Vegetable and Fruit Consumption Behaviours of Secondary and High School Students

Introduction: Individuals should consume at least five portions of vegetables and fruit per day to maintain a healthy diet. Therefore, the factors that affect vegetable and fruit consumption among young people and adolescents should be identified, and the causes of inadequate consumption of vegetables and fruit should be examined. The aim of this study was to determine the daily amount of vegetable and fruit consumption of adolescents studying at secondary and high schools, their distribution according to the vegetable and fruit consumption change stages in the transtheoretical model, and the factors related to the change processes. Method: This study used a descriptive research design. It was conducted in 2016 at four secondary schools and three high schools affiliated with the Fethiye District Directorate of National Education. The data were collected from 1,870 students through stratification conducted at each school. An introductory information form, the transtheoretical model vegetable and fruit consumption change stages and change process scales were used to collect the data.  Number, percentiles, independent samples t-test and One-way Analysis of Variance (ANOVA) were used for analysis of the data. Findings: This study found that the participants were aged from 11 to 17. Of the participants, 59.4% were male, and approximately two thirds of them were secondary school students. According to the change stages of the transtheoretical model, 32.1% of the students were regularly consuming five portions of vegetables and fruit for more than one month.  This study also found that there was a statistically significant difference between the sex, age, grade, number of siblings of the students, the economic status of their families, having the support of their families and friends, their access to vegetables and fruit at home and school, and their daily consumption of vegetables and fruit, as well as their fruit and vegetable consumption behaviors (p<.01). The change stages of the transtheoretical model and the vegetable-fruit consumption behaviors of the students were found to be related (p<.05). Conclusion: This study found that the vegetable and fruit consumption of males and adolescents older than 15 years of age was inadequate; factors such as economic status, the influence of family and friends, and access to vegetables and fruit had effects on  consumption. The number of portions consumed per day was related to the vegetable and fruit consumption behavior. Considering these results, it is recommended that health improvement practices should be developed, and the support  of individuals and institutions  should be increased,  including the support of family, school, friends, teachers, and health institutions in particular. These health improvement practices should be developed for students who are older, who are in the upper grades, who are male,  who suffer from economic insufficiency, and  who lack access  to vegetables and fruit. Access to vegetables and fruit should be made easier in the areas where these students reside.Giriş: Sağlıklı beslenmenin sürdürülebilmesi için günlük sebze ve meyve tüketiminin en az beş porsiyon olması gerekmektedir. Bu nedenle, gençlerde ve ergenlerde sebze ve meyve tüketimini etkileyen faktörlerin belirlenmesi, yetersiz tüketimin nedenlerinin araştırılması gerekmektedir. Bu çalışmanın amacı, ortaokul ve lise düzeyinde öğrenim gören adölesanların günlük sebze ve meyve tüketimi miktarları, transteorik model sebze ve meyve tüketimi değişim aşamalarına göre dağılımları ve değişim süreçleri ile ilişkili faktörlerin belirlenmesidir.  Yöntem: Fethiye İlçe Milli Eğitim Müdürlüğüne bağlı dört ortaokul ve üç lisede 2016 yılında yapılan bu çalışma tanımlayıcı tiptedir. Her okuldan tabakalama yapılarak 1870 kişiden veri  toplanmıştır. Araştırmanın verilerinin toplanmasında, tanıcı bilgi formu, transteoretik model sebze ve meyve tüketimi değişim aşamaları ve değişim süreci ölçekleri kullanılmıştır. Verilerin analizinde ise, sayı, yüzdelik dilimler, bağımsız değişkenlerde t testi ve Tek Yönlü Varyans Analizi kullanılmıştır. Bulgular: Katılımcıların yaşları 11-17 arasında, %59.4’ü erkek, yaklaşık 2/3’ü ortaokul öğrencisidir. Transteoretik model değişim aşamalarına göre, bir aydan fazladır düzenli olarak günde beş porsiyon sebze ve meyve tüketen öğrencilerin oranı ise %32.1’dir.  Öğrencilerin cinsiyet, yaş, sınıf, kardeş sayısı, ailelerinin ekonomik durumları, aile ve arkadaş desteğine sahip olmaları, evde ve okulda sebze-meyveye erişim durumları ve günlük tüketim miktarları ile sebze ve meyve tüketim davranışları arasında istatistiksel olarak anlamlı farklılık saptanmıştır (p<.01). Transteoretik model değişim aşamaları ile sebze-meyve tüketim davranışlarının ilişkili olduğu belirlenmiştir (p<.05). Sonuç: Çalışma sonucunda, erkeklerin, 15 yaş üzerindeki adölesanların sebze ve meyve tüketimin yetersiz olduğu; ekonomik durum, aile ve arkadaş etkisi, sebze ve meyveye erişim gibi faktörlerin tüketimde etkili olduğu; günlük tüketilen porsiyon sayısının sebze ve meyve tüketim davranışıyla ilişkili olduğu belirlenmiştir. Bu sonuçlar ışığında, yaşı daha büyük, ileri sınıflarda öğrenim gören, cinsiyeti erkek olan, ekonomik yetersizliği olan öğrencilere yönelik sağlığı geliştirici uygulamalar ve özellikle aile, okul, arkadaş, öğretmen, sağlık kurumları vb. gibi destekleyici bireysel ve kurumsal çevrenin oluşturulması, öğrencilerin bulundukları ortamlarda sebze ve meyveye erişimlerinin kolaylaştırılması önerilmektedir.  

___

  • 1. Boeing H, Bechthold A, Bub A, Ellinger S, Haller D, Kroke A, et al. Critical review: vegetables and fruit in the prevention of chronic diseases. European Journal of Nutrition 2012; 51: 1-27.
  • 2. Boffetta P, Couto E, Wichmann J, Ferrari P, Trichopoulos D, Bueno-de-Mesquita HB, et al. Fruit and vegetable intake and overall cancer risk in the European Prospective Investigation into Cancer and Nutrition (EPIC). Journal of the National Cancer Institute 2010; 102(8): 529-537.
  • 3. Hartley L, Igbinedion E, Thorogood M, Clarke A, Stranges S, Hooper L, et al. Increased consumption of fruit and vegetables for the primary prevention of cardiovascular diseases. Cochrane Database Syst Rev 2013; 6: 1-55.
  • 4. Redding CA, Rossi JS, Rossi SR, Velicer WF, Prochaska JO. Health behavior models. In International Electronic Journal of Health Education, 2010; 3:180-193.
  • 5. Prochaska JO, Velicer WF. The transtheoretical model of health behavior change. American Journal of Health Promotion 1997; 12(1): 38-48.
  • 6. Erol S, Erdoğan S. Sağlık davranışlarını geliştirmek ve değiştirmek için transteoretik modelin kullanılması. Anadolu Hemşirelik ve Sağlık Bilimleri Dergisi 2007; 10: 86-94.
  • 7. Prochaska JO. Strong and weak principles for progressing from precontemplation to action on the basis of twelve problem behaviors. Health Psychology 1994; 13(1): 47.
  • 8. Hildebrand DA, Betts NM. Assessment of stage of change, decisional balance, self-efficacy, and use of processes of change of low-income parents for increasing servings of fruits and vegetables to preschool-aged children. Journal of Nutrition Education and Behavior 2009; 41(2): 110-119.
  • 9. Horwath CC, Nigg CR, Motl RW, Wong KT, Dishman RK. Investigating fruit and vegetable consumption using the transtheoretical model. American Journal of Health Promotion 2010; 24(5): 324-333.
  • 10. Di Noia J, Schinke SP, Prochaska JO, Contento IR. Application of the transtheoretical model to fruit and vegetable consumption among economically disadvantaged African-American adolescents: preliminary findings. American Journal of Health Promotion 2006; 20(5): 342-348.
  • 11. Mao C, Xu L, Xu L, Ma H, Liu T, Qu X, et al. Assessment of fruit and vegetable intake behavior among adolescents in Hangzhou, China. Indian Journal of Pediatrics 2012; 79 (9):1218-1223.
  • 12. Gross SM, Pollock ED, Braun B. Family influence: Key to fruit and vegetable consumption among fourth-and fifth-grade students. Journal of Nutrition Education and Behavior 2010; 42(4): 235-241.
  • 13. Lorson BA, Melgar-Quinonez HR, Taylor CA. Correlates of fruit and vegetable intakes in US children. Journal of the American Dietetic Association 2009; 109(3): 474-478.
  • 14. Rieth MA, Moreira MB, Fuchs FD, Moreira LB, Fuchs SC. Fruits and vegetables intake and characteristics associated among adolescents from Southern Brazil. Nutrition Journal 2012; 11(1): 95.
  • 15. Aksoydan E, Cakir N. Adolesanların beslenme alışkanlıkları, fiziksel aktivite düzeyleri ve vücut kitle indekslerinin değerlendirilmesi. Gülhane Tıp Dergi 2011; 53: 264-270.
  • 16. Çavdar S, Sümer EÇ, Eliaçık K, Arslan A, Koyun B, Korkmaz N, ve ark. İzmir'de liseye devam eden ergenlerin sağlık davranışları.Turk Pediatri Arsivi 2016; 51: 22-34.
  • 17. Wang X, Ouyang Y, Liu J, Zhu M, Zhao G, Bao W, et al. Fruit and vegetable consumption and mortality from all causes, cardiovascular disease, and cancer: systematic review and dose-response meta-analysis of prospective cohort studies. BMJ 2014; 349:4490.
  • 18. Grimm KA, Kim SA, Yaroch AL, Scanlon KS. Fruit and vegetable intake during infancy and early childhood. Pediatrics 2014; 134(1): 63-69.
  • 19. Erol S, Ergün A, Kadıoğlu H. Adölesanlarda meyve ve sebze tüketimi değişim süreci ölçeği türkçe forunun güvenilirlik ve geçerliliği. HSP 2016; 3(2):106-114.
  • 20. Lynch C, Kristjansdottir AG, Te Velde SJ, Lien N, Roos E, Thorsdottir I, et al. Fruit and vegetable consumption in a sample of 11-year-old children in ten European countries–the PRO GREENS cross-sectional survey. Public Health Nutrition 2014; 17(11): 2436-2444.
  • 21. Ball K, Crawford D, Mishra G. Socio-economic inequalities in women's fruit and vegetable intakes: a multilevel study of individual, social and environmental mediators. Public Health Nutrition 2006; 9: 623-630.
  • 22. Attorp A, Scott JE, Yew AC, Rhodes RE, Barr SI, Naylor PJ. Associations between socioeconomic, parental and home environment factors and fruit and vegetable consumption of children in grades five and six in British Columbia, Canada. BMC Public Health 2014; 14(1): 150.
  • 23. Peltzer K, Pengpid S. Fruits and vegetables consumption and associated factors among in-school adolescents in five Southeast Asian countries. International Journal of Environmental Research and Public Health 2012; 9(11): 3575-3587.
  • 24. Wyse R, Campbell E, Nathan N, Wolfenden L. Associations between characteristics of the home food environment and fruit and vegetable intake in preschool children: a cross-sectional study. BMC Public Health 2011; 11(1): 938.
  • 25. Terry-McElrath YM, O'Malley PM, Johnston LD. Accessibility over availability: associations between the school food environment and student fruit and green vegetable consumption. Childhood Obesity 2014; 10(3): 241-250.