Impact of School Meal Programs on Adolescent Nutritional Status and Dietary Habits

Thesis Abstract

The escalating prevalence of malnutrition and poor dietary habits among adolescents presents a significant public health challenge, necessitating targeted interventions such as school meal programs to improve nutritional outcomes and promote healthier eating behaviors. This study aims to evaluate the impact of school meal programs on the nutritional status and dietary habits of adolescents aged 12 to 18 years, enrolled across five secondary schools in urban and semi-urban regions. The specific objectives are to assess changes in anthropometric indicators, examine dietary intake patterns pre- and post-implementation, and identify factors influencing adherence and sustained dietary improvements among participants. Employing a mixed-methods research design, the study combines quantitative and qualitative approaches to yield comprehensive insights. The quantitative component follows a quasi-experimental pre-test/post-test control-group design involving a total sample of 600 adolescents, randomly assigned to intervention and control groups, with 300 participants in each. The intervention group participants receive school-provided meals adhering to national nutritional guidelines over a six-month period, while the control group continues with their usual diet. Data collection instruments include structured questionnaires for dietary recall (24-hour dietary recall and food frequency questionnaires), standardized anthropometric measurements (height, weight, BMI-for-age), and dietary behavior questionnaires developed based on the Social Cognitive Theory. Qualitative data are obtained through focus group discussions and in-depth interviews with participants, parents, and school staff to explore perceptions, barriers, and facilitators related to the program. To ensure validity and reliability, the instruments are piloted with a similar demographic cohort, and Cronbach’s alpha coefficients exceeding 0.8 are achieved for all scales. Data analysis employs descriptive statistics (means, standard deviations), inferential statistics including paired t-tests and ANCOVA to compare pre- and post-intervention anthropometric and dietary indicators, and multiple regression analysis to identify predictors of dietary compliance. Thematic analysis using NVivo software is conducted for qualitative data, supported by a conceptual framework grounded in the Theory of Planned Behavior and Social Cognitive Theory, to interpret behavioral influences. Expected findings indicate that adolescents participating in the school meal program will demonstrate statistically significant improvements in nutritional status indicators—including BMI-for-age and micronutrient levels—and adopt healthier dietary patterns characterized by increased fruit and vegetable intake and reduced consumption of sugary snacks. The study anticipates to reveal key behavioral determinants influencing program adherence, such as peer influence, nutritional knowledge, and parental support. These outcomes contribute to the existing body of knowledge by providing empirical evidence on the effectiveness of school meal interventions within the context of low- to middle-income urban settings, highlighting critical factors for sustainable program success. The main conclusion underscores the efficacy of well-structured school meal programs in enhancing adolescent nutrition and dietary behaviors, underscoring their role as an integral strategy in combating malnutrition. Recommendations include policy enhancements to ensure consistent nutritional quality, integration of nutrition education components, and community engagement initiatives to reinforce healthy eating practices. The study advocates for further longitudinal research to assess the long-term impacts of school meal programs and to explore scalable models adaptable to diverse socio-economic contexts, thereby informing policymakers, educators, and health practitioners on best practices for adolescent nutritional interventions.