(P08-010-24) What Drives Schoolchildren’s Food Choices? Insights From a Gamified Choice Experiment in Tunisia

Objectives: To identify potential food attributes (accessibility, preparation, and price) and contextual factors (parental supervision and peer influence) which can influence schoolchildren’s food choices in urban Tunisia, using a gamified Choice Experiment (CE).

Methods: A representative sample of schoolchildren aged 8-12y was recruited using a two-stage cluster-randomized, cross-sectional school survey in Greater Tunis, Tunisia (n=2,465). A structured questionnaire was administered face-to-face, and children played a gamified CE on a tablet which included choice tasks/vignettes simulating real-life food choice options for children on a typical school day. Six nodes (breakfast, road to school, recess, lunch, snack and dinner) with different settings (home, school, and neighborhood) were developed. In each node, children were presented with a set of nine items: three food types (beverage, side and meal) with three options reflecting different levels of healthiness (healthy, somewhat healthy and unhealthy) for each type. Children were allowed to select multiple items. Nine random-effects binary logit models were estimated to explain the choice of beverage/side/meal items, in four lumped nodes (home, school, lunchbox and road).

Results: The CE generated 43,938 choice observations. Children had a preference for choosing healthier beverages as compared to the other food types in all settings except schools. Meal-meal dependencies in all four nodes showed that choosing healthy meals significantly increased the likelihood of choosing unhealthy ones and vice versa. No significant effect of price in food choice was observed. Food items not easily accessible at home (e.g. in a cupboard) were significantly less likely to be selected (OR range: 0.61-0.78) regardless of food type or healthiness levels. Presence of a peer/parent eating unhealthy foods significantly increased the odds of choosing unhealthy items, only on the trajectories to/from school.

Conclusions: Reducing availability and accessibility of unhealthy foods and encouraging support from peers and parents could improve schoolchildren's food intake. Compensation behaviors might explain children’s tendency to simultaneously choose healthy and unhealthy meals.

Funding Sources: International Development Research Centre - Canada