedback in girls and their parents can induce lower fat intake in middle-school girls. However, to have an impact on the consumption of soft drinks and water, governmental laws that restrict the at-school availability of low-nutritive products may be necessary.

Evaluation of Energy, Nutrient and Dietary Fiber Intakes of Adolescent Males

OBJECTIVE

The minimal data available on the current energy, nutrient and dietary fiber intakes of adolescent males challenges the development of effective nutrition education programs. There is a need for research into the current intakes of adolescent males and in particular their relation to the current Dietary Reference Intakes (DRIs). The primary objective of this study was to assess the diet of adolescent males and relate energy, nutrient and dietary fiber intakes to the DRIs. Secondary objectives were to relate energy, macronutrient and dietary fiber intakes to body mass index (BMI)-for-age percentile categories as well as to explore vitamin/mineral supplement use and soft drink consumption.

METHODS

Three-day food records were completed by 180 healthy adolescent males for analysis of energy, nutrient and dietary fiber intakes from food and supplements. Following adjustment for intra-individual variability, nutrient intake percentile distributions were related to the DRIs. Energy, macronutrient and dietary fiber intakes were compared among BMI-for-age percentile categories and diets were evaluated for vitamin/mineral supplement use and soft drink consumption.

RESULTS

Median intakes for percent energy from carbohydrate, fat and protein were within the Accepted Macronutrient Distribution Ranges. Intakes of micronutrients with Estimated Average Requirement values indicated that greater than 50% of subjects consumed inadequate amounts of vitamin A and vitamin B6, and greater than 75% of subjects consumed inadequate amounts of magnesium, phosphorus and zinc. Subjects classified as overweight had significantly lower energy and carbohydrate intakes compared with subjects classified as having an acceptable body weight. The prevalence of vitamin/mineral supplement use was 16.1% and 67% of subjects reported daily consumption of soft drinks.

CONCLUSION

Results of this study reveal that adolescent males are consuming the recommended amounts of macronutrients but may be at risk for consuming inadequate levels of specific micronutrients. Nutrition education programs should consider targeting select micronutrients to improve nutritional intakes of adolescent males.

The contribution of psychosocial and home environmental factors in explaining eating behaviours in adolescents

OBJECTIVE

The present study aimed at investigating the influence of food availability, rules and television viewing habits on eating behaviours in adolescents.

DESIGN

Cross-sectional study.

SETTING

Four randomly selected middle schools.

SUBJECTS

A sample of 534 seventh and eighth graders.

INTERVENTIONS

Validated questionnaires were used to measure the family environment and fat, soft drink and fruit consumption. Hierarchical regression analyses on fat, soft drink and fruit consumption, with demographic and psychosocial variables entered as the first and environmental factors as the second block were conducted in boys and girls.

RESULTS

Boys with more unhealthy products available at home consumed more fat (P< or =0.001, 95% CI: 8.2-29.4) and more soft drinks (P< or =0.01, 95% CI: 0.2-1.4). Boys who reported better television viewing habits ate more fruit (P< or =0.001, 95% CI: -1.7 to -0.5). Girls who reported better television viewing habits consumed less fat (P< or =0.01, 95% CI: 1.4-9.0) and more fruit (P< or =0.05, 95% CI: -1.0 to -0.1). Girls who reported higher availability of healthy products at home (P< or =0.05, 95% CI: 0.3-3.1) and more food rules (P< or =0.001, 95% CI: -1.8 to -0.5), consumed more fruit. Environmental factors were poor predictors of soft drink consumption among girls.

CONCLUSION

Availability of (un)healthy food products, family food rules and TV viewing habits were related to one or more eating behaviours in boys or girls. Although home environmental factors can play an important role in influencing adolescents' eating behaviours, these factors were generally less predictive than demographic and psychosocial variables.

Comparison of energy and nutrient intakes among meals and snacks of adolescent males

BACKGROUND

Eating behaviors developed during adolescence can have immediate health implications and influence future chronic disease risk. The objectives of this study were to determine and compare the distribution of energy and nutrient intakes among meals and snacks, and relate eating occasion frequency to body mass index (BMI) of adolescent males.

METHODS

Healthy adolescent males (n = 180) completed 3-day food records. Following analysis for energy and nutrient intakes, 3-day averages and frequencies were computed for all meals and snacks.

RESULTS

Dinner was the largest contributor of energy, macronutrients, cholesterol, dietary fiber, and sodium, whereas both dinner and breakfast were the largest contributors of calcium and iron. On average, subjects consumed 1.63 snacks/day, with 77% consuming > or = 1 snack/day. BMI was significantly greater and energy intake was significantly lower in subjects having < or = 3 eating occasions/day relative to 4 or > or = 6 eating occasions/day. The 26% of subjects classified as inconsistent breakfast consumers had significantly higher BMIs and lower iron intakes relative to consistent breakfast consumers.

CONCLUSIONS

This study provides valuable information regarding eating occasion frequency and contribution of meals and snacks to energy and nutrient intakes in adolescent males. Such information could be used to improve nutrition education programs for adolescents aimed at chronic disease prevention.

Fruits, vegetables, and football: findings from focus groups with alternative high school students regarding eating and physical activity

PURPOSE

To increase our understanding of factors that may influence the dietary and physical activity practices of adolescents attending an alternative high school (AHS).

METHODS

Seventy students (36 girls, 34 boys) from urban and suburban AHSs in the Minneapolis-St. Paul metropolitan area participated in 7 focus groups to discuss their perceptions and opinions about factors that influence their eating and physical activity behaviors and to offer suggestions regarding school-based strategies to support and to promote healthy physical activity and eating practices among students. Mixed-gender groups were facilitated by a trained moderator by using a set of standardized questions to guide the 45- to 60-minute discussions. Focus groups were audiotaped, transcribed, and analyzed using a 3-step process for qualitative analysis.

RESULTS

Time, cost, availability, and convenience were identified as key factors that influenced students' food choices and the choice to be active physically. Access to healthy foods and physical activity was problematic, especially at school. Students also reported that social support from their friends, family, and teachers, and role-modeling behaviors of adults enhanced their likelihood of eating healthy foods and being active.

CONCLUSIONS

Study findings suggest that programs that target social-environmental factors that include norms, role models, social support, and opportunities to practice a health behavior have the potential to affect positively the dietary and physical activity practices of teenagers attending an AHS. Interventions that aim to increase opportunities at school to practice healthy eating and physical activity may be effective, especially in promoting and supporting healthy behavior change among students.

School food policy at primary and secondary schools in Belgium-Flanders: does it influence young people's food habits?

OBJECTIVE

To describe the availability of food items at primary and secondary schools in Belgium-Flanders and to examine the influence of school food policy (availability of food items, school food rules, nutrition education programmes) and aggregated school socioeconomical status (AGG SES) on the consumption of fruit, soft drinks, crisps and sweets, using multilevel modelling.

DESIGN, SETTING AND SUBJECTS

In spring 2002, 360 schools were invited to participate in the Health Behaviour in School-aged Children survey. In January 2003, the same schools were asked to complete a short school policy questionnaire. Pupils of 197 schools participated in the pupil survey (n=16560); 247 school principals completed the school questionnaire; for 157 schools data were available for both (n=12 360).

RESULTS

Mineral water, fruit juice, chocolate milk, and soup were available in most schools. Whole fat milk was available in most primary schools; soft drinks, diet soft drinks and biscuits were available in most secondary schools. Fruit was available in 14% of primary and 26% of secondary schools. Assessment of the variation in the outcome variables revealed no significant between-school variation in primary schools, but considerable variation between secondary schools in the consumption of soft drinks, sweets and crisps (but not fruit). School characteristics explaining some of this school variance independent of pupil level characteristics were: for soft drinks: availability at the school, rules regarding the consumption of sweets and AGG SES; for sweets: AGG SES; and for crisps: rules regarding the consumption of savoury snacks and AGG SES.

CONCLUSION

The results indicate that school food policy can have an impact on adolescents' food habits.