Evaluation of the nutritional habits of second-year high school students in the Seferihisar region with the ecological framework

KOPAN, Duygu; HASSOY, Hur; ERGIN, Isil; MESERI, Reci

doi:10.1590/1678-9865202134e200089

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ORIGINAL • Rev Nutr 34 • 2021 • https://doi.org/10.1590/1678-9865202134e200089 copy

Evaluation of the nutritional habits of second-year high school students in the Seferihisar region with the ecological framework

Avaliação dos hábitos nutricionais dos alunos do segundo ano do ensino médio na Região de Seferihisar pelo modelo ecológico

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective

The study aims to identify the nutritional habits of second-year high school students in Seferihisar, Turkey, and the factors associated thereof, based on the Ecological Framework.

Methods

In this cross-sectional study by a self-reported questionnaire, second-year high school students (n=392) attending public schools in Seferihisar had their nutritional habits measured with the Adolescent Food Habits Checklist scale. The food habit score was calculated and associated factors were evaluated in 4 layers based on the Mary Story’s Ecological Framework (individual factors, social, physical and macro-level environments). The data analysis for the association of these layers with the food habits score was executed through multi-level linear regression.

Results

Students’ participation rate was 87.7% (n=344). Of all the layers (from individual factors to the influence of the social environment and macro-level environment: nutritional literacy, the food consumption of their peers at school, availability of fruits-vegetables at home, buying junk food at the school canteen, presence of posters at school, etc.), the option for advertised food items was statistically explanatory based on the linear regression analysis (p<0.05).

Conclusions

The model derived from the Ecological Framework explained 45% of the nutritional habits with an equivalent contribution from the four layers. Availability of healthy food items where the students lived and higher levels of nutritional literacy led to healthy nutritional habits. Having healthy food items sold at school canteens at affordable prices, using posters to promote a healthy diet, and introducing nutrition-related courses into the curricula would support students in developing healthy nutritional habits.

Keywords
Adolescent; Feeding behavior; Nutritional assessment

Individual Factors		Distribution of students		Nutritional habits	p
Individual Factors		n	%	AFHC Score±SD
Age					0.613
	≤15	283	82.3	10.68±3.92
	>15	53	15.4	10.38±4.23
	Missing	8	02.3
Sex					0.248
	Female	179	52.1	10.83±3.87
	Male	165	47.9	10.34±4.03
Living arrangements					0.032^* * p<0.05,
	At home with parents	333	96.8	10.68±3.92
	Other	11	03.2	8.09±4.25
Wealth^a a ANOVA test was used					0.107
	Low	168	48.8	10.26±3.75
	Moderate	139	40.4	10.69±4.14
	High	37	10.8	11.76±3.75
Dieting					0.006^* * p<0.05,
	On a diet	27	07.8	12.59±4.44
	Not on a diet	317	92.2	10.43±3.86
Mobile phone screen time (hour/day)^a a ANOVA test was used					0.001^* * p<0.05,
	<1	20	05.8	12.55±4.07
	1-2	78	22.7	11.65±3.69
	>2	238	69.2	10.13±3.92
	Missing	8	2.3
Body weight perception^a a ANOVA test was used					0.030^* * p<0.05,
	Underweight	61	17.7	9.51±3.36
	Normal	215	62.5	10.67±4.07
	Overweight	67	19.5	11.33±3.92
	Missing	1	00.3
Nutritional literacy level					0.038^* * p<0.05,
	Adequate	253	73.5	10.92±4.04
	Inadequate	91	26.5	10.01±3.69
Physical Activity level^a a ANOVA test was used					0.008^* * p<0.05,
	Insufficient	124	36.0	9.79±3.70
	Light physical activity	75	21.9	11.39±4.02
	Vigorous physical activity	93	27.0	11.05±4.02
	Missing	52	15.1
Social Environments
	Father cares about the diet				0.002^* * p<0.05,
	Yes	186	54.1	11.16±3.85
	No	141	41.0	9.79±3.90
	Missing	17	04.9
Mother provides guidance for the nutrition					<0.001^ p<0.001. AFHC: Adolescent Food Habits Checklist; SD: Standard Deviation.
	Yes	292	84.8	10.94±3.87
	No	51	14.8	8.61±3.88
	Missing	1	00.4
Mother is a role model in nutrition					<0.001^ p<0.001. AFHC: Adolescent Food Habits Checklist; SD: Standard Deviation.
	Yes	129	37.5	11.58±4.10
	No	212	61.6	9.99±3.73
	Missing	3	00.9
Parents forbid food items					0.001^* * p<0.05,
	Yes	164	47.6	11.34±3.90
	No	179	52.0	9.92±3.89
	Missing	1	00.3
Family meals (at least once a day)					0.059
	Yes	318	92.4	10.71±3.96
	No	26	07.6	9.19±3.58
Close friends on a diet					0.031^* * p<0.05,
	Yes	171	49.7	11.04±4.06
	No	168	48.8	10.11±3.82
	Missing	5	01.5
Consumes the same food items as friends at school					<0.001^ p<0.001. AFHC: Adolescent Food Habits Checklist; SD: Standard Deviation.
	Yes	202	58.7	9.87±3.86
	No	138	40.1	11.78±3.79
	Missing	4	01.2
Friends support the change in body weight					0.016^* * p<0.05,
	Yes	227	67.9	10.95±3.85
	No	107	32.1	9.84±3.96

Physical Environment Factors		Distribution of students		Nutritional habits	p
Physical Environment Factors		n	%	AFHC Score±SD	p
Regular availability of fruits-vegetables at home					0.002^* * p<0.05;
	Yes	319	92.7	10.78±3.89
	No	25	07.3	8.28±3.95
Buying junk food at the school canteen					0.004^* * p<0.05;
	Yes	165	47.9	9.96±3.70
	No	179	52.1	11.18±4.08
Buying food & beverage in the vicinities of the school					0.009^* * p<0.05;
	Yes	206	59.8	10.14±3.98
	No	138	40.2	11.28±3.80
Visuals promoting a healthy diet at school					0.008^* * p<0.05;
	Yes	40	11.6	12.15±3.49
	No	302	87.8	10.39±3.98
	Missing	2	00.6
Eating out with friends					0.013^* * p<0.05;
	Yes	236	68.6	10.24±3.99
	No	108	31.4	11.38±3.74
Macro-Level Environment Factors
Opting for advertised food items					<0.001^ p<0.001. AFHC: Adolescent Food Habits Checklist; SD: Standard Deviation.
	Yes	194	56.4	9.60±3.60
	No	145	42.1
	Missing	5	01.5
Adopting a celebrity’s diet as a role model					<0.001^ p<0.001. AFHC: Adolescent Food Habits Checklist; SD: Standard Deviation.
	Yes	122	35.4	11.63±3.95
	No	222	64.6	10.03±3.83

Individual Factors	Model 1		Model 2		Model 3		Model 4
Individual Factors	β	95% CI	β	95% CI	β	95% CI	β	95% CI
Living Arrangements (at home with parents/other)	0.11	-0.01-0.21	0.10	-0.01-0.21	0.01	-0.13-0.16	0.03	-0.14-0.19
Dieting (yes/no)	0.15	0.03-0.25^* * p<0.05;	0.09	-0.01-0.20	0.08	-0.08-0.25	0.09	-0.07-0.25
Mobile phone screen time (≤2 hours/>2 hours)	0.19	0.07-0.29^* * p<0.05;	0.16	0.05-0.27^* * p<0.05;	0.18	-0.01-0.35	0.11	-0.06-0.28
Nutritional literacy (adequate/inadequate)	0.20	0.08-0.30^* * p<0.05;	0.16	0.04-0.26^* * p<0.05;	0.24	0.27-0.41^* * p<0.05;	0.23	0.06-0.40^* * p<0.05;
Level of physical activity (sufficient/insufficient)	0.14	0.02-0.25^* * p<0.05;	0.12	0.01-0.22^* * p<0.05;	0.04	-0.14-0.22	0.03	-0.20-0.15
Social Environment Factors
Father cares about his diet (yes/no)			0,07	-0.04-0.18	0.11	-0.06-0.29	0.09	-0.08-0.27
Mother provides guidance about diet (yes/no)			0,13	0.01-0.24^* * p<0.05;	0.01	-0.18-0.19	0.01	-0.16-0.19
Mother is a role model in diet (yes/no)			0,10	-0.01-0.20	0.10	-0.07-0.28	0.11	-0.06-0.28
Close friends on a diet (yes/no)			0.08	-0.02-0.19	0.03	-0.14-0.20	0.08	-0.08-0.24
Consuming the same food that friends do at school (no/yes)			0.26	0.15-0.36^ p<0.001. CI: Confidence Interval.	0.28	0.11-0.45^* * p<0.05;	0.26	0.08-0.42^* * p<0.05;
Friends’ support to body weight change (support/do not support)			0.09	-0.02-0.20	0.05	-0.12-0.21	0.07	-0.09-0.23
Physical Environment Factors
Regular availability of fruits-vegetables at home (yes/no)					0.16	-0.01-0.33	0.20	0.03-0.37^* * p<0.05;
Buying junk food at school canteen (no/yes)					0.20	0.02-0.37^* * p<0.05;	0.18	0.01-0.35^* * p<0.05;
Presence of banners, posters promoting a healthy diet at school (yes/no)					0.20	0.02-0.37^* * p<0.05;	0.17	0.01-0.33^* * p<0.05;
Eating out with friends (no/yes)					0.08	-0.09-0.25	0.08	-0.09-0.24
Macro-level Environment Factors
Opting for advertised food items (no/yes)							0.28	0.09-0.45^* * p<0.05;
Adopting the diet of a person in the media as a role model (yes/no)							0.14	-0.03-0.30
Explanatory and significance levels of the models
R²:	0.14		0.287		0.375		0.448
Adj. R²:	0.125		0.255		0.274		0.343
p	<0.001		<0.001		<0.001		<0.001

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[1] CONTRIBUTORS

D. KOPAN was responsible for data collection, analysis, interpretation, discussion, and writing of the manuscript. H. HASSOY, designed the original study, coordinated the data collection and manuscript development, and contributed to data analysis and discussion. I. ERGIN and R. MESERI were responsible for coordinating the investigation, guiding the analyses, and revising the final version of the manuscript. All authors declare that there is no conflict of interest regarding this study.