| Abstract|| |
Background: Knowledge and awareness of fruit and vegetable consumption is considered as one of the determining factors of this behavior in children and adolescents. This study is conducted to assess adolescents' awareness of fruit and vegetable consumption in Tehran city. Materials and Methods: The present research is a cross-sectional, descriptive-analytic study which is conducted to assess Tehranian adolescents' awareness of fruit and vegetable consumption. In this research, 500 students aged 11–14 years from middle schools in Tehran (250 boys and 250 girls) were studied. Participants were selected by multistage random sampling method. The inclusion criteria were age 11–14 years, informed consent and voluntary participation of students in the study. Data were collected by means of a researcher-made questionnaire which included 11 questions about demographic characteristics and 17 questions about participants' awareness. The face validity and content validity of this questionnaire are assessed, and its reliability is measured by internal consistency method (α = 0.7). Completed questionnaires were collected, and data were entered into the computer. T-test, one-way analysis of variance, and descriptive statistics were used to analyze the collected data by means of SPSS 18. Results: The mean scores of adolescents' awareness of fruit and vegetable consumption was 27.21 with standard deviation of 3.26. The awareness of fruit and vegetable consumption in 35 students (7%) was poor, in 266 students (53.2%) was moderate and in 181 students (36.2%) was good. The findings of this study showed a significant difference between boys' and girls' awareness of fruit and vegetable consumption. There was a significant association between student' awareness and age, number of family members, and mothers' education level as well. However, there was no relationship between participants' awareness and their fathers' education level and also a residential area. Conclusion: Tehranian adolescents' awareness of fruit and vegetable consumption is not acceptable. It is recommended to design and implement some interventional programs to promote adolescents' awareness of fruit and vegetable consumption.
Keywords: Adolescents, awareness, fruit and vegetable consumption
|How to cite this article:|
Rakhshanderou S, Ramezankhani A, Mehrabi Y, Ghaffari M. Adolescents' awareness of fruit and vegetable consumption in Iran: An unacceptable status. Ann Trop Med Public Health 2017;10:1746-51
|How to cite this URL:|
Rakhshanderou S, Ramezankhani A, Mehrabi Y, Ghaffari M. Adolescents' awareness of fruit and vegetable consumption in Iran: An unacceptable status. Ann Trop Med Public Health [serial online] 2017 [cited 2018 Nov 16];10:1746-51. Available from: http://www.atmph.org/text.asp?2017/10/6/1746/222713
| Introduction|| |
During the past decade, some factors such as urbanization, industrialization, and development of technology and economy have led to a rapid change in people's lifestyle and diet. Due to this, the prevalence of diet-related chronic diseases has increased worldwide., Noncommunicable diseases(NCDs) were responsible for 38 million (68%) of the world's 56 million deaths in 2012. More than 40% of them (16 million) were premature deaths under age 70 years. Almost three quarters of all NCD deaths (28 million), and the majority of premature deaths (82%), occur in low- and middle-income countries. About 9 million out of 36 million people who have died from chronic diseases in 2008 have been <60 years old. Hence, their death had occurred during the most productive period of their life.
Fruit and vegetable consumption is one of the most important indicators of the diet quality  and has protective effects against many of chronic diseases such as cardiovascular diseases, obesity, and various types of cancer, especially respiratory system and gastrointestinal tract cancers which nowadays are major public health problems.,,
Epidemiologic evidence have shown that despite these benefits, fruit and vegetable consumption in adolescents is lower than recommended amounts in diet guidelines.,,,, In most of the countries, national guidelines have recommended at least 5 servings of fruit and vegetable per day for adolescents. In addition, almost in all countries, the proportion of adolescents who consume fruit and vegetable daily has decreased. It is important to know that healthy behaviors such as eating adequate fruit and vegetable are learnt in childhood, and therefore its consumption in adulthood is related to that.,
During childhood and adolescence, the body grows rapidly and therefore it needs more nutrients which may be provided by fruit and vegetables. According to the results of several studies, eating patterns are established in childhood and adolescence periods., Childhood and adolescence periods are the best time for modification of eating-related behaviors because behavior modification in this time is much easier than in adulthood. To improve fruit and vegetable consumption in children, it is necessary to know and understand the determinants of fruit and vegetable consumption. Interventions to improve health-related behaviors should be designed for the most important determinants of these behaviors. According to the results of studies conducted all around the world, awareness is one of the most important determinants of fruit and vegetable consumption. Shaikh et al. conducted a systematic review on articles that have been published about the relationship between psychosocial determinants and fruit and vegetable consumption in adulthood during 1994–2006 in England. In 7 out of 8 studies that were related to fruit and vegetable consumption, an effective association between awareness and fruit and vegetable consumption was reported. In addition, in a study conducted by Najimi and Ghafari, adolescents' awareness of fruit and vegetable consumption is mentioned as one of the most important factors in consuming these foods. In Madhujith and Perera's study, a positive and significant association between awareness and fruit and vegetable consumption in young people was observed.
Considering the importance of knowledge and awareness as one of the determinants of fruit and vegetable consumption in children and adolescents, and also, this issue that until now no study has reported the Tehranian students' awareness of fruit and vegetable consumption, the present study is conducted to assess adolescents' awareness of fruit and vegetable consumption. We hope that results of this study would provide researchers and authorities with some practical approaches to plan, implement, and evaluate the related educational interventions in Iranian adolescents.
| Materials and Methods|| |
This research is a cross-sectional, descriptive-analytic study which is conducted in 2013 to assess Tehranian students' awareness of fruit and vegetable consumption. In this study, 500 students aged 11–14 years were assessed in Tehran city. Participants were selected by multistage random sampling method. Residential areas of 2, 4, 6, 10, and 16 in Tehran were chosen for this study. In each area, male and female guidance schools were chosen randomly (10 schools). The number of participating students from each school was calculated according to the sample size. The inclusion criteria were age 11–14 years, informed consent, and voluntary participation of students in the study. A researcher-made questionnaire was the tool used to collect the data. It included 11 questions about demographic characteristics and 17 questions about participants' awareness. Face validity of the questionnaire was assessed using the target group (10 students aged 11–14 years who were not selected as samples). Content validity of the questionnaire was also assessed in qualitative method and using experts' opinions (content validity index = 0.75, content validity ratio = 0.94). The reliability of the tool was assessed by internal consistency (α = 0.7). After obtaining the permission from the relevant institutions, to fill in questionnaires, necessary coordination with teachers of each class was performed. Then, questionnaires were given to the students, and required explanations about the way of answering questionnaires were offered. We assured students that questionnaires are anonymous and the data will be analyzed in general. Completed questionnaires were collected, and the data were entered into the computer. To analyze the data, SPSS 16 software (Chicago, SPSS Inc.) was used and descriptive statistics, t-test and one-way analysis of variance were applied.
| Results|| |
This study is conducted on 500 Tehranian adolescents aged 11–14 years (250 boys and 250 girls) with the mean age of 12.61 ± 1.01 years. The number of family members of studied people was 2–9 people. The mean score of adolescents' awareness of fruit and vegetable consumption was 27.21 with the standard deviation of 3.26. From all the studied participants, 35 people (7%) had a poor awareness, 266 people (53.2%) had a moderate awareness, and 181 people (36.2%) had a good awareness of fruit and vegetable consumption. The results of the study showed that 37 people of adolescents (7.4%) had chosen the answer of “fat and cholesterol, protein and calorie” for the question of “which of the following substances are abundant in fruits and vegetables”? While 388 people of them (77.6%) knew that fruits and vegetables are rich in vitamins and minerals, 73 people (14.6%) did not know which nutrients are available in fruit and vegetable.
The question “how many servings of fruit and vegetable, people at your age should consume daily?” indicates the minimum amount of fruit and vegetable that the World Health Organization (WHO) has recommended to be consumed. 99 people (19.8%) did not know the minimum recommended amount, and 5 people (1%) said that the fruit and vegetable are not needed for adolescents at all. Fifty-seven people of adolescents (11.4%) answered at least once, 252 people (50.4%) answered at least 2–3 times, and 24 people (4.8%) answered more than 5 times is the daily recommended fruit and vegetable consumption. Only 62 people (12.4%) knew that the minimum recommended amount by the WHO is 4–5 times/day [Table 1].
|Table 1: Awareness score mean and standard deviation and also frequency of answers about fruit and vegetable consumption|
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The independent t-test showed a statistically significant difference between boys' and girls' awareness scores (P = 0.029). The mean awareness score of girls was 0.65 more than boys. Therefore in this research, there was a significant association between awareness and sex. One-way analysis of variance also showed a significant association between awareness and studied participants' age (P = 0.005). In the multiple comparison by Fisher's least significant difference (LSD) test, the results showed that there is a significant difference between awareness scores of adolescents aged 11 and 13 years (mean difference = 0.91, P = 0.046) and those aged 11 and 14 years (mean difference = 1.18, P = 0.04) and also 12 and 14 years (mean difference = 0.86, P = 0.039). Thus, adolescents who are older have a higher awareness of fruit and vegetable consumption in comparison with younger ones. The test showed a significant association between mother's education level and adolescents' awareness (P = 0.004) as well.
The results of the multiple comparisons by LSD test showed that there is a significant difference between awareness score of adolescents with underdiploma-educated mothers are and those with college-educated mothers (mean difference = 1.25, P = 0.001). Adolescents with college-educated mothers had a higher awareness of fruit and vegetable consumption than those with underdiploma-educated mothers [Table 2].
|Table 2: Mean and standard deviation of adolescents' awareness intake under demographic variables|
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One-way variance analysis showed a significant association between awareness and number of family members (P = 0.001). The results of Scheffe multiple comparison test indicated that there is a significant difference between awareness score of adolescents with 3 family members and those with 5 and more family members (mean difference = 1.21, P = 0.044) and also between awareness score of adolescents with 4 family members and those with 5 or more family members (mean difference = 1.23, P = 0.002). Therefore, adolescents with smaller families had higher awareness of fruit and vegetable consumption than those with larger families. This test indicated that there is no significant difference between awareness score of adolescents with 3 and 4 family members. It also showed that there is no significant association between awareness score and subjects' father education level and residential area [Table 2].
| Discussion|| |
The present study is conducted on Tehranian adolescents aged 11–14 years to assess their awareness of fruit and vegetable consumption. The results of this study showed that 35 people (7%) of studied adolescents had poor awareness, 266 people (53.2%) had moderate, and 181 people (36.2%) had a good awareness of fruit and vegetable consumption.
Delvarian-Zadeh et al.'s study on nutritional knowledge, attitude, and practice of female junior high school students in two regions of Iran showed that 9.9%, 59.5%, and 30.7% of female adolescents had poor, moderate, and good awareness, respectively, which is consistent with the results of the present study. The findings of a study conducted by Beech et al. also showed that 39% of the studied population had a good awareness of the nutritional value of fruit and vegetables. Awareness is defined as the required knowledge to perform a behavior. Therefore, it is very important to consider it as one of the most effective factors in the success of health promotion programs.
According to the results of this research, 99 people (19.8%) of adolescents did not know the minimum daily recommended servings of fruit and vegetable. Unfortunately, 5 people (1%) answered that fruit and vegetable are not needed for adolescents at all. Meanwhile, 57 people (11.4%) answered at least one serving, 252 people (50.4%) answered at least 2–3 servings and 24 people (4.8%) answered that more than 5 servings of fruit and vegetable are required daily. Only 62 people (12.4%) knew that the minimum recommended amount of fruit and vegetable is 4–5 servings per day.
Watters et al. conducted a study on the relationship between psychosocial factors and fruit and vegetable consumption and found out that only 26% of people know the recommended amount of 5 and more servings of fruit and vegetable consumption per day. This report is consistent with results of the present study.
The studies conducted on the effect of awareness of fruit and vegetable consumption in children has revealed various results. Evidence of Reynolds et al.'s study in 2004 indicated that awareness of recommended servings of fruit and vegetable is a strong medium for fruit and vegetable intake. Kristjansdottir et al.'s study on environmental determinants of fruit and vegetable consumption in Icelandic 11-year-old children showed that awareness of recommended amounts is one of the strongest determinants of fruit and vegetable consumption in children. Fruit and vegetables are low-density foods in terms of calorie and micronutrients and are considered as vital components of a healthy diet. According to age and sex, it is recommended that children and adolescents consume about 4–5 serving of fruit and vegetable daily. The WHO and Food and Agriculture Organization recommend daily consumption of at least 400 g of fruit and vegetables to prevent chronic diseases including cardiovascular disease, cancer, diabetes, and obesity. In addition, dietary guidelines for Americans indicate that adult people should consume fruits at least 2 times and vegetables 3 times daily.
In general, incorrect knowledge of students about standard daily consumption of fruit and vegetables may form their consumption habit, and it is needed to educate people and correct their knowledge about that.
In the present study, only 113 (22.6%) out of 500 participating adolescents knew that fruit and vegetable consumption is more important to prevent cardiovascular diseases. About 188 people (37.6%) gave a false answer to this question, and 197 (39.4%) of participants did not know that to prevent which diseases fruit and vegetable consumption is more effective. By having some protective compounds such as potassium, folate, vitamin, fiber, and other phenolic components and also by means of various mechanisms such as reducing antioxidants, improving lipoprotein profile, reducing blood pressure, increasing insulin sensitivity, and improving homeostasis regulation, fruit and vegetable would decrease chronic diseases, especially cardiovascular diseases.
The understood benefit of performing a healthy behavior is one of the strongest determinants of adopting that behavior. If students understand the benefits of fruit and vegetable consumption in preventing cardiovascular diseases, they will show a greater tendency to consume enough fruit and vegetables.
In this study, girls' awareness of fruit and vegetable consumption was higher than boys. The studies have shown that variable of sex is one of the important determinants of fruit and vegetable consumption. In a systematic review conducted by Rasmussen et al., sex difference in fruit and vegetable consumption was reported in 49 articles, and in 27 articles, it was indicated that girls have more tendency to consume fruit and vegetable. Perhaps, it shows that girls' awareness of fruit and vegetable consumption is higher than boys  which is completely consistent with findings of this study. We can justify this fact in this way that due to their role and having a higher sensitivity about their weight, girls like to know about nutritional values of foods including fruits and vegetables, more than boys.
In this study, adolescents with college-educated mothers have a higher awareness of fruit and vegetable consumption in comparison with those with underdiploma-educated mothers. Mothers plat a key role in the house, especially in family meals planning and are considered as the most effective and important people about that. It is obvious that having academic education and a higher literacy level would be effective in all areas, especially in growing and training children. In Rasmussen et al.'s systematic review, the positive association between mother's education level and fruit and vegetable consumption in adolescents is mentioned in 8 articles.
| Conclusion|| |
Only about one-third of Tehranian students have a good awareness of fruit and vegetable consumption, and this status is not acceptable at all. Therefore, it seems necessary to design and implement educational plans and interventions to promote adolescents' awareness of fruit and vegetable consumption. Utilizing suitable educational methods and also having the participation of students and their families, especially mothers are the most important parts of these interventions.
The authors express their thanks and gratitude to Tehran's Education Office managements, and all managers, teachers, and especially all students participated in this study.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Nago ES, Verstraeten R, Lachat CK, Dossa RA, Kolsteren PW. Food safety is a key determinant of fruit and vegetable consumption in urban beninese adolescents. J Nutr Educ Behav 2012;44:548-55.
Maghsoudi Z, Azadbakht L. How dietary patterns could have a role in prevention, progression, or management of diabetes mellitus? Review on the current evidence. J Res Med Sci 2012;17:694-709.
Svastisalee CM, Holstein BE, Due P. Fruit and vegetable intake in adolescents: Association with socioeconomic status and exposure to supermarkets and fast food outlets. J Nutr Metab 2012;2012:185484.
World Health Organization. Diet, Nutrition and the Prevalence of Chronic Diseases. Report of a Joint WHO/FAO Expert Consultation. Technical Report Series, No 916. Geneva: World Health Organization; 2003.
Lazzeri G, Pammolli A, Azzolini E, Simi R, Meoni V, de Wet DR, et al
. Association between fruits and vegetables intake and frequency of breakfast and snack consumption: A cross-sectional study. Nutr J 2013;12:123.
De Bourdeaudhuij I, Klepp KI, Due P, Perez Rodrigo C, de Almeida MD, Wind M, et al
. Reliability and validity of a questionnaire to measure personal, social and environmental correlates of fruit and vegetable intake in 10-11 years old children in five European countries. Public Health Nutr 2004;8:189-200.
Magarey A, Daniels LA, Smith A. Fruit and vegetable intakes of Australians aged 2-18 years: An evaluation of the 1995 National Nutrition Survey data. Aust N
Z J Public Health 2001;25:155-61.
Andersen LF, Øverby N, Lillegaard IT. Intake of fruit and vegetables among norwegian children and adolescents. Tidsskr Nor Laegeforen 2004;124:1396-8.
Larson NI, Neumark-Sztainer D, Hannan PJ, Story M. Trends in adolescent fruit and vegetable consumption, 1999-2004: Project EAT. Am J Prev Med 2007;32:147-50.
Rasmussen M, Krølner R, Svastisalee CM, Due P, Holstein BE. Secular trends in fruit intake among Danish schoolchildren, 1988 to 2006: Changing habits or methodological artefacts? Int J Behav Nutr Phys Act 2008;5:6.
Consumption of Fruit and Vegetables and Associated Factors among 11- to 13-year old children in Portugal. Master Thesis by Olga Vea. Department of nutrition, Faculty of Medicine Univeristy of Oslo; July, 2007.
Dixon Z, Newman FL, Chapa L, Vaccaro JA, Huffman FG. Social determinants of fruit and vegetable intake and validation of Pro-Children Eating Habits Questionnaire for 3rd
grade children. Internet J Health 2012;13:1-9.
Pedersen TP, Meilstrup C, Holstein BE, Rasmussen M. Fruit and vegetable intake is associated with frequency of breakfast, lunch and evening meal: Cross-sectional study of 11-, 13-, and 15-year-olds. Int J Behav Nutr Phys Act 2012;9:9.
Moore LL, Singer MR, Qureshi MM, Bradlee ML, Daniels SR. Food group intake and micronutrient adequacy in adolescent girls. Nutrients 2012;4:1692-708.
Lien N, Lytle LA, Klepp KI. Stability in consumption of fruit, vegetables, and sugary foods in a cohort from age 14 to age 21. Prev Med 2001;33:217-26.
Rasmussen M, Krolner R, Klepp KI, Lytle L, Brug J, Bere E, et al.
Determinants of fruit and vegetable consumption among children and adolescents: A review of the literature. Part I: Quantitative studies. Int J Behav Nutr Phys Act 2006;3:22.
Larson N, Fulkerson J, Story M, Neumark-Sztainer D. Shared meals among young adults are associated with better diet quality and predicted by family meal patterns during adolescence. Public Health Nutr 2013;16:883-93.
Shaikh AR, Yaroch AL, Nebeling L, Yeh MC, Resnicow K. Psychosocial predictors of fruit and vegetable consumption in adults a review of the literature. Am J Prev Med 2008;34:535-43.
Najimi A, Ghaffari M. Increasing fruit and vegetables consumption among elementary school children. J Health Syst Res 2013;9:395-402.
Perera T, Madhujith T. The pattern of consumption of fruits and vegetables by undergraduate students: A case study. Trop Agric Res 2012;23:261-71.
Delvarian-Zadeh M, Khosravi A, Razavian-Zadeh N, Bolbol-Haghighi N, Abbasian M, Taghavi N. Nutritional knowledge, attitude and practice of female junior high school students in two regions of Iran. J Knowl Health 2011;6:19-26.
Beech BM, Rice R, Johnson C, Nichlas TA. Knowledge, attitudes, and practices related to fruit and vegetable consumption of high school students. J Adolesc Health 1999;24:244-50.
Watters JL, Satia JA, Galanko JA. Associations of psychosocial factors with fruit and vegetable intake among African-Americans. Public Health Nutr 2007;10:701-11.
Reynolds KD, Bishop DB, Chou CP, Xie B, Nebeling L, Perry CL, et al.
Contrasting mediating variables in two 5-a-day nutrition intervention programs. Prev Med 2004;39:882-93.
Blanchette L, Brug J. Determinants of fruit and vegetable consumption among 6-12 years old children and effective interventions to increase consumption. J Hum Nutr Dietet 2005;18:431-43.
Kristjansdottir AG, De Bourdeaudhuij I, Klepp KI, Thorsdottir I. Children's and parents' perceptions of the determinants of children's fruit and vegetable intake in a low-intake population. Public Health Nutr 2009;12:1224-33.
Gaines A, Turner LW. Improving fruit and vegetable intake among children: A review of interventions utilizing the social cognitive theory. J Health Promot 2009;7:52-66.
U.S. Department of Health and Human Services. Healthy People 2010. Retrieved September 10, 2008; 2005b. Available from: http://www.healthypeople.gov
. [Last accessed on 13 Feb 20].
Dauchet L, Amouyel F, Hercberg S, Dallongeville J. Fruit and vegetable consumption and risk of coronary heart disease: A meta-analysis of cohort studies. J Nutr 2006;136:2588-93.
Department of Public Health, School of Public Health, Shahid Beheshti University of Medical Sciences, Tabnak Ave, Daneshjou Blvd, Velenjak, Tehran
Source of Support: None, Conflict of Interest: None
[Table 1], [Table 2]