Center for Research on Population and Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon.
London School of Hygiene and Tropical Medicine, London, United Kingdom.
PLoS One. 2022 Jul 20;17(7):e0264963. doi: 10.1371/journal.pone.0264963. eCollection 2022.
In the context of the rapid nutrition transition experienced by middle-income countries of the Arab region, children and adolescent's food choices and dietary behaviors are early risk factors for the development of non-communicable diseases. Assessment of factors influencing food choices among this age group is challenging and is usually based on self-reported data, which are prone to information and recall bias. As the popularity of technologies and video gaming platforms increases, opportunities arise to use these tools to collect data on variables that affect food choice, dietary intake, and associated outcomes. This protocol paper describes the SCALE study (School and community drivers of child diets in Arab cities; identifying levers for intervention) which aims to explore the environments at the level of households, schools and communities in which children's food choices are made and consequently identify barriers and enablers to healthy food choices within these environments.
Field studies are being conducted in primary schools, among children aged 9-12 years, in Greater Beirut, Lebanon and Greater Tunis, Tunisia. A stratified random sample of 50 primary schools (public and private) are selected and 50 children are randomly selected from grades 4-5-6 in each school. The study includes surveys with children, parents/caregivers, school directors, teachers, and nutrition/health educators to assess individual diets and the contextual factors that influence children's food choices. Innovative locally adapted tools and methods such as game-based choice experiments, wearable cameras and neighborhood mapping are used to describe the environments in which children's food choices are made.
The SCALE study will generate contextual knowledge on factors in school and neighborhood environments that influence child dietary behaviors and will inform multi-level interventions and policies to address childhood malnutrition (under-and over-nutrition). By integrating methods from various disciplines, including economics, data science, nutrition, and public health and by considering factors at various levels (home, school, and neighborhood), the study will identify levers for intervention with the potential to improve children's dietary behaviors. This will help fill existing gaps in research on food systems and consequently guide positive change in Lebanon and Tunisia, with the potential for replicability in other contexts.
在中收入阿拉伯国家经历快速营养转型的背景下，儿童和青少年的食物选择和饮食行为是导致非传染性疾病的早期危险因素。评估这一年龄组的食物选择影响因素具有挑战性，通常基于自我报告的数据，这些数据容易受到信息和回忆偏差的影响。随着技术和视频游戏平台的普及，为收集影响食物选择、饮食摄入和相关结果的变量数据提供了机会。本研究方案描述了 SCALE 研究（阿拉伯城市儿童饮食的学校和社区驱动因素；确定干预的杠杆），旨在探讨儿童做出食物选择的家庭、学校和社区层面的环境，并在此环境中确定健康食物选择的障碍和促进因素。
在黎巴嫩大贝鲁特和突尼斯大突尼斯的小学中开展了实地研究，研究对象为 9-12 岁的儿童。从公立和私立学校中分层随机选择了 50 所小学，然后从每所学校的 4-5-6 年级中随机抽取 50 名儿童。研究包括对儿童、家长/照顾者、校长、教师和营养/健康教育者进行调查，以评估儿童的饮食和影响儿童食物选择的背景因素。研究还使用了基于游戏的选择实验、可穿戴相机和邻里地图等创新的、本土化的工具和方法，以描述儿童做出食物选择的环境。
SCALE 研究将产生关于影响儿童饮食行为的学校和邻里环境因素的背景知识，并为解决儿童营养不良（营养不足和营养过剩）问题提供多层次的干预和政策建议。通过整合经济学、数据科学、营养和公共卫生等多个学科的方法，并考虑家庭、学校和邻里等各个层面的因素，研究将确定干预的杠杆，有可能改善儿童的饮食行为。这将有助于填补食物系统研究方面的空白，并最终有助于黎巴嫩和突尼斯的积极变革，同时也有可能在其他情况下复制。
