Factors Associated With Unhealthy Snacks Consumption Among Adolescents in Iran’s Schools

Abstract

Background: Well-informed interventions are needed if school-based health promotion is to be effective. Among other aims, the Iranian Health Promoting School (IHPS) program that was launched in 2011, has an important aim of promoting dietary behaviors of adolescents. The present study, therefore, aimed to investigate the factors affecting unhealthy snacking of adolescents and provide evidence for a more effective IHPS program. Methods: In a cross-sectional study design, 1320 students from 40 schools in Kerman city were selected using a proportional stratified random sampling method. A modified qualitative Food Frequency Questionnaire (FFQ) was used to gather data about unhealthy snacking behavior. Data about intrapersonal and environmental factors were obtained using a validated and reliable questionnaire. A mixed-effects negative-binomial regression model was used to analyze the data. Results: Taste and sensory perception (prevalence rate ratio [PRR]=1.18; 95% CI: 1.09-1.27), being a male (PRR=1.20; 95% CI: 1.05-1.38) and lower nutritional knowledge (PRR=0.96; 95% CI: 0.91-0.99) were associated with higher weekly unhealthy snaking. Perceived self-efficacy (PRR=0.95; 95% CI: 0.91-1.00) negatively influenced the frequency of unhealthy snaking, with this approaching significance (P<.06). In case of environmental factors, high socio-economic status (SES) level (PRR=1.45; 95% CI: 1.26-1.67), single-parent family (PRR=1.14; 95% CI: 1.01-1.30), more social norms pressure (PRR=1.08; 95% CI: 1.01-1.17), pocket money allowance (PRR=1.21; 95% CI: 1.09-1.34), easy accessibility (PRR=1.06; 95% CI:1.01-1.11), and less perceived parental control (PRR=0.96; 95% CI: 0.92-0.99) all had a role in higher consumption of unhealthy snacks. Interestingly, larger school size was associated with less unhealthy snacking (PRR=0.79; 95% CI: 0.68-0.92). Conclusion: Unhealthy snacking behavior is influenced by individual, socio-cultural and physical-environmental influences, namely by factors relating to poor parenting practices, high SES level, family characteristics, improper social norms pressure, and less knowledge and self-efficacy of students. This evidence can be used to inform a more evidencebased IHPS program through focusing on supportive strategies at the home, school, and local community levels.

Double-duty actions: seizing programme and policy opportunities to address malnutrition in all its forms

“…Evidence from Brazil, Iran, Mexico, Haiti, Guatemala, India, South Africa, and the Philippines shows that foods sold by vendors in and outside of schools include chips, cookies, crackers, ice cream, fried foods, sugary drinks, hamburgers, pizza and confectionary. 39,[104][105][106][107][108][109][110][111] A review of school food policies in eight countries in Latin America also reported widespread availability of these foods in kiosks in and out of schools. 112 Studies also found that significant proportions of students consume snacks and sugar sweetened beverages (SSBs) on and off school property, 109,113 and that there is widespread promotion of snack foods and drinks inside schools, 39,113 such as signage boards with the school's name advertising a food/beverage.…”

Determinants of nutritional knowledge, attitude, and practice among southwestern Iranian households: A community-based study

“…Therefore, the associations between SES and nutritional KAP should be examined along with different demographic variables to gain a better understanding of KAP's determinants (Al-Shookri et al, 2011;Beydoun and Wang, 2008;Heshmat et al, 2016;Parmenter et al, 2000). The association of SES or income with nutritional KAP has been revealed in the literature (Heshmat et al, 2016;Skårdal et al, 2014;Turrell et al, 2002;Wardle and Griffith, 2001;Yazdi Feyzabadi et al, 2017). However, limited data are available for evaluating the status of nutritional KAP among communities living in southwestern Iran (Ghajari, 2016;Naghashpour et al, 2014) and no study has examined the associations between demographic and socioeconomic variables and nutritional KAP of households in this area.…”

Children Food and Nutrition Literacy - a New Challenge in Daily Health and Life, the New Solution: Using Intervention Mapping Model Through a Mixed Methods Protocol

“…The results showed that lower nutritional knowledge (PRR = 0.96; 95% CI: 0.91-0.99) was associated with higher weekly unhealthy snaking. The results also indicate that nutritional knowledge and unhealthy nutrition behaviors are affected by individual, social, and cultural factors, and it is necessary to pay attention to all aspects in order to improve nutrition knowledge and unhealthy nutrition behaviors [ 19 ]. In line with the implementation of the fourth sub-study, an interventional study conducted to compare food and nutrition literacy between the two intervention and control groups by Pirzadeh et al in 2011, examined the effect of training on nutritional behavior based on the Beliefs, Attitudes, Subjective Norms and Enabling Factors (BASNEF) model on female students.…”

“…Evidence suggests that healthier eating practices have a positive correlation with higher food and nutrition literacy [ 17 ]. Improving food and nutrition literacy is a crucial factor in choosing the right foods and keeping the food pattern right [ 18 , 19 ]; also, the review of the content of the Health Promoting Schools program in Iran shows that the dimensions of nutritional literacy and nutrition enhancement in such programs have not been adequately addressed [ 20 ]. In this study, an intervention mapping approach is used to design an intervention to improve the food and nutrition literacy of students.…”