Individual-Level Drivers of Food Choices and Diet Quality Among Adolescents in Urban West Africa: Evidence From Accra, Ghana.

Diet quality is influenced by multiple individual factors, but their relative strength and importance remain unclear. We investigate the associations between five domains of individual factors (economic, cognitive, aspirational, situational and consumer behaviour) and diet intake of adolescents in Accra, Ghana. A cross-sectional survey among Junior High School (JHS) students (n = 409, mean age 14.3 years ± 1.28 (SD)) in Accra, Ghana, was conducted. Data on diet intake, knowledge, attitude and practices (KAP) and socioeconomic background characteristics were collected. Adjusting for other factors, students' total budget was positively associated with food group diversity (β = 0.12, 95% confidence interval [CI] 0.09-0.15) but inversely associated with diet quality (β = -0.07, 95% CI -0.11 to -0.03). Positive attitude towards nutrition and healthy eating was inversely associated with unfavourable diversity (β = -0.17, 95% CI -0.31 to -0.03). Differences between negative deviants relative to positive deviants were determined by attitude towards healthy eating (odds ratio [OR] = 0.41; 95% CI 0.17-0.99) and family practices (OR = 0.48; 95% CI 0.23-1.00). We provide evidence that higher food budgets were associated with higher diet diversity, but not with improved diet quality. Attitude, but not knowledge, was linked to better diet quality. Future studies should focus on the specific contribution of aspirational, situational and behavioural factors in directing increased diversity towards favourable eating habits.