Factors shaping adolescent snack choices in urban Bangladeshi schools: a mixed methods study

Research on adolescents' snack choices in school food environments has predominantly focused on high-income countries, leaving gaps in low- and middle-income contexts. This study addresses these gaps by examining snack choices and their individual, social and environmental influencing factors among adolescents in 20 urban high schools in Bangladesh using a mixed-methods approach guided by a conceptual model informed social cognitive theory (SCT) and an ecological perspective. Quantitative data were collected through surveys with 975 adolescents (ages 11-17), while qualitative data included focus group discussions with 60 adolescents. Adolescents frequently purchased energy-dense, non-nutritious snacks during school breaks, spending 10-20 Bangladeshi Taka (0.1-0.2 USD) daily. Individual factors such as taste were not widely prioritised in the quantitative survey but emerged as a central influence in the qualitative FGDs, often overriding health or hygiene considerations. While health considerations were frequently reported across both data sources, adolescents typically defined healthy food in terms of safety from contamination and chemical adulteration, rather than nutritional content. Many viewed home-cooked meals as compensating for less healthy snacks. Social peer influences were perceived as secondary in the survey data, yet qualitative findings revealed that peers exerted a significant influence through shared routines, group preferences, and subtle conformity. Environmental factors, including cost, availability, and hygiene, were cited less frequently in the survey but featured prominently in the FGDs. Adolescents often selected snacks based on affordability, accessibility, and perceived cleanliness, highlighting the influence of the school food environment on their choices. Interventions should generate demand for nutritious snacks, address food safety concerns, challenge compensatory health beliefs, and consider adolescents' psycho-emotional stressors. Policies must reshape school food environments to ensure safe, affordable, and nutritious snacks.