Social inequalities and the neighbourhood’s role in shaping adolescents’ dietary and physical activity behaviours

Adolescents from higher socioeconomic families tend to have healthier dietary behaviours and meet the physical activity recommendations more often than adolescents from lower socioeconomic families. For adolescents, the neighbourhood is essential and is a mix of social, physical and organisational structures. Targeting the social and physical environment surrounding adolescents could move the focus away from an individual behavioural responsibility to seek explanations and understanding of how the environments and neighbourhood can play a role in health inequalities. This PhD thesis aimed to examine and describe how the neighbourhood, with its unique social and physical level determinants could influence dietary and physical activity behaviours of adolescents from diverse socioeconomic urban districts in Oslo, Norway, and discuss the findings in relations to an ecological model. The thesis used a mixed-methods approach combining qualitative focus groups with adolescents and personal interviews with some parents, together with quantitative research in a cross-sectional study. The results from this thesis showed that all the adolescents, regardless of their neighbourhood, craved unhealthy food typically high in salt, sugar and saturated fat. They all expressed knowledge of a healthy lifestyle, wanted to eat and share food with friends, and longed to be more independent of their parents. In the higher socioeconomic neighbourhoods, factors like social norms, parental facilitation, high parental engagement, adolescents’ high engagement in and the high availability of organised physical activities interacted, making healthy behaviour more feasible. In the lower socioeconomic neighbourhoods, parental engagement in organised physical activities varied, and more conflicts regarding serving of home-based meals were reported. In addition, fast-food restaurants and malls were considered the preferred social arenas for adolescents, often because of a lack of safe youth clubs and fewer options for organised physical activity, especially for girls, in the local neighbourhood. The thesis demonstrates how several factors showed similar patterns regardless of the adolescents’ neighbourhoods, but also how there were variations between the neighbourhoods. By focusing the research on the adolescents’ unique neighbourhood, the thesis identified how several factors at different levels in an ecological model could interact and shape the behaviours of the adolescents. It demonstrates the importance of looking beyond the individual level and including the outer levels in an ecological model to capture the complexity of the social inequalities found in adolescents’ environment influencing their dietary and physical activity behaviours