Prevalence, determinants, and barriers to healthy food choices among school-going older adolescents within Lubaga division: a cross-sectional study

Abstract

Childhood and adolescent obesity is increasing in Uganda, with the Uganda Ministry of Health’s 2022/2023 reports showing 10.4% overweight and 2.3% obesity prevalence among adolescents and young adults. This trend elevates risks for non-communicable diseases. However, limited studies focus specifically on older adolescents’ food choices. Objective: To determine the prevalence, determinants, and perceived barriersto healthy food choices among older school going adolescents within Lubaga Division, Kampala Capital City. Methods: A mixed-methods study was conducted with 299 older adolescents for quantitative analysis and four focus group discussions (FGDs) for qualitative insights. Healthy food choices were measured using a dietary diversity score based on WHO guidelines and adapted USDA and Ugandan food pyramids, emphasizing variety and limiting unhealthy fats, added sugar, and high sodium. Univariate, bivariate and multivariable analyses were conducted to examine associations between different factors and healthy food choices, using SPSS. Variables with P-value <0.05 at multivariable logistic regression analysis were considered statistically significant. Qualitative data was thematically analyzed using ATLAS ti. Software. Results: The study found that 42.1% of the participants made healthy food choices. Factors more likely to influence healthy choices included availability of food (OR = 1.59, CI: 1.15–2.20) and family influence (OR = 1.44, CI: 1.07–1.94). Factors less likely to promote healthy choices were taste preference (OR = 0.68, CI: 0.53–0.89) and cost of food (OR = 0.60, CI: 0.34–0.64). Barriers included poor sensory appeal, limited availability, high cost, and peer/media influence. Conclusion: With adolescence being a critical period for establishing enduring dietary habits, addressing the identified barriers of cost, limited availability of healthy options, and the influence of unhealthy food in canteens and leveraging factors such as nutritional knowledge and positive parental influence are crucial for promoting healthier eating habits and improving the long-term health and well-being of this population. By implementing the evidence-based recommendations, we can create a more supportive environment for adolescents to make healthy food choices, contributing to a healthier future.