الفهرس 
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Abstract
Nutrition is crucial for growth and development, health, and overall well-being during childhood and adolescence. Children and teenagers are snacking more frequently, eating more food away from home, and consuming more soft drinks. Food marketing encourages teenagers to eat nutrient-poor, high-energy meals. These eating habits might continue throughout maturity and result in weight gain, obesity, and non-communicable disease.
Through a variety of platforms and methods, including television advertising, in-school marketing, product placements, kids’ clubs, the internet, and cellphones, adolescents have been targeted with extensive and aggressive food marketing and advertising practices. Therefore, it is crucial to raise teenagers’ understanding of food advertising, nutrition, and a healthy diet.
The aim of the present study to study the relationship between food advertising exposure and food choices of secondary school students in Alexandria. Specific objectives were to describe secondary school students’ patterns of exposure to food advertisement, the patterns of students’ daily food consumption and food choices and to investigate the relationship between food choice and food advertising exposure.
Across-sectional study was conducted among 400 randomly selected from secondary school students, in the public and private secondary schools of Alexandria Governorate, Egypt during the academic year 2020 -2021. A self-administered questionnaire was used for collecting data about socio-demographic characteristics, food habits, food advertisement exposure, and attitude and behavior towards food advertisements.
The study revealed the following results:
• About17% of the students skipped a meal daily; breakfast was the most missed meal during the day in 50% of those who reported skipping meals, higher among public schools (38.2%) than private schools (11.8%).
• A quarter of the studied students (25%) didn’t know the amount of fluid they consume daily and about another quarter (26.8%) drunk less than four cups daily while about 10.8% drunk more than 8 cups daily.
• The commonly consumed snacks by the studied students were juices and fruits (22.7%) of the studied students followed by biscuits and candy by 22% of them with higher percentage among public schools than private schools.
• About 54.5% of the studied sample sometimes consume fast foods and soft drinks with higher percentage among private schools’ students (65.8%) than public schools’ students (51.9%).
• Eating in front of television, computer or mobile, it was found that nearly half of the studied students (51.3%) sometimes watch television, computer or mobile while eating with higher percentage in private schools (69.7%) than public schools (46.9%). Only 5.8% never watch television, computer or mobile.
• More than half of the studied students (56.3%) reported sometimes sleeping directly after eating in a period of less than two hours with higher percentage in public schools (56.5%) than private schools (55.3%).
• It was found that half of the studied students (50%) reported drinking tea sometimes directly after meals.
• Nearly half (42.3%) of families always consume fast food, while 47% of families never consume fast food.
• Nearly half of the studied students 45.8% spent all their money on food outside home with higher percentage among public schools than private.
• It was found that 43.5% of the studied students were exposed to food advertisements through televisions or cinemas with higher percentage among public schools than private schools (45.4% vs. 35.5%, respectively).
• About 33.5% of the studied students were exposed to advertisements five times or more daily with higher percentage among private than public schools’ students.
• The most popular food items advertisements seen were for fast foods from famous restaurants by 31.0% of the students higher among public than private schools’ students (33.3% vs. 21.1%).
• More than half 57.3% of the studied students watch food advertisements on television waiting for the next program with higher percentage among private schools than public schools (63.2% vs. 55.9%, respectively).
• It was found that 42.3% of the studied students spent only one hour higher among public than private schools’ students (47.8% vs. 18.4%).
• More than three quarters (85.8%) of the studied students find food advertisements entertaining and attractive.
• Media advertisements are highly trusted by the students where more than three quarters of the studied students (81.8%) either always or sometimes trust the advertisements with higher percentage among public than private schools’ students (71.1% vs. 84.2%, respectively).
• About two thirds (65%) of the students consult their parents, relatives, or friends before buying advertising food while 34.3% never consult anyone higher among private than public schools’ students (44.7% vs 31.8%, respectively).
• Near half of the students always try the recommended advertised food by friends or relatives, and that was higher among public schools’ students than private schools’ students (45.4% vs. 31.6 %) while 48.5% of the students never tried and that was higher among private than public schools’ students (64.5% vs. 44.8%, respectively).
• More than half 47.3% of the studied students always recommend liked advertised food to others, 44.3% never recommend liked advertised food.
• One third (30.3%) of the studied students wanted to buy an advertised food because of discounts or offers and that was the commonest cause for public schools’ students (31.8%) followed by being a well-known brand in 25.0%.
• Most of adolescents, 96.8% Participated or were aware with health campaigns about healthy higher among public than private schools’ students (97.5% vs 93.4%).
• Most of the studied students 91.25% didn’t visit a dietitian during the past 6 months or followed a special diet program while about 6.3% of the studied students visited the dietitian for weight loss and 2.5% of the studied students visited the dietitian for weight gain.
• The commonest food advertising means were televisions, cinema, social media, and during mobile browsing reported by the participants, the table shows that buying advertised food was in 90.2%, 90.4%, and 95.5%, respectively.
• Most of adolescents bought advertised food 96% were those exposed to food ads four times daily while 63.2% in those exposed only once daily.
• Buying advertised food was 95% higher among students who watched television for two hours and 93.5% among those watched television for more than two hours while those who didn’t watch television were the lowest (61.8%).
• Most of the students who trusted food advertisements bought it were 94.5% among students.
• Most of the students 94.2% found food advertisements entertaining and attractive bought food seen in advertisements higher than who didn’t (71.9%).
• Buying fast food was higher in students who watched television two hours daily (71.3%) followed by those who watched television one hour only (67.9%).
6.2. Conclusion
from the data of the present study, we can conclude the following:
• About half of adolescents skip breakfast before going to school.
• Nearly two- third of adolescents have unhealthy eating habits as drinking tea directly after meals or sleeping directly after eating.
• As regards socioeconomic status as it increases the consumption of fast food increase due to increase of purchasing power and pocket money.
• About half of adolescents spend all of their pocket money on food outside home.
• The more time spent in front of a screen the more vulnerable the students become eating Unhealthy snacks.
• More than half of adolescents eat in front of mobile, television or computer.
• Quarter of the students watch food advertisements more than five times a day through different advertising means.
• The more Adolescents exposed to food advertisements per day the more advertised products they buy.
6.3. Recommendations
Based on the study findings, the following recommendations are suggested:
• Nutrition educational program should be planned for and offered on regular basis to all secondary students to update their knowledge about food advertising and nutrition.
• Posters about nutrition and advertisements effect can be distributed at schools to encourage students to pay attention to nutritional health
• Developing an educational program to increase adolescents understanding and attitudes toward social media and food advertisements.
• Identifying new teaching and training strategies on healthy diet for adolescents to increase student interest in healthy nutrition.
• Integrating learning programs that encourages healthy eating and avoidance of fast food in the school curriculum.
• Increase the family and community awareness about food advertising and negative impact of unhealthy food on health of adolescents, through mass media, social media, and intergenerational programs.
• The school health nurse should encourage the students to take responsibility for choosing healthy snacks and avoid junk food
• Conducting future research and investigation to assess effect of social media on adolescents.