Individual and environmental factors influencing adolescents’ dietary behavior in low- and middle-income settings

Objective Given the public health importance of improving dietary behavior in chronic disease preven-tion in low- and middle-income countries it is crucial to understand the factors influencingdietary behavior in these settings. This study tested the validity of a conceptual frameworklinking individual and environmental factors to dietary behavior among Ecuadorian adoles-cents aged 10–16 years. Methods A cross-sectional survey was conducted in 784 school-going Ecuadorian adolescents inurban and rural Southern Ecuador. Participants provided data on socio-economic status,anthropometry, dietary behavior and its determining factors. The relationships between indi-vidual (perceived benefits and barriers, self-efficacy, habit strength, and a better under-standing of healthy food) and environmental factors (physical environment: accessibility tohealthy food; social environment: parental permissiveness and school support), and theirassociation with key components of dietary behavior (fruit and vegetables, sugary drinks,breakfast, and unhealthy snack intake) were assessed using structural equation modeling. Results The conceptual model performed well for each component of eating behavior, indicatingacceptable goodness-of-fit for both the measurement and structural models. Models forvegetable intake and unhealthy snacking showed significant and direct effects of individual. factors (perceived benefits). For breakfast and sugary drink consumption, there was a direct and positive association with socio-environmental factors (school support and parental permissiveness). Access to healthy food was associated indirectly with all eating behaviors (except for sugary drink intake) and this effect operated through socio-environmental (parental permissiveness and school support) and individual factors (perceived benefits). Conclusion Our study demonstrated that key components of adolescents’ dietary behaviors are influenced by a complex interplay of individual and environmental factors. The findings indicate that the influence of these factors varied by type of dietary behavio