What influences urban Indian secondary school students' food consumption? – A qualitative study
Introduction
Over the last decade, India has witnessed an unprecedented rise in the prevalence of overweight and obesity among adolescents (Khadilkar et al., 2011, Rani and Sathiyasekaran, 2013). The health implications of these conditions can be profound (Caballero, 2007, Nishida et al., 2004). Obese adolescents are at significant risk of developing adult obesity (Black et al., 2013) (Koplan, Liverman, & Kraak, 2005) and its unhealthy consequences including coronary heart disease, non-insulin dependent diabetes mellitus, several cancers, osteoarthritis (Misra and Khurana, 2011, Stein and Colditz, 2004) and psychosocial problems such as depression and low self-esteem (Daniels, 2006). Therefore, the promotion of healthy eating habits in adolescence can significantly aid in preventing morbidity and mortality from the emerging epidemic (Meredith and Dwyer, 1991, World Health Organization, 2003).
There has been a significant change in the food consumption patterns of young adults in India over the past two decades (Popkin, 2001, Ramachandran, 2011, Shetty, 2013). Although limited, local evidence suggests that Indian adolescents generally consume poor diets (Kotecha et al., 2013, Singla et al., 2012). These are characterised by high consumption of energy-dense, nutrient-poor foods (Goel et al., 2013, Singh et al., 2006), and low consumption of fresh fruits and vegetables (Bachani, Sogarwal, Shukla, Shelat, & Gupta, 2013). Unhealthy dietary behaviours including meal skipping and snacking on fast food items are common among Indian adolescents (Goel et al., 2013, Kotecha et al., 2013, Mahajan et al., 2012). Such unhealthy meal practices have been linked to the mounting prevalence of obesity and non-communicable diseases worldwide (Birch and Anzman, 2010, Wang et al., 2009).
A number of factors may influence the eating behaviours of adolescents (Story, Neumark-Sztainer, & French, 2002). They may either promote or impede healthy dietary practices. Hitherto, food researchers have used a number of theoretical models to explain dietary behaviours (Abood et al., 2003, Brunso et al., 2004, Conner et al., 2002, Di Noia et al., 2006, Hoek et al., 2004). Social Cognitive Theory (SCT) (Bandura, 2004), the Health Belief Model (HBM) (Daddario, 2007), the Theory of Planned Behaviour (TPB) (Ajzen, 1991), the Transtheoretical Model (TTM) (Prochaska & Velicer, 1997) and the Food-Related Lifestyle Model (FRLM) (Brunso & Grunert, 1998) are among the most commonly used theories in food behaviour research.
A range of factors including intrapersonal, social and environmental factors influence young people's food consumption (Ganasegeran et al., 2012, Larson and Story, 2009, Savige et al., 2007, Story et al., 2002b). Some common intrapersonal predictors include demographic factors such as age and gender (Cooke & Wardle, 2005), snacking (Savige et al., 2007), taste preferences (Holsten, Deatrick, Kumanyika, Pinto-Martin, & Compher, 2012), identity and the development of autonomy (Stok, De Ridder, Adriaanse, & De Wit, 2010), body image (Hill, 2002), health attitude and nutrition knowledge (Franko et al., 2013, Lake et al., 2004), self-efficacy (Haerens et al., 2008) and food preparation skills (Hartmann, Dohle, & Siegrist, 2013). Common social determinants include parental and family influences (Lachal et al., 2012, Pearson et al., 2012), peer group (Finnerty, Reeves, Dabinett, Jeanes, & Vögele, 2010) and culture (Turrell & Mathers, 2000). The home environment (Hendrie, Sohonpal, Lange, & Golley, 2013), the school environment (Burke, 2002), the local neighbourhood (Story, Neumark-Sztainer, et al., 2002) and mass media (Boyland & Halford, 2013) are commonly recognised environmental influences.
Although empirical evidence on the influences on dietary behaviours of adolescents is expanding, very limited evidence exists about Indian adolescents. Therefore, in order to inform future nutrition interventions to facilitate healthy eating among 238 million Indian adolescents, it is important to understand key stakeholders' perceptions of the influences over the eating habits of this population. The main stakeholders include adolescents, their caregivers, teachers and school principals. Evidence suggests that caregivers and their teenagers often share different perceptions of food-related issues such as healthy diets and family meals (Boutelle et al., 2001, De Bourdeaudhuij and Van Oost, 1998, Fulkerson et al., 2006, Woodruff and Hanning, 2008). Similarly, teachers and school principals may also have diverse views regarding adolescents' dietary practices. The views of all these four stakeholder groups are important to promote adolescents’ health and well-being. Therefore, the aim of this qualitative inquiry was to assess the influences on adolescent dietary behaviour from the perspectives of Indian adolescents, as well as their parents, teachers, and school principals.
Section snippets
Methods
The social constructivism paradigm was employed to inform this qualitative inquiry (Denzin & Lincoln, 2011). Through this phenomenological framework, the researchers aim to understand the perceptions of respondents of the situation being examined (Creswell, 2009). These perceptions are primarily governed by the culture in which the respondents live and are developed through their interactions with the members of the community (Creswell, 2013). The participants were purposefully recruited (
Results
The years 9 students (n = 15; Boys = 5; Girls = 10), parents (n = 15; Father = 1; Mothers = 14), teachers (n = 12; Male = 0; Females = 12) and principals (n = 10; Male = 1; Females = 9) identified a number of factors which they consider perceived to influence the dietary behaviours of adolescents. These factors are described below.
Discussion
The above findings are consistent with known influences of food choice (Boyland and Halford, 2013, Burke, 2002, Finnerty et al., 2010, Pearson et al., 2010, Story et al., 2002b). This suggests that these models are applicable to the Indian context and can be applied to nutrition promotion design.
Parents were seen to have major influence over adolescents' food habits. The feeding practices adopted by Indian parents appeared to reflect three different authoritative, authoritarian and permissive
Conclusions
This qualitative inquiry provides first-hand evidence about the perceptions of secondary school students, their parents, teachers, and school principals of the influences on adolescents' dietary behaviours. The findings show that parents, peers, the home and school environments, and the mass media are important influences over teenagers’ food consumption. These findings suggest major targets for effective nutrition interventions to improve the eating behaviours of Indian teenagers.
Conflict of interest
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding statement
NR was supported through a Victoria India Doctoral Scholarship; and internal funding was provided by the School of Exercise and Nutrition Sciences, Deakin University.
Acknowledgements
The authors thank the students, parents, teachers, and principals who generously took part in this study.
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