Ultra-processed food consumption, dietary behaviors, and marketing exposure among school adolescents in urban Ethiopia: a qualitative study.

backgroundAdolescence is a critical period for establishing lifelong dietary habits. The growing availability and marketing of ultra-processed foods (UPFs) pose increasing public health nutrition concerns, particularly in rapidly urbanizing settings. However, qualitative evidence on how adolescents in urban Ethiopia engage with UPFs remains limited. This study explored UPF-related dietary behaviors, consumption patterns, and exposure to food marketing among school adolescents in Adama Town, Ethiopia.

methodsA qualitative study was conducted using 15 in-depth interviews with purposively selected secondary-school adolescents aged 13-19 years to ensure variation by age, sex, and school type. Interviews were conducted in Afan Oromo, audio-recorded, transcribed, translated into English, and analyzed thematically using Braun and Clarke's framework. Trustworthiness was enhanced through peer debriefing, reflexivity, and audit trails.

resultsSeven interrelated themes described adolescents' dietary behaviors, consumption patterns, marketing exposure, and recommended responses related to UPFs. Adolescents expressed ambivalent views, describing UPFs as hygienic, quality-assured, affordable, and timesaving, while also recognizing concerns related to artificial ingredients, high sugar and fat content, and long-term health effects. Consumption ranged from frequent intake of packaged snacks, sugary drinks, and some commercially prepared staple foods to occasional fast-food consumption, shaped by taste, availability, affordability, situational need, and social influences from family and peers. Participants identified perceived benefits, including quick energy, weight gain, durability, and trust in the safety of commercially produced foods, alongside recognized risks such as dental problems, obesity, chronic diseases, addiction, and exposure to expired or contaminated products. Exposure to food marketing through mass media, packaging, and branding increased awareness and desire for UPFs, although some adolescents expressed skepticism toward misleading promotions and held mixed views on marketing restrictions. Despite consumption, many adolescents demonstrated reflective awareness and recommended moderation, preference for natural or homemade foods, checking expiry dates, and stronger regulation and consumer education to reduce harms.

conclusionSchool adolescents in urban Ethiopia navigate a complex interplay of taste, convenience, affordability, social influence, and health awareness in their engagement with UPFs. Public health nutrition interventions should address both individual dietary behaviors and the broader food environment, including exposure to food marketing, to promote healthier dietary choices among adolescents.