Attitudes, norms and behaviors enhancing unhealthy food choices in daily life of high school students in Shirak Marz, Armenia

Abstract

Background: It has been shown that negative attitudes towards healthy eating behaviors are common among school-aged children. Over 340 million youth aged 5-19 years in the world are either overweight or obese. Unhealthy eating behavior is proven to be a major risk factor for metabolic health conditions, obesity, cardiovascular diseases, diabetes, cancer, psychological problems, and health-risk behaviors. Some of the key factors influencing food choices among high-school children are cost of food, food availability, time spent on eating, social support, food preferences, role-modeling behaviors of parents, and eating out. High prevalence of inadequate diet among Armenian families has been reported. Children in Armenia face many nutritional problems, including high rates of both stunting (9.4%) and overweight (13.6%). Aim: Given the scarcity of studies investigating eating behaviors among adolescents in Armenia, the current study seeks to fill this gap, exploring unhealthy eating behaviors among high school students and assessing the attitudes, norms and behaviors enhancing unhealthy food choices among them via applying the Theory of Planned Behavior (TPB) as a theoretical framework. Methods: A qualitative design with 12 focus group discussions (FGD) and 15 in-depth interviews (IDI) was used in this study. High school students residing in Shirak marz, Armenia, and their parents, teachers and school canteen staff served as the study population. Semi structured interview guides for each category of participants were developed based on TPB. Direct content analysis with deductive approach was used for data analysis. Due to time limitations, 16 of the 27 interviews, including 8 FGDs and 8 IDIs both from urban and rural areas, were used for data analyses.Results: According to the study results, most of the TPB constructs underlied unhealthy eating behaviors of adolescents aged 15-18 years old living in Shirak marz. The most preferred foods by the adolescents were fast foods, sweets, salads and sugar sweetened beverages. Taste was the most powerful attitudinal factor influencing their food choices. Knowledge on unhealthy food choices and the consequences of unhealthy diet on one’s health were adequate among both urban and rural participants, but unlike rural participants, this factor did not result in healthy eating behavior among urban participants. Parents, friends and advertisements were the main role models affecting adolescents’ eating behaviors. Lack of time, high cost of food, seasonal changes in food availability, limited food choices in school canteens and low coverage of schools with canteens, especially in the villages, had considerable impact on adolescent’s food choices. Conclusion: According to the study results, most of the TPB constructs were associated with unhealthy eating behaviors of adolescents aged 15-18 years old. Based on the study findings, recommendations were made to conduct social advertising of healthy food choices and healthy eating behaviors among adolescents, increase the coverage of schools with cafeterias and empower school cafeterias, so that they suggest healthy, tasty and affordable food choices, are adequately equipped for food maintenance, and are continuously monitored.