Secondary School Food Environment and Purchase Choices of Adolescents in Mbeya City

Abstract

Background: Increasing levels of overweight and obesity among adolescents are quite alarming worldwide. Among the depicted causes is poor diet, in which the food environment plays a major role in contributing. Still, little is known about adolescents and the school food environment they are exposed to in Tanzania.

Objective: This study aimed to explore the secondary school food environment and document food and drink mostly purchased by secondary school adolescents

Methodology: This cross-sectional study involved 8 secondary schools in Mbeya City, 384 secondary school adolescents and 35 food outlets. Aspects of the food environment studied were under the external domain, food availability, price and promotion and policy and guideline. Personal domain: accessibility, affordability and desirability. Direct observation was used in food outlets with the help of an observation tool adopted from the Nutrition Environment Measure Survey. Structured interviews were done with the school administrators or teachers responsible for nutrition issues in school with the help of a questionnaire designed based on WHO Nutrition Friendly Schools Initiative. Also, a student purchased a recall questionnaire designed based on the Nutrition Environment Measure Survey, which also helped identify the adolescents' demographic characteristics. Descriptive statistics and ordinal logistic regression were used to establish prevalences and associations between variables.

Results: Most available food outlets outside the school were retail shops and canteens inside the schools. The foods most purchased by adolescents are sweets, fried snacks, and sugar-sweetened beverages. Most adolescents purchase their food and drinks in school shops and canteens. Cereal-based foods are most available, while fruit and vegetables are least available inside and outside school. Adolescents care most about taste and least about nutrition and weight control while purchasing food and drinks. Demographic characteristics like age, level of education, and the type of school adolescents attend are associated with purchasing certain foods.

Conclusion: Secondary schools have weak policies and guidelines on the food environment, and they are filled with ultra-processed foods, fried snacks, and sugar-sweetened beverages. Adolescents respond to their environment by purchasing what is most available. Adolescents’ responses depend on their age and the school type, either public or private. This situation calls for effective planning and interventions from the national to the institutional/school levels to ensure a nutrition-enabling environment is created in secondary schools.