title: Individual and Environmental Factors Influencing Adolescents' Dietary Behavior in Low- and Middle-Income Settings.
abstract: OBJECTIVE
  Given the public health importance of improving dietary behavior in chronic disease prevention in low- and middle-income countries it is crucial to understand the factors influencing dietary behavior in these settings. This study tested the validity of a conceptual framework linking individual and environmental factors to dietary behavior among Ecuadorian adolescents aged 10-16 years.
  
  
  METHODS
  A cross-sectional survey was conducted in 784 school-going Ecuadorian adolescents in urban and rural Southern Ecuador. Participants provided data on socio-economic status, anthropometry, dietary behavior and its determining factors. The relationships between individual (perceived benefits and barriers, self-efficacy, habit strength, and a better understanding of healthy food) and environmental factors (physical environment: accessibility to healthy food; social environment: parental permissiveness and school support), and their association 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, indicating acceptable goodness-of-fit for both the measurement and structural models. Models for vegetable 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).
  
  
  CONCLUSIONS
  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 behavior.
authors.affiliation: Nutrition and Child Health Unit, Department of Public Health, Prince Leopold Institute of Tropical Medicine, Antwerp, Belgium.
authors.forename: Roosmarijn
authors.initials: R
authors.lastname: Verstraeten
authors.affiliation: Poverty, Health, and Nutrition Division, International Food Policy Research Institute (IFPRI), Washington, DC, United States of America.
authors.forename: Jef L
authors.initials: JL
authors.lastname: Leroy
authors.affiliation: Consumer and Sensory Research Institute Ltd (IBKiS), Warsaw, Poland.|Department of Agricultural Economics, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium.
authors.forename: Zuzanna
authors.initials: Z
authors.lastname: Pieniak
authors.affiliation: Departamento de Biociencias, Universidad de Cuenca, Cuenca, Ecuador.
authors.forename: Angélica
authors.initials: A
authors.lastname: Ochoa-Avilès
authors.affiliation: Public Health section, School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, United Kingdom.
authors.forename: Michelle
authors.initials: M
authors.lastname: Holdsworth
authors.affiliation: Department of Agricultural Economics, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium.
authors.forename: Wim
authors.initials: W
authors.lastname: Verbeke
authors.affiliation: Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
authors.forename: Lea
authors.initials: L
authors.lastname: Maes
authors.affiliation: Nutrition and Child Health Unit, Department of Public Health, Prince Leopold Institute of Tropical Medicine, Antwerp, Belgium.
authors.forename: Patrick
authors.initials: P
authors.lastname: Kolsteren
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior; D062408:Breakfast; D002648:Child; D003430:Cross-Sectional Studies; D004032:Diet; D019422:Dietary Sucrose; D004484:Ecuador; D005247:Feeding Behavior / Q000523:psychology*; D005260:Female; D005518:Food Preferences; D006801:Humans; D008297:Male; D011582:Psychological Theory; D062410:Snacks; D012959:Socioeconomic Factors
chemical_list: D019422:Dietary Sucrose