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01.12.2015 | Research article | Ausgabe 1/2016 Open Access

BMC Public Health 1/2016

Influences on eating: a qualitative study of adolescents in a periurban area in Lima, Peru

BMC Public Health > Ausgabe 1/2016
Jinan C. Banna, Opal Vanessa Buchthal, Treena Delormier, Hilary M. Creed-Kanashiro, Mary E. Penny
Wichtige Hinweise

Competing interests

The authors declare that they have no competing interests.

Authors’ contributions

JB participated in the design of the study and study protocols, carried out the data collection in Peru, transcribed and analyzed the data, and drafted the manuscript. OV and TD participated in the data analysis and helped to review and edit the manuscript. HC participated in the design of the study and study protocols, helped to facilitate the data collection, and helped to review and edit the manuscript. MP conceived of the study, participated in the design of the study and study protocols, helped to facilitate the data collection, and helped to review and edit the manuscript. All authors read and approved the final manuscript.

Authors’ information

JB is an Assistant Professor in the Department of Human Nutrition, Food and Animal Sciences at the University of Hawaii at Manoa. Her research interest is in improving dietary intake of underserved children and adolescents domestically and internationally and developing tools to assess food behaviors and dietary intake, particularly in Spanish-speaking populations. Her previous work at the University of California, Davis involved the development of two tools, a food behavior checklist and physical activity questionnaire, to be used in the low-income Spanish-speaking community in the U.S. to evaluate nutrition education interventions.
OB is an Assistant Professor of Social and Behavioral Health in the Department of Public Health at the University of Hawaii at Manoa, where she teaches courses in evaluation methods and health promotion program design. Her research focuses in the areas of household food insecurity, social and environmental factors affecting dietary behavior in low-income communities, and the influence of extended families and social networks on dietary behavior. She currently leads an evaluation research team that provides services to both the Hawaii Department of Human Services’ SNAP-Ed program, and Hawaii Department of Health’s Healthy Hawaii Initiative.
TD is an Assistant Professor of Public Health at the University of Hawaii at Mānoa, where she trains in the first of its kind Native Hawaiian and Indigenous Health MPH specialization. She holds a Bachelor’s degree in nutrition from McGill University and is a registered dietitian in Québec. She completed her Master’s research in nutrition at McGill University’s Centre for Indigenous Peoples’ Nutrition and Environment (CINE), and has PhD in Public Health (Health Promotion) from Université de Montréal. Her research is primarily community-based with Indigenous communities, uses participatory approaches and privileges Indigenous knowledge frameworks and addresses social perspectives of food, public health and health promotion, food security, traditional food systems, diabetes and obesity prevention, and aboriginal conceptions of health.
After obtaining an M.Phil. from University College, London, HC came to the Instituto de Investigación Nutricional in Lima, Peru in 1971 where she has conducted nutrition research ever since. Her research has focused primarily on the diagnosis of the nutritional situation of infants and children (IYC) in underprivileged populations of Peru, and the development and implementation of nutrition intervention strategies to improve infant, young child, adolescent girls and family feeding, nutrition and anemia in coastal, highland and rain forest (Indigenous) communities. She has been involved in the development of manuals, guides and materials in these topics. She has considerable experience in applying formative research to design effective education-communication interventions.
MP is senior researcher and general director of the Instituto de Investigacion Nutricional (IIN) in Lima, Peru. She trained in Natural Sciences at the University of Cambridge (MA) and Medicine at the University of Birmingham (MBChB) and worked for 7 years in General Medicine and Pediatrics in the UK NHS before obtaining a Wellcome Trust Senior Research scholarship to work on the microflora of the intestine of children with persistent diarrhea at the IIN. After completion of the scholarship she returned to Lima and has been resident since 1989. Her current areas of research include human nutrition including dietary intakes, diet related behavior; poverty and its relation to health and nutrition, overweight and obesity; public health including vaccine trials and health service research.



Peruvian adolescents are at high nutritional risk, facing issues such as overweight and obesity, anemia, and pregnancy during a period of development. Research seeking to understand contextual factors that influence eating habits to inform the development of public health interventions is lacking in this population. This study aimed to understand socio-cultural influences on eating among adolescents in periurban Lima, Peru using qualitative methods.


Semi-structured interviews and pile sort activities were conducted with 14 adolescents 15–17 years. The interview was designed to elicit information on influences on eating habits at four levels: individual (intrapersonal), social environmental (interpersonal), physical environmental (community settings), and macrosystem (societal). The pile sort activity required adolescents to place cards with food images into groups and then to describe the characteristics of the foods placed in each group. Content analysis was used to identify predominant themes of influencing factors in interviews. Multidimensional scaling and hierarchical clustering analysis was completed with pile sort data.


Individual influences on behavior included lack of financial resources to purchase food and concerns about body image. Nutrition-related knowledge also played a role; participants noted the importance of foods such as beans for anemia prevention. At the social environmental level, parents promoted healthy eating by providing advice on food selection and home-cooked meals. The physical environment also influenced intake, with foods available in schools being predominantly low-nutrient energy-dense. Macrosystem influences were evident, as adolescents used the Internet for nutrition information, which they viewed as credible.


To address nutrition-related issues such as obesity and iron-deficiency anemia in Peruvian adolescents, further research is warranted to elucidate the roles of certain factors shaping behavior, particularly that of family, cited numerous times as having a positive influence. Addressing nutrition-related issues such as obesity and iron-deficiency anemia in this population requires consideration of the effect of social and environmental factors in the context of adolescent lifestyles on behavior. Nutrition education messages for adolescents should consider the cultural perceptions and importance of particular foods, taking into account the diverse factors that influence eating behaviors.
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