Home availability of both healthful and unhealthful foods may influence consumption among rural adolescent populations. In conjunction, the availability of food in an individual’s local food environment has the potential to significantly impact what is procured for the home and eaten away from the home. The purpose of this study was to determine how in-store food availability and parental purchases influences home availability and, ultimately, dietary intake among adolescents. This study measured perceived home availability, using the University of Minnesota Project EAT Survey, and dietary intake, using the NHANES Dietary Screener Questionnaire, of (n=28) adolescent participants in two Kentucky counties during 2013. Availability of food in local stores was measured using the Nutrition Environment Measures Survey in Stores (NEM-S). The results of multiple linear regression analysis suggest that overall store availability does not significantly impact parental purchases. However, in-store availability of specific unhealthy food categories, such as snacks, junk food, candy, and pop, was associated with increased parental purchases of similar unwholesome items and a greater predicted intake of sugar. Therefore, it may be beneficial to develop interventions aimed at decreasing the availability of unhealthy food items in stores in order to improve diet quality among rural adolescents.

The current study evaluated the factor analytic structure and developmental trajectory of ethnic identity, as measured by the Multigroup Ethnic Identity Measure, (MEIM) among early rural adolescents. The convergent validity of the measure for rural youth was also examined. The sample for this study was drawn from a larger longitudinal study focusing on violence prevention efforts with an early adolescent sample residing in rural Florida. The final sample size for these secondary analyses was 5,695 participants. The sample was 53 % Caucasian, 24% Latino, 15% African American, and 8% Other. The mean age of the students was 11.3 years. Data were collected at seven time points. A confirmatory factor analysis (CFA) was conducted with the entire sample to determine whether a two-factor model was a satisfactory fit for the entire sample at Times 1-7. Individual growth curve modeling was used to determine ethnic identity trajectories. This study demonstrated that the MEIM taps into two factors (Exploration and Commitment) for rural adolescents. Moreover, the findings demonstrated multigroup equivalence across waves 1-7 of data collection for the Caucasian, African American, and Latino groups. Further, results from the growth curve modeling procedures indicated that Caucasian participants demonstrated a greater increase in Exploration relative to Latino and African American participants. Lastly, results from the convergent validity analyses indicated that Commitment was negatively related to attitudes towards violence and positively related towards attitudes towards nonviolence. Implications for future research and prevention programs that incorporate ethnic identity constructs are discussed.

Social cohesion among peers profoundly influences decision making during adolescence. Despite this, the current research is very limited concerning the association of social cohesion and intimacy among rural adolescent peers with dietary intake and weight outcomes. This is problematic because social cohesion could be an unknown contributing factor in obesity among rural adolescents. The purpose of this study was to investigate how social cohesion and intimacy among rural adolescents in Kentucky and North Carolina affects the outcomes of a text message intervention aimed at improving fruit, vegetable, fast food and sugar sweetened beverage intake. Additionally, to determine if social cohesion is an independent contributing factor to dietary intakes and weight outcomes among rural adolescents. It was found that the intervention had no effect on fruit and vegetable consumption and purchases and sugar sweetened beverage calories. However, the intervention did have a modest effect on the amount of times fast food was consumed per week.

Determining the level of belief one has in themselves, or their self-efficacy, can be a key factor to improve certain dietary patterns and choices in the rural youth population. Sugar sweetened food and beverage consumption continues to rise and fruit and vegetable intake remains a struggle in rural areas; addressing both the food environment and adolescents’ self-efficacy could have a lasting impact on changing the nature of a generation of rural student’s food and beverage choices. This study measured self-efficacy levels of (n=425) adolescents in rural Kentucky and North Carolina using the Youth Impact Questionnaire and dietary intake using the NHANES Dietary Screener. Multiple linear regression analysis found that higher levels of self-efficacy resulted in a statistically significant ability to consume more vegetables. Further associations found that higher levels of self-efficacy resulted in increased fruit consumption, and improved added sugar food and beverage selections. These findings suggest that it could be beneficial to target adolescents’ self-efficacy as a way to modify certain health behaviors in a sparse food environment such as these rural Appalachian areas.

Background: Bangladesh is home to 36 million adolescents with the majority living in rural areas. Adolescence presents an additional window of opportunity to correct nutritional deficits among rural Bangladeshi adolescents. A high-quality, diverse diet is pivotal in this regard. Ultra-processed food (UPF) consumption is an emergent threat to public health. This study aimed to explore dietary diversity (DD) and UPF consumption in terms of gender and socio-economic stratification among rural adolescents in Matlab, Bangladesh. Methods: Adopting cross-sectional design 1441 adolescents were surveyed. Dietary diversity score and ultra-processed food consumption score (UFCS) were constructed through 24-hour recalls. Means and consumption proportions were compared across gender and socio-economic strata. Binary and ordinal logistic regression models were fitted to isolate socio-demographic variables associated with inadequate DD and higher UFCS respectively. Results: 43% of the adolescents had inadequate DD. Pro-boy gap in DD was evident, so was heavy reliance on rice and scant consumption of nutrient-rich foods. UPF consumption was low. Belonging to the richest and to food secure households were associated with lower odds of inadequate DD. Girls were more likely to have inadequate DD but less likely to have higher UFCS. Gender modified the effect of socio-economic status on UPF consumption. Conclusions: The diet of adolescents in Matlab lacked diversity, putting them at significant risk of nutritional deficiencies. Improving their DD requires pragmatic policies and tailored programs to tackle affordability and food insecurity issues, address social norms and intra-household dynamics that favor boys, and sensitize the adolescents to importance of consuming diverse diet. / 15-year Follow-up of MINIMat Trial

Background: With an estimated number of 1.2 billion in the world, adolescents represent a major transformative force in global health. Optimum adolescent nutrition is increasingly important for scaling up population health gains in low- and middle-income countries (LMICs) of South Asia. Nevertheless, little is known about the gender and socio-economic stratification of diets consumed by rural adolescents in these countries. The aim of this project was to understand the gender and socio-economic stratification of their diet with a dual, descriptive-analytic focus on dietary diversity (DD) and consumption of ultra-processed and deep-fried foods. Methods: This thesis builds upon cross-sectional analyses of data collected during 15-year follow-up of the MINIMat (Maternal and Infant Nutrition Interventions in Matlab) trial, from September 2017 to June 2019. Data on dietary and socio-demographic variables were collected through household survey; using a pre-tested, structured questionnaire. A single, 24-hour recall was employed to assess consumption of staples and non-staples arranged in 10 groups, ultra-processed foods (UPF) in four groups, and of one group of deep-fried foods. Data were analyzed using logistic regression models. The analytic sample comprised 2463 adolescents. Results: The prevalence of inadequate DD was 42.3% (40.3-44.2). Consumption of dark green leafy vegetables, vitamin A-rich fruits and vegetables, and animal-source foods–except fish–appeared low. The proportions of adolescents consuming meat, egg and dairy were higher among those from the richest households than those from the poorest households, and among boys than girls. Belonging to the poorest households (adjusted odds ratio (aOR): 1.59; 95% confidence interval (CI): 1.27-2.00) and the food insecure households (aOR: 1.34; 95% CI: 1.13-1.59), and attaining secondary education (aOR: 1.38; 95% CI: 1.11-1.71) were positively associated with inadequate DD. Adolescents having mothers with secondary education or above had lower odds of inadequate DD (aOR: 0.76; 95% CI: 0.60-0.96). Gender was not an independent predictor of inadequate DD.Approximately 83% (81.5-84.4) adolescents reportedly consumed at least one ultra-processed or deep-fried food in the 24 hours preceding the survey. Packaged confectioneries were the most consumed and sugar-sweetened beverages (SSB) the least consumed UPF group. Boys had greater odds of consumption than girls for all UPF groups and deep-fried foods. The association was strongest for SSB (aOR: 2.57; 95% CI: 1.97, 3.37), followed by deep-fried foods (aOR 1.96; 95% CI: 1.66, 2.32). Belonging to the richest households was associated with consumption of ready-to-eat foods (aOR 1.55; 95% CI: 1.12-2.16) and of SSB (aOR: 1.44; 95% CI: 1.02-2.03). Adolescents with higher educational attainment had lower odds of consuming SSB (aOR 0.73; 95% CI: 0.54-0.98). Conclusion: The studies presented compelling evidence of limited DD concurrent with emergent consumption of ultra-processed and deep-fried foods in a rural cohort of adolescents. Inadequate DD was more likely among those from the poorest and the food insecure households. For ultra-processed and deep-fried foods, gender association persisted across the food groups with boys having a greater likelihood of consumption than girls. Wealth status influenced consumption of “instant” foods and SSB only. This suboptimal dietary pattern may place the adolescents at heightened risk of different forms of malnutrition.