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Jiang K, Zhang L, Xie C, Li Z, Shi Z, Sharma M, Zhao Y. Understanding the Knowledge, Attitudes, and Practices of Healthy Eating among Adolescents in Chongqing, China: An Empirical Study Utilizing Structural Equation Modeling. Nutrients 2024; 16:167. [PMID: 38201997 PMCID: PMC10780587 DOI: 10.3390/nu16010167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 12/20/2023] [Accepted: 12/27/2023] [Indexed: 01/12/2024] Open
Abstract
Healthy eating is crucial for optimal growth, development, and the prevention of chronic diseases in adolescents. Our study aimed to develop a comprehensive structural equation model (SEM) to analyze the relationships between knowledge, attitudes, practices (KAP), and healthy eating among adolescents in Chongqing. An online questionnaire was administered to middle school students in 39 districts and counties of Chongqing, China from 2 December to 15 December 2021 to collect sociodemographic and KAP information. SEM models were constructed to examine the relationships between educational environment and healthy eating knowledge, attitudes, and practices. The Monte Carlo test was employed to assess the significance of the mediating effect of relevant variables. The study included 139,832 adolescents aged 14.8 ± 0.7 years, with a 14% rate of overweight and obesity. Health and nutrition knowledge averaged a score of 3.60 ± 1.50 (correct rate: 60%). Participants had positive attitudes (average score: 13.61 ± 2.29) and engaged in healthy eating practices (average score: 12.06 ± 3.08). The results of the SEM revealed a significant influence of the educational environment on adolescents' knowledge (β = 0.235, p < 0.001) and attitude towards healthy eating (β = 0.143, p < 0.001). Knowledge exhibited positive effects on both attitude (β = 0.225, p < 0.001) and practice (β = 0.054, p < 0.001), while attitude exhibited positive effects on practice behavior (β = 0.565, p < 0.001). The indirect effect of knowledge on practices through attitude was more substantial than the direct effect (ratio 2.361). Our study highlights the mediating role of attitude between healthy eating knowledge and practices. A significant association exists between a favorable educational environment and improved knowledge and positive attitudes toward healthy eating among adolescents. In the future, nutrition and health education should prioritize exploring effective ways to translate knowledge into practices.
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Affiliation(s)
- Ke Jiang
- School of Public Health, Chongqing Medical University, Chongqing 400331, China; (K.J.); (L.Z.); (Z.L.)
- Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing 400016, China
- Research Center for Public Health Security, Chongqing Medical University, Chongqing 400016, China
| | - Laixi Zhang
- School of Public Health, Chongqing Medical University, Chongqing 400331, China; (K.J.); (L.Z.); (Z.L.)
- Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing 400016, China
- Research Center for Public Health Security, Chongqing Medical University, Chongqing 400016, China
| | - Changxiao Xie
- Department of Nutrition and Food Hygiene, West China School of Public Health, Sichuan University, Chengdu 610041, China;
| | - Zhourong Li
- School of Public Health, Chongqing Medical University, Chongqing 400331, China; (K.J.); (L.Z.); (Z.L.)
- Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing 400016, China
- Research Center for Public Health Security, Chongqing Medical University, Chongqing 400016, China
| | - Zumin Shi
- Human Nutrition Department, College of Health Sciences, QU Health, Qatar University, Doha P.O. Box 2713, Qatar;
| | - Manoj Sharma
- Department of Social and Behavioral Health, School of Public Health, University of Nevada, Las Vegas, NV 89119, USA;
- Department of Internal Medicine, Kirk Kerkorian School of Medicine, University of Nevada, Las Vegas, NV 89102, USA
| | - Yong Zhao
- School of Public Health, Chongqing Medical University, Chongqing 400331, China; (K.J.); (L.Z.); (Z.L.)
- Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing 400016, China
- Research Center for Public Health Security, Chongqing Medical University, Chongqing 400016, China
- Chongqing Key Laboratory of Child Nutrition and Heath, Children’s Hospital of Chongqing Medical University, Chongqing 401147, China
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Park S, Lee SH, Merlo C, Blanck HM. Associations between Knowledge of Health Risks and Sugar-Sweetened Beverage Intake among US Adolescents. Nutrients 2023; 15:nu15102408. [PMID: 37242294 DOI: 10.3390/nu15102408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 05/13/2023] [Accepted: 05/17/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Sugar-sweetened beverage (SSB) intake is associated with adverse health outcomes. OBJECTIVE We examined associations between the knowledge of health risks related to SSB and SSB intake among adolescents. DESIGN A cross-sectional study using 2021 YouthStyles survey data. PARTICIPANTS/SETTINGS 831 US adolescents (12-17 years old). MAIN OUTCOME MEASURES The outcome variable was SSB intake (none, 1-6 times/week, and ≥1 time/day). Exposure variables were knowledge of seven SSB-related health risks. STATISTICAL ANALYSES PERFORMED Seven multinomial regressions were used to estimate adjusted odds ratios (AOR) for drinking SSB, according to knowledge of SSB-related health risks and after controlling for sociodemographics. RESULTS Overall, 29% of adolescents consumed SSB ≥1 time/day. Although most adolescents identified cavities (75.4%), weight gain (74.6%), and diabetes (69.7%) as being related to drinking SSB, fewer adolescents identified related conditions such as high blood pressure (31.7%), high cholesterol (25.8%), heart disease (24.6%), and some cancers (18.0%). Compared to non-SSB consumers, drinking SSB ≥1 time/day was significantly higher among adolescents who lacked knowledge of associations between SSB intake and weight gain (AOR = 2.0), heart disease (AOR = 1.9), or some cancers (AOR = 2.3) after controlling for covariates. CONCLUSIONS Among US adolescents, knowledge of SSB-related health risks varied by condition, ranging from 18% (some cancers) to 75% (cavities and weight gain). There were increased odds of drinking SSB among those unaware that weight gain, heart disease, and some cancers are associated with SSB intake. Intervention could evaluate whether increasing certain types of knowledge may influence youth SSB intake.
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Affiliation(s)
- Sohyun Park
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA
- Division of Overdose Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA
| | - Seung Hee Lee
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA
| | - Caitlin Merlo
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA
| | - Heidi M Blanck
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA
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