Abstract:
Unhealthy diet and physical inactivity are among the key modifiable risk factors for noncommunicable diseases, such as diabetes and cardiovascular disease. Although such
diseases often only appear in adulthood, these behaviors are typically initiated or
reinforced already during adolescence. However, knowledge on underlying factors for
adolescents' unhealthy dieting and physical inactivity in sub-Saharan Africa (SSA) is
poor. We conducted in-depth interviews and focus group discussions to explore the
perceptions of a diverse group of 78 young people of 10-19 years of age, which also
included some adolescents living with HIV, as this is an emerging group in the
HIV/AIDS epidemic in many parts of SSA. In addition, 10 stakeholders, such as
teachers, clinicians, and staff from organizations at the Kenyan coast and seven young
adult community representatives informed us on: (a) adolescents' unhealthy food choices
and their forms of sedentary behavior; (b) predisposing factors; and (c) protective factors
against unhealthy food choices and sedentary behavior of adolescents living in Kilifi
County. The findings reveal that adolescents occasionally access nutritious foods, such as
fruits, vegetables, and animal protein. However, there is a growing tendency to consume
unbalanced diets with high intake of carbohydrates, oily foods, and consumption of sugar
dense processed foods and drinks. Sports and domestic chores were found to be major
sources of physical activity. Sedentary lifestyles characterized by a long-time sitting and
chatting, watching sports games and movies were described. Adolescents living with
HIV did not indicate any divergent perceptions from those of other adolescents relating
to diet and physical activity, but mentioned health-related conditions, such as medication,
asthma, and low body weight, as a risk factors for sedentary lifestyle. Using a SocioEcological model, our findings suggest that risk factors are numerous and interrelated,
especially at intrapersonal, interpersonal, and community level. The negative influences
at an intrapersonal level were as follows: body image concerns, attitudes and
misconceptions, substance use behavior, and taste for unhealthy foods. In the
interpersonal domain, household poverty and parenting practices that condone unhealthy
habits were identified risk factors. Availability of affordable unhealthy foods, high prices
for nutritious food, farming practices, gambling, and influx of transportation alternatives
in the community were interrelated but also had relationships with intrapersonal and
interpersonal risk factors. Modernization and poor implementation of policies were
discussed as enabling factors especially by stakeholders from a societal perspective.
Seasonality and farming practices, school attendance, community-based services, and
regulations mitigating adolescents' engagement in gambling were identified as potential
protective factors. Our findings provide a unique qualitative insight of the factors
underlying adolescents' dietary and sedentary lifestyle and highlight the need for
ecological intervention approaches to address these forms of health risk behavior in a
rural African setting.