Food and Nutrition Literacy and Dietary Behaviors among Lower Secondary School Students in Samut Songkhram Province, Thailand: A Cross-Sectional Study

Niwat Songsin; Khamchira  Rattakankowibool; Darawadee  Pektawong; Praewa Taweesap; Rusnanee Samoh; Kanokporn  Somporn; Adithep Phranphithak; Prakasit Wannapaschaiyong

doi:10.55489/njcm.170720266642

Authors

Niwat Songsin Department of Community Public Health, College of Allied Health Sciences, Suan Sunandha Rajabhat University, Bangkok, Thailand
Khamchira Rattakankowibool Department of Community Public Health, College of Allied Health Sciences, Suan Sunandha Rajabhat University, Bangkok, Thailand
Darawadee Pektawong Department of Community Public Health, College of Allied Health Sciences, Suan Sunandha Rajabhat University, Bangkok, Thailand
Praewa Taweesap Department of Community Public Health, College of Allied Health Sciences, Suan Sunandha Rajabhat University, Bangkok, Thailand
Rusnanee Samoh Department of Community Public Health, College of Allied Health Sciences, Suan Sunandha Rajabhat University, Bangkok, Thailand
Kanokporn Somporn Department of Community Public Health, College of Allied Health Sciences, Suan Sunandha Rajabhat University, Bangkok, Thailand
Adithep Phranphithak Department of Community Public Health, College of Allied Health Sciences, Suan Sunandha Rajabhat University, Bangkok, Thailand
Prakasit Wannapaschaiyong Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Thailand

DOI:

https://doi.org/10.55489/njcm.170720266642

Keywords:

Food and Nutrition Literacy, Dietary Behaviors, Lower Secondary School Students, Thailand

Abstract

Background: Food and nutrition literacy (FNL) is an important determinant of healthy dietary behaviors among adolescents. This study examined the relationship between FNL and dietary consumption behaviors among lower secondary school students in Samut Songkhram Province, Thailand.

Methods: A cross-sectional survey was conducted among 584 Grade 7-9 students selected through multistage sampling from six schools between July and November 2025. Data were collected using validated questionnaires assessing FNL (functional, interactive, and critical domains) and dietary consumption behaviors. Descriptive statistics, Pearson’s correlation, t-tests, and multiple linear regression analyses were performed.

Results: Participants demonstrated a moderate overall level of FNL (mean=3.04±0.48), while dietary consumption behaviors were low (mean=2.16±0.16). Overall FNL was positively correlated with dietary behaviors (r=0.509, p<0.001). Functional (r=0.250), interactive (r=0.155), and critical literacy (r=0.206) were also significantly associated with dietary behaviors (all p<0.001). Multiple regression identified FNL (β=0.502, p<0.001) as the strongest predictor of dietary behaviors, with gender also significant (β=0.149, p<0.001). The model explained 29.7% of the variance in dietary behaviors (R²=0.297). Female students reported significantly higher FNL and healthier dietary behaviors than males.

Conclusions: Food and nutrition literacy is strongly associated with healthier dietary behaviors among adolescents. Interventions strengthening nutrition literacy, particularly interactive and critical skills, may improve dietary practices.

References

Wiafe MA, Apprey C, Annan RA. Dietary diversity and nutritional status of adolescents in rural Ghana. Nutr Metab Insights. 2023;16:11786388231158487. DOI: https://doi.org/10.1177/11786388231158487 PMid:36923452 PMCid:PMC10009014

NCD Risk Factor Collaboration (NCD-RisC). Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults. Lancet. 2024;403(10431):1027-1050. DOI: https://doi.org/10.1016/S0140-6736(23)02750-2 PMid:38432237 PMCid:PMC7615769

World Health Organization. Obesity and overweight [Internet]. Geneva: World Health Organization; 2024 [cited 2025 May 20]. Available from: https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweigh

Black RE, Victora CG, Walker SP, Bhutta ZA, Christian P, de Onis M, et al. Maternal and child undernutrition and overweight in low-income and middle-income countries. Lancet. 2013;382(9890):427-451. DOI: https://doi.org/10.1016/S0140-6736(13)60937-X PMid:23746772

Poti JM, Braga B, Qin B. Ultra-processed food intake and obesity: what really matters for health processing or nutrient content? Curr Obes Rep. 2017;6(4):420-431. DOI: https://doi.org/10.1007/s13679-017-0285-4 PMid:29071481 PMCid:PMC5787353

Borges CA, Marchioni DML, Levy RB, Slater B. Dietary patterns associated with overweight among Brazilian adolescents. Appetite. 2018;123:402-409. DOI: https://doi.org/10.1016/j.appet.2018.01.001 PMid:29355584

Keats EC, Rappaport AI, Shah S, Oh C, Jain R, Bhutta ZA. The dietary intake and practices of adolescent girls in low- and middle-income countries: a systematic review. Nutrients. 2018;10:1978. DOI: https://doi.org/10.3390/nu10121978 PMid:30558128 PMCid:PMC6315365

UNICEF Thailand. Obesity exceeds underweight for the first time among school-age children and adolescents globally [Internet]. Bangkok/New York: UNICEF; 2025 Sep 10 [cited 2026 Jun 11]. Available from: https://www.unicef.org/thailand/press-releases/obesity-exceeds-underweight-first-time-among-school-age-children-and-adolescents

Choeibuakaew W, Yodrak W, Saithanoo S, Vanaleesin S. The development of early adolescent food and nutrition literacy model in southern Thailand. Health Science Journal of Thailand. 2025;7(2):9-15. DOI: https://doi.org/10.55164/hsjt.v7i2.270546

World Health Organization. WHO acceleration plan to stop obesity. Geneva: World Health Organization; 2023. Available from: https://www.who.int/publications/i/item/9789240075634

Nutbeam D. Health promotion glossary. Health Promot Int. 1998;13(4):349-364. DOI: https://doi.org/10.1093/heapro/13.4.349

Klakasikit C, Panya T, Philuek H, et al. Nutrition literacy and food consumption behaviors among undergraduate students in northern Thailand using a mixed method approach. Discov Soc Sci Health. 2026;6:29. DOI: https://doi.org/10.1007/s44155-026-00368-9

Wungrath J, Chanwikrai Y, Khumai N, Sutan P. Perception towards food choice among low-income factory worker parents of pre-school children in northern Thailand: a qualitative study. Malays J Public Health Med. 2023; 22:98-106. DOI: https://doi.org/10.37268/mjphm/vol.22/no.3/art.1682

Silva P, Araújo R, Lopes F, Ray S. Nutrition and food literacy: Framing the challenges to health communication. Nutrients. 2023;15(22):4708. DOI: https://doi.org/10.3390/nu15224708 PMid:38004102 PMCid:PMC10674981

Yuen EYN, Thomson M, Gardiner H. Measuring nutrition and food literacy in adults: a systematic review and appraisal of existing measurement tools. HLRP: Health Lit Res Pract. 2018;2(3):e134-e160. DOI: https://doi.org/10.3928/24748307-20180625-01 PMid:31294289 PMCid:PMC6607839

Deesamer S, Piaseu N, Maneesriwongul W, Orathai P, Schepp KG. Development and psychometric testing of the Thai-Nutrition Literacy Assessment Tool for Adolescents. Pacific Rim Int J Nurs Res. 2020;24(1):5-19.

O'Leary M, Mooney E, McCloat A. The relationship between nutrition knowledge and dietary intake of university students: A scoping review. Dietetics. 2025;4(2):16. DOI: https://doi.org/10.3390/dietetics4020016

Ministry of Public Health. Standard report: Overweight and obesity among school-aged children, Samut Songkhram Province [Internet]. Nonthaburi: Ministry of Public Health; 2022 [cited 2025 Apr 17]. Available from: https://hdc.moph.go.th/skm/public/standard-report-detail/64cfdc7621c3894d76bc9774f7494776

Krejcie RV, Morgan DW. Determining sample size for research activities. Educational and Psychological Measurement, 1970;30(3): 607-610. DOI: https://doi.org/10.1177/001316447003000308

Koedphaen C. Factors associated with food and nutrition literacy among junior high school students in a province of the lower northern region [master's thesis]. Phitsanulok: Naresuan University; 2022. Available from: http://nuir.lib.nu.ac.th/dspace/handle/123456789/5768

Best JW. Research in education. 3rd ed. Englewood Cliffs (NJ): Prentice-Hall; 1977.

Koedphaen C. Factors associated with food and nutrition literacy among junior high school students in a province of the lower northern region [master's thesis]. Phitsanulok: Naresuan University; 2022. Available from: http://nuir.lib.nu.ac.th/dspace/handle/123456789/5768

Müllertz ALO, Stjernqvist NW, Outzen MH, Bloch P, Elsborg P, Ravn-Haren G. A cross-sectional study of the association between food literacy and dietary intake among Danish adolescents. Appetite. 2024;200:107526. DOI: https://doi.org/10.1016/j.appet.2024.107526 PMid:38797236

Siviroj P, Wungrath J, Ongprasert K. Associated factors of dietary patterns among adolescents in the rural northern region of Thailand: A community-based cross-sectional study. Healthcare. 2024;12(12):1215. DOI: https://doi.org/10.3390/healthcare12121215 PMid:38921329 PMCid:PMC11203095

Man CS, Salleh R, Ahmad MH, et al. Dietary patterns and associated factors among adolescents in Malaysia: findings from the Adolescent Nutrition Survey 2017. Int J Environ Res Public Health. 2020;17(10):3431. DOI: https://doi.org/10.3390/ijerph17103431 PMid:32423077 PMCid:PMC7277301

Qutteina Y, Hallez L, Raedschelders M, De Backer C, Smits T. Food for teens: How social media is associated with adolescent eating outcomes. Public Health Nutr. 2022;25(2):290-302. DOI: https://doi.org/10.1017/S1368980021003116 PMid:34325764 PMCid:PMC8883778

Kamel IH, Metwally AM, Zaki DA, et al. Nutrition literacy across adolescence stages in Egypt: a quartile-based analysis for tailored educational strategies. BMC Public Health. 2025;25:2389. DOI: https://doi.org/10.1186/s12889-025-23583-6 PMid:40618101 PMCid:PMC12228376

Daneshvar S, Ghaffari M, Ramazankhani A, Marashi T. Conceptual explanation of adolescents' media health literacy: A qualitative content analysis. J Educ Health Promot. 2023;12:333. DOI: https://doi.org/10.4103/jehp.jehp_129_23

Nutbeam D. Health literacy as a public health goal: A challenge for contemporary health education and communication strategies into the 21st century. Health Promot Int. 2000;15(3):259-267. DOI: https://doi.org/10.1093/heapro/15.3.259

Trübswasser U, Talsma EF, Ekubay S, Poelman MP, Holdsworth M, Feskens EJM, Baye K. Factors influencing adolescents' dietary behaviors in the school and home environment in Addis Ababa, Ethiopia. Front Public Health. 2022;10:861463. DOI: https://doi.org/10.3389/fpubh.2022.861463 PMid:35462798 PMCid:PMC9024113

Fleary SA, Joseph P, Pappagianopoulos JE. Adolescent health literacy and health behaviors: a systematic review. J Adolesc. 2018;62:116-127. DOI: https://doi.org/10.1016/j.adolescence.2017.11.010 PMid:29179126

Velardo S. The nuances of health literacy, nutrition literacy, and food literacy. J Nutr Educ Behav. 2015;47(4):385-389. DOI: https://doi.org/10.1016/j.jneb.2015.04.328 PMid:26026651

Otsuka Y, Kaneita Y, Itani O, Jike M, Osaki Y, Higuchi S, et al. Gender differences in dietary behaviors among Japanese adolescents. Prev Med Rep. 2020;20:101203. DOI: https://doi.org/10.1016/j.pmedr.2020.101203 PMid:32995146 PMCid:PMC7509230

Mueller K, Messner A, Nairz J, et al. Determinants of diet quality in adolescents: results from the prospective population-based EVA-Tyrol and EVA4YOU cohorts. Nutrients. 2023;15(24):5140. DOI: https://doi.org/10.3390/nu15245140 PMid:38140399 PMCid:PMC10746085

Jurado-Gonzalez P, López-Toledo S, Bach-Faig A, Medina FX. Barriers and enablers of healthy eating among university students in Oaxaca de Juarez: A mixed-methods study. Nutrients. 2025;17(7):1263. DOI: https://doi.org/10.3390/nu17071263 PMid:40219019 PMCid:PMC11990523