Drivers of Adolescent Dietary Behaviours and Nutritional Status in The Volta and Oti Regions of Ghana and the Readiness to Adopt Sustainable Healthy Diet

Abstract

Background: Adolescence is a pivotal life stage, presenting a unique window of opportunity to address early childhood malnutrition and foster the formation of lifelong healthy habits that optimise overall health and well-being. By identifying the key factors that shape dietary behaviours and nutritional status during this formative stage, we can significantly enhance public health strategies designed to improve nutritional outcomes and promote sustainable eating practices among this vulnerable population. This study investigates the factors influencing adolescent dietary behaviours, nutritional status and their readiness to adopt sustainable healthy diets in Ghana. The study seeks to understand how these factors influence adolescent dietary behaviours, nutritional status, and readiness to adopt sustainable healthy diets in the Volta and Oti Regions. Materials and methods: A community-based sequential mixed method approach was used to collect data. First, a cross-sectional quantitative survey was carried out involving 667 adolescents aged 10-19 years living in the Volta and Oti regions of Ghana, complemented by in-depth interviews to gather comprehensive insights. A face-to-face data collection method was employed to collect data on adolescent sociodemographic and parental characteristics, nutritional knowledge, food insecurity and dietary diversity, dietary habits, adolescent perceptions of high in fat, sugar, and salt (HFSS) food advertisements and awareness, knowledge and the readiness to adopt sustainable diet behaviours using pre-tested questionnaires and interview guide. Dietary intakes were assessed using a 24-hour dietary recall and a food frequency questionnaire. The HFIAS tool was used to assess food insecurity. A freestanding stadiometer was used to measure height, and an Omron HBF 400 body fat monitor was used to measure weight. This was achieved through pre-tested questionnaires and an interview guide. Bivariate and Multivariate logistic regression models were used to analyse the data. The significance level was set at P ≤ 0·05. Qualitative data were analysed using thematic analysis. Results: Overall, 61% experienced food insecurity, with predictors including, regional disparities (aOR = 1.61; CI=1.09-2.39), urban-rural differences (aOR = 0.67; CI=0.46-0.97), maternal education [aOR=0.41; (95% CI=0.22-0.78)], and wealth (aOR=0.02; (95%CI=0.0 0.09)]. Most adolescents (63.3%) had inadequate dietary diversity, consuming fewer than five food groups, and 16% had low DDS scores of fewer than four food groups. The mean DDS was 5.3 ± 2.5 on a scale of 0 to 12. Although 68.2% consumed plant-source proteins, only 53% ate vegetables and 43.2% ate fruits. Inadequate diets were associated with permissive households [OR=0.32, (95% CI: 0.16-0.63)], busy lifestyles [OR = 11.9, (95% CI = 1.99-70.91)], and lack of cooking skills [OR =0.35, (95% CI: 0.13-0.95)]. Urban adolescents [OR=2.08, (95% CI: 1.29-3.35)] and those with high nutrition knowledge [OR=3.77, (95% CI: 2.09-6.81)] had better dietary diversity. A majority, 65.7% of adolescents found fast-food advertisements fun, 60.7% enjoyed them, and over half found the products appealing (55.6%) and popular (57.0%); 50.1% considered them healthy. Positive perceptions were linked to residence, age, sex, nutritional knowledge, wealth quintile, and BMI. Adolescents residing in urban areas were more likely to perceive the fast-food advertisement, as popular (AOR 1.54, 95% CI 1.04-2.29), enjoyable (AOR 1.56, 95% CI 1.02-2.37) or tempting to try (AOR 2.32, 95% CI 1.59-3.39). Urban adolescents were more likely to find the fast-food advertisements popular (AOR 1.54, 95% CI 1.04-2.29), enjoyable (AOR 1.56, 95% CI 1.02-2.37), or tempting (AOR 2.32, 95% CI 1.59 3.39). Similarly, 66.5% liked sugar-sweetened beverage advertisements, 61.3% found them fun, and over half found them appealing (56.7%) and popular (56.2%); 50% considered them healthy. Female adolescents were more likely to find SSB advertisements fun and appealing [AOR = 1.95, (95% CI: 1.32–2.88)] and [AOR = 1.53, (95% CI: 1.05–2.22)], respectively. Most adolescents consumed three meals daily, though many skipped meals, especially breakfast. Higher adolescent and maternal education, fathers in farming [cOR = 2.0 (95% CI=1.09-3.65), p=0.024)], being in the fourth wealth quintile [cOR = 2.39 (95% CI=1.42-4.04), p<0.001)], and medium [cOR = 1.61 (95% CI=1.08-2.41), p=0.020)] or high [cOR = 1.47 (95% CI=1.01-2.13), p=0.044)] nutritional knowledge predicted healthier dietary behaviours. Authoritative parenting correlated with healthier diets compared to neglectful parenting [aOR=0.44 (95% CI=0.29 0.68), p<0.001)]. Adolescents in higher wealth quintiles [cOR = 3.44, (95% CI = 2.07-5.72)] and those with high nutritional knowledge [cOR = 1.67, (95% CI = 1.15-2.41)] had higher odds of being overweight, while food-insecure adolescents [aOR = 0.33, 95% CI = 0.21-0.53)], those with authoritative parenting [cOR = 0.55, (95% CI = 0.38-0.79)], and authoritarian parenting [cOR = 0.56, (95% CI = 0.34-0.91)] had lower odds. Stunting odds decreased significantly with maternal education [cOR = 0.29, (95% CI = 0.17-0.53)], fathers who were farmers [cOR = 0.43, (95% CI = 0.23-0.7)], and higher wealth quintiles [cOR = 0.24, (95% CI = 0.15-0.41); cOR = 0.09, (95% CI = 0.05-0.15)]. A significant proportion of adolescents showed good understanding of sustainable dietary behaviours, with 57% exhibiting high knowledge and over 60% recognising substantial environmental benefits from reducing food waste, prioritizing plant-based proteins, consuming fruits and vegetables, and purchasing local food. Around 58% were considering adopting sustainable diet behaviours, while 17.4% were ready to implement them. Adolescents with high sustainability knowledge [aOR=8.13 (95% CI=3.05-21.64)] and a positive view of sustainability were twice as likely to adopt sustainable diet practices [aOR=2.69 (95% CI=1.06-6.84), p=0.038]. Food-insecure adolescents were less likely to be ready for sustainable healthy diet practices [aOR=0.33 (95% CI=0.13-0.87), p=0.025]. Parenting styles and parental role-modelling of healthy eating did not significantly influence readiness for sustainable dietary changes. Conclusion: This study highlights a significant prevalence of food insecurity and inadequate dietary diversity among adolescents in Ghana's Volta and Oti regions, with many consuming fewer than five food groups. While plant-source proteins were common, fruit and vegetable intake were low. Parenting styles and socioeconomic factors significantly influenced dietary behaviours; adolescents from permissive households, those with busy lifestyles, and those lacking cooking skills had poorer diets. Higher education levels among adolescents and their mothers, along with authoritative parenting styles, were linked to healthier diets. Urban adolescents and those with high nutritional knowledge showed better dietary diversity. The study emphasizes the impact of marketing on adolescents' food preferences, especially in urban areas with high exposure to HFSS food advertisements. The appeal of fast-food and sugar sweetened beverage advertisements among adolescents necessitates targeted public health interventions to counter unhealthy food marketing. Despite a good understanding of sustainable dietary practices, food insecurity hindered adolescents’ adoption of these behaviours. Improving dietary diversity in low- and middle-income countries like Ghana requires addressing individual, household, socioeconomic, and environmental barriers, with key influences being parenting styles, adolescent nutrition knowledge, and food costs. To improve adolescents' nutritional status in Ghana, comprehensive nutrition education programmes should be introduced in schools and in the communities, involving students and parents to create a supportive home environment for healthy choices. Community-based interventions, such as food assistance programmes and local farmer partnerships, should address food insecurity. Promoting sustainable diets through awareness campaigns and stricter regulations on unhealthy food marketing will empower adolescents to make informed dietary decisions and develop healthier eating habits.