Background: Whole grain consumption is associated with reduced risk of chronic disease. One-fifth of UK adults and children do not consume any whole grains, and adolescents have low consumption rates. There is little research on correlates of whole grain consumption in this age group. This study aimed to identify the socio-demographic, environmental, and behavioural factors associated with whole grain intake in UK adolescents, based on the health behavioural Reasoned Action Approach (RAA) model.
Methodology: In Study I, five focus groups explored 50 adolescent’s attitudes towards, knowledge and consumption of wholegrain foods, as well as barriers to, and facilitators of, consumption. Focus groups were analysed using thematic analysis. Study II conducted SenseCam assisted in-depth interviews with eight adolescents. Participants wore SenseCam for three days, then undertook traditional 24-hour recalls and in-depth interviews for attitudes, knowledge and consumption of wholegrain foods; as well as barriers and facilitators to consumption. SenseCam images prompted conversation during the interviews, which were audio-recorded and analysed using inductive content analysis. In study III, an RAA-based online survey was developed, as informed by Studies I and II. A total of 160 participants completed an online Food Frequency Questionnaire to estimate whole grain intake, and a survey examining their knowledge, attitudes, and consumption of wholegrain foods, as well as barriers and facilitators to consumption. Linear regression models, adjusted for demographic characteristics, were used to identify factors associated with whole grain intake. Participants in this thesis were adolescents of mixed genders and ethnicities, aged 11-16 years; recruited from schools in Leeds city area.
Results: Most participants had heard of whole grains but their consumption levels were generally low. The mean whole grain intake was around 10 servings of wholegrain food per week – approximately 1.4 servings per day. Breads and breakfast cereals were the most commonly consumed products. Adolescents were more influenced by parents and online media than by peers. Most adolescents related “whole grains” to wholemeal toast, and were not aware that varieties they already consumed, such as popcorn, quinoa and brown rice, were whole grain as well. Many recognised whole grain health benefits related to digestive health but not those related to heart disease or cancers. Barriers to whole grain consumption included negative sensory properties, poor availability and lack of varieties in stores, a lack of knowledge of the health benefits and difficulties in identifying wholegrain products. Suggested facilitators to consumption included promotion through social media celebrities, increased parental awareness and school-based education, improved sensory appeal, increased availability and variety, and tailoring of products for young people. Key factors significantly associated with increased whole grain intake (survey results, p<0.01): home availability of whole grains (R2=0.21), a supportive friend and family environment to consume more wholegrain foods (R2=0.19), personal dietary-consciousness (R2=0.18) and higher physical activity levels (R2=0.17), followed by positive attitudes to whole grains (R2=0.13), and intention to consume more wholegrain foods (R2=0.11). Being male and from a higher family socioeconomic status were also associated with greater whole grain consumption (R2=0.10). Frequency of eating out and getting lunch from school – non-RAA construct factors – were negatively associated with whole grain consumption (R2=0.17, and R2=0.15, respectively). The constructs of RAA successfully captured a number of whole grain consumption correlates among adolescents, explaining 19.9% of the variance in whole grain consumption.
Conclusion: Findings of this study suggest future interventions should address a broad range of factors, in particular awareness to improve parental and adolescent attitudes and increased home availability of wholegrain foods. Study outcomes may inform future interventions to increase whole grain intake in this age group.
