title: Socio-economic status and urbanization are linked to snacks and obesity in adolescents in Botswana.
abstract: OBJECTIVE
  To describe patterns of food consumption associated with overweight/obesity (OW/OB) and their links to socio-economic status (SES) and urbanization.
  
  
  METHODS
  A nationwide cross-sectional survey.
  
  
  METHODS
  Secondary schools in cities, towns and villages in Botswana, Africa.
  
  
  METHODS
  A total of 746 adolescent schoolchildren.
  
  
  RESULTS
  OW/OB is associated with greater SES, city residence and a snack-food diet pattern. Students belonging to higher SES compared with those from a lower SES background reported significantly (P < 0·01) more daily servings of snack foods (1·55 v. 0·76) and fewer servings of traditional diet foods (0·99 v. 1·68) and also reported that they ate meals outside the home more often (90% v. 72%). Students in cities ate significantly (P < 0·01) more servings of snacks (1·69 v. 1·05 v. 0·51) and fewer servings of traditional foods (0·67 v. 1·52 v. 1·61) compared with those in urban and rural villages. The odds of OW/OB were increased 1·16-fold with a snack-food diet, a result that was diminished when controlled for SES.
  
  
  CONCLUSIONS
  These data suggest that nutritional transition occurs at different rates across urbanization and SES levels in Botswana. In cities, increasing the availability of fruit while reducing access to or portion sizes of snack items is important. Emphasis on continued intake of traditional foods may also be helpful as rural areas undergo economic and infrastructural development.
authors.affiliation: University of Botswana, Gaberone, Botswana.
authors.forename: Segametsi D
authors.initials: SD
authors.lastname: Maruapula
authors.forename: Jose C
authors.initials: JC
authors.lastname: Jackson
authors.forename: Joanna
authors.initials: J
authors.lastname: Holsten
authors.forename: Sheila
authors.initials: S
authors.lastname: Shaibu
authors.forename: Leapetswe
authors.initials: L
authors.lastname: Malete
authors.forename: Brian
authors.initials: B
authors.lastname: Wrotniak
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: Ratcliffe
authors.forename: George G
authors.initials: GG
authors.lastname: Mokone
authors.forename: Nicolas
authors.initials: N
authors.lastname: Stettler
authors.forename: Charlene
authors.initials: C
authors.lastname: Compher
mesh_terms: D000293:Adolescent; D000886:Anthropometry; D015992:Body Mass Index; D001902:Botswana / Q000453:epidemiology; D003430:Cross-Sectional Studies; D004032:Diet; D004034:Diet Surveys; D002149:Energy Intake; D005247:Feeding Behavior; D005260:Female; D005638:Fruit; D006801:Humans; D008297:Male; D009765:Obesity / Q000453:epidemiology*; D012574:Schools; D062410:Snacks; D012959:Socioeconomic Factors; D014505:Urban Population; D014507:Urbanization