Perceived barriers mediate the association between self-efficacy and fruit and vegetable consumption among students in alternative high schools

Background. Dietary behaviors are not well understood among alternative high school (AHS) students, schools that serve students at risk of academic failure. AHS students are more likely to be racial/ethnic minorities, and have higher levels of poverty, and higher rates of risky health behaviors. Therefore, we examined whether perceived barriers to healthy eating (HE) mediated the association between self-efficacy to eat healthfully and fruit/vegetable (FV) consumption among students attending AHS.

Methodology. Students (n=145) from 6 AHS participating in an obesity prevention study completed self-report questionnaires that included reliable measures of perceived barriers to healthy eating (alpha= 0.82 ), self-efficacy (alpha= 0.84 ), and FV consumption (alpha=0.85).

Mixed model logistic regression, adjusting for sociodemographic characteristics and clustering within schools, was used to test a series of regression models performed according to mediation analysis procedures.

Results. Students' mean age was 17.3 years (SD=1 year), 52% were male, 63% were low-income; and 61% were non-white. Participants reported a median FV intake of 3.6 servings/ day, mean self-efficacy score of 22.2 (range 3-35), and mean HE barriers score of 6.9 (range 3-13). HE barriers fully mediated the relationship between self-efficacy and FV consumption (Sobel test statistic =2.7, p=0.007).

Significance. FV consumption has been linked to a lower risk of chronic disease, particularly diseases associated with overweight and obesity. Study results suggest interventions targeting the dietary practices of AHS students should include a component on decreasing perceived barriers as a way to increase self-efficacy and ultimately FV intake among students at high risk for obesity.