Understanding the Knowledge, Attitudes, and Practices of Healthy Eating among Adolescents in Chongqing, China: An Empirical Study Utilizing Structural Equation Modeling

Ke Jiang; Laixi Zhang; Changxiao Xie; Zhourong Li; Zumin Shi; Manoj Sharma; Yong Zhao

doi:10.3390/nu16010167

Understanding the Knowledge, Attitudes, and Practices of Healthy Eating among Adolescents in Chongqing, China: An Empirical Study Utilizing Structural Equation Modeling

Nutrients. 2024 Jan 4;16(1):167. doi: 10.3390/nu16010167.

Authors

Ke Jiang^{1

2

3}, Laixi Zhang^{1

2

3}, Changxiao Xie⁴, Zhourong Li^{1

2

3}, Zumin Shi⁵, Manoj Sharma^{6

7}, Yong Zhao^{1

2

3

8}

Affiliations

¹ School of Public Health, Chongqing Medical University, Chongqing 400331, China.
² Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing 400016, China.
³ Research Center for Public Health Security, Chongqing Medical University, Chongqing 400016, China.
⁴ Department of Nutrition and Food Hygiene, West China School of Public Health, Sichuan University, Chengdu 610041, China.
⁵ Human Nutrition Department, College of Health Sciences, QU Health, Qatar University, Doha P.O. Box 2713, Qatar.
⁶ Department of Social and Behavioral Health, School of Public Health, University of Nevada, Las Vegas, NV 89119, USA.
⁷ Department of Internal Medicine, Kirk Kerkorian School of Medicine, University of Nevada, Las Vegas, NV 89102, USA.
⁸ Chongqing Key Laboratory of Child Nutrition and Heath, Children's Hospital of Chongqing Medical University, Chongqing 401147, China.

Abstract

Healthy eating is crucial for optimal growth, development, and the prevention of chronic diseases in adolescents. Our study aimed to develop a comprehensive structural equation model (SEM) to analyze the relationships between knowledge, attitudes, practices (KAP), and healthy eating among adolescents in Chongqing. An online questionnaire was administered to middle school students in 39 districts and counties of Chongqing, China from 2 December to 15 December 2021 to collect sociodemographic and KAP information. SEM models were constructed to examine the relationships between educational environment and healthy eating knowledge, attitudes, and practices. The Monte Carlo test was employed to assess the significance of the mediating effect of relevant variables. The study included 139,832 adolescents aged 14.8 ± 0.7 years, with a 14% rate of overweight and obesity. Health and nutrition knowledge averaged a score of 3.60 ± 1.50 (correct rate: 60%). Participants had positive attitudes (average score: 13.61 ± 2.29) and engaged in healthy eating practices (average score: 12.06 ± 3.08). The results of the SEM revealed a significant influence of the educational environment on adolescents' knowledge (β = 0.235, p < 0.001) and attitude towards healthy eating (β = 0.143, p < 0.001). Knowledge exhibited positive effects on both attitude (β = 0.225, p < 0.001) and practice (β = 0.054, p < 0.001), while attitude exhibited positive effects on practice behavior (β = 0.565, p < 0.001). The indirect effect of knowledge on practices through attitude was more substantial than the direct effect (ratio 2.361). Our study highlights the mediating role of attitude between healthy eating knowledge and practices. A significant association exists between a favorable educational environment and improved knowledge and positive attitudes toward healthy eating among adolescents. In the future, nutrition and health education should prioritize exploring effective ways to translate knowledge into practices.

Keywords: adolescents; attitudes; healthy eating; knowledge; practices; structural equation modeling.

MeSH terms

Adolescent
China
Diet, Healthy*
Empirical Research
Health Knowledge, Attitudes, Practice*
Humans
Latent Class Analysis

Grants and funding

This project was supported by the science popularization and communication research fund of the China Nutrition Society (grant number CNS-SCP2020-34), and 2023 Think Tank Research fund of the Chongqing Association for Science and Technology (grant number 2023KXKT12).