School Food Environment in Urban Zambia: A Qualitative Analysis of Drivers of Adolescent Food Choices and Their Policy Implications

Abstract

Identifying context specific points for reforming policy to promote healthier food environments and consumer behavior in critical life stages like adolescence is crucial in addressing the double burden of malnutrition. Using a qualitative study design, we conducted 20 focus group discussions with grade 10 pupils from ten secondary schools in Lusaka. Turner’s framework which conceptualizes the food environment into two domains—the external domain (availability, pricing, vendor and product properties, and marketing and regulation of food) and the internal domain (accessibility, affordability, convenience, and desirability of food)—was used to guide thematic data analysis and results interpretation. Adolescents stated their food choices are largely based on personal preference linked to the need for social acceptability among peers. Adolescents felt their food choice is limited to ‘cheap junk foods’ which are affordable and readily available at school. Healthy foods like fruits were said to be inaccessible and unaffordable by the majority of adolescents. Some adolescents stated they were attracted to certain foods by adverts they see on TV and social media. School food environments in urban Lusaka do not support healthy food choices. Policy reforms are required to increase access to affordable healthy food options in schools, and to curb the indiscriminate marketing of unhealthy foods to adolescents.

Parents' perceived risks and benefits on avoidance of street food near schools in Indonesia: Moderating role of school type

“…This study found that Indonesian parents of schoolchildren try to prevent street food consumption if they perceive it to have high health and sanitation risks and low nutritional benefits. This finding aligns with similar studies on street food consumers' attitudes, where hygiene, sanitation, and health risks were the most influential among all types of perceived risks in Korea, India, and Sri Lanka (Choi et al, 2013;Gupta et al, 2018;Mudunkotuwa & Arachchi, 2020). While value benefit was perceived as a more influential benefit in…”

“…In school settings where canteens are unavailable, students opt for small kiosks, open markets, and street food vendors instead of traveling long distances. This limited access to affordable outlets compels them to choose street foods near schools (Mukanu et al, 2022; Trübswasser et al, 2021). Additionally, affordability of snacks offered by street food vendors aligns with the students' purchasing capacity and their tastes and preferences as young individuals (Anggiruling et al, 2019; Mukanu et al, 2022).…”

“…This limited access to affordable outlets compels them to choose street foods near schools (Mukanu et al, 2022; Trübswasser et al, 2021). Additionally, affordability of snacks offered by street food vendors aligns with the students' purchasing capacity and their tastes and preferences as young individuals (Anggiruling et al, 2019; Mukanu et al, 2022). From the perspective of students' parents, food cost primarily guides their food choices, with economic hardship, elevated prices of fresh food, and limited access to environmentally‐friendly food options also playing significant roles (Ravikumar et al, 2022).…”

Diet Therapy and Public Health

“…However, we must be cognizant that the demand by consumers is a key determinant of the food offered by these informal food outlets [ 58 , 66 ]. This is also the case in terms of the type of food sold in schools, as evidence [ 67 , 68 ] has shown that the reason why this food is mostly unhealthy [ 69 ] is because children demand unhealthy food [ 70 ], and their preference for this food is fueled by food marketing [ 61 ]. This has a strong policy implication; hence, policy reforms are required to increase access to affordable healthy food options in communities and schools, so as to curb the indiscriminate sale and marketing of unhealthy food.…”

Nutrition policy reforms to address the double burden of malnutrition in Zambia: a prospective policy analysis

“…, 2020 ). In addition, although the adolescent age group has been identified as a ‘second window of opportunity’ for preventing adverse nutrition-related problems later in life ( Patton et al , 2022 ), little attention is paid to this population group in Zambia, despite being exposed to unhealthy food environments that foster unhealthy diets ( Mukanu et al , 2022 ). While Zambia has strong policies addressing undernutrition and stunting ( National Food and Nutrition Commission, 2018 ), these do not adequately tackle food environment drivers of the double burden of malnutrition and hence the need for nutrition policy reforms.…”