Understanding the influencing factors of adolescents' (12-17) healthy and unhealthy food choices and experiences in Tamil Nadu, India: a socioecological perspective

Adolescents' food choices are critical for long-term health, yet increasing consumption of unhealthy foods driven by environmental and social factors contributes to rising obesity and non-communicable diseases. This study explored the perceptions of parents, teachers, and adolescents regarding the factors influencing adolescent food choices in urban, slum, and rural areas of Tamil Nadu. Adolescents illustrated their preferred foods through drawings used emojis to express emotions related to their food choices. Employing Bronfenbrenner's ecological theory, thematic analysis revealed that key factors influencing both healthy and unhealthy food choices across all regions included taste preferences, textural appeal, food cravings, peer and media influence, and family practices. In urban areas, economic status, food access, and working parents led to unhealthy eating, worsened by the COVID-19 pandemic, while in rural areas, COVID-19 reinforced traditional, healthy eating habits. However, "eye eating", emerged as a coping strategy to reduce unhealthy food cravings in urban settings. In rural areas, nearby neighbourhoods and extended families supported the provision of home-cooked meals in the absence of working parents. In slums, food bloggers and the accessibility of affordable street foods were prominent influencers. Emotional states influenced food choices across all settings: unhealthy foods were associated with immediate gratification, as evident in the drawings displayed by adolescents, followed by guilt, while home-cooked meals, particularly in rural areas, were linked to comfort. Leveraging "eye eating" by visually promoting healthy foods in urban areas, and strengthening nutrition education through families and schools in rural settings, can guide tailored interventions for healthier adolescent diets.