Influence of Family Behaviour on Adolescents’ Eating Habits in Karbala City, Iraq

Marlen Hashem Salloum*, Nuhad Mohammed Aldoori

Department of Pediatric Health Nursing, College of Nursing, University of Babylon, FC66+9MC, Hillah, Babylon Governorate, Iraq

*Corresponding Author’s Email: marlen.salloum@gmail.com

ABSTRACT

Background: Teenagers in the age range of 10 to 19 years are in a developmental stage where they experience significant physical and mental growth as they transition from puberty to adulthood. Examining the interpersonal effects that influence health behaviours in the context of parent- adolescent relationships is especially significant and rich. Objectives: To identify the family behaviours concerning adolescents’ eating habits in Holy Karbala city, specifically to find-out the differences in family behaviours and adolescents’ eating habits according to their demographic characteristics. Methods: The study design is cross-sectional and stratified sampling method which was conducted at 373 teenagers aged 10 to 19 years, to assess the “Influence of Family Behaviours on Eating Habits among Secondary School Students” in Holy Karbala city centre at 20 governmental secondary schools in education directorate. Students in secondary schools filled out Eating Habits Questionnaires (EHQs) to provide the data. The questionnaire format comprising two sections was designed to cover all aspects of the study; the section one includes demographic characteristics and section two includes family behaviours. The data collected during May 2024. Results: It revealed that most of adolescents (98.9%) live with their families and less than half of adolescents (48.3%) strongly agrees that they enjoy eating meals with their family, and vast majority of them (92.8%) have good level of family behaviours regarding eating habits. Also, the findings indicated a significant impact of family behaviours on the eating habits of adolescents, particularly in relation to the father's level of education. As well, it demonstrated that the occupation of the father had a significant impact on the family behaviours of adolescents. Conclusion: The investigation reveals that elevated levels of positive family behaviours improve the quality of adolescents’ eating habits. Recommendations through the nurse’s role in educating the families’ adolescents to promote healthier food choices.

Keywords: Adolescent; Eating Behaviours; Family; Nursing Education

INTRODUCTION

Teenage years ultimately serves as the transitional phase between childhood and adulthood (Yahia et al., 2025). It generally commences with puberty and concludes when an individual attains constitutional autonomy from their parents or guardians, or "adulthood" (Heslin & McNulty, 2023). The age range of adolescence (10–19 years), it is a stage of fast maturation and growth where there are last growth spikes. High levels of energy and nutrition are needed to keep up with the teens’ rapid intellectual and physical development (Herdiansyah, Setiawan & Tanziha, 2025). Eating habits through adolescence age are also influenced by their desire to attain the perfect body image (Okab & Jawad, 2024). During these years of fast development and change, parents’ views and behaviours toward teenagers also shift, where the parents make an effort to meet their teenagers’ needs as they grow and change on the inside and outside (Liu et al., 2025). Examining the interpersonal effects that influence health behaviours in the context of parent-adolescent relationships is significant and rich, as well as, parents frequently attempt to regulate their children’s health-related habits and act like role models regarding behaviours that promote health (Maia et al., 2025). The arrangement of meal preparation, snack intervals, and food accessibility at home may promote action cues. Encouragement, child engagement, and nutritional education can enhance children’s autonomy, thereby improving their self-efficacy and outcome expectations (Alaslani et al., 2025). Moreover, teenagers who grow up with strict and controlling parents tend to eat poorly and drink more sugar- sweetened beverages (Ardakani et al., 2024; Hübner & Bartelmeß, 2024). According to literatures, studies should focus on adolescents’ eating habits because the rapid physical changes that occur during adolescence have an impact on their quality of life. In addition, eating disorders are therefore severe mental illnesses that often manifest in adolescence and have substantial psychological and physiological aftereffects (Ispas et al., 2025).

Examining the interpersonal effects that influence health behaviours in the context of parent- adolescent relationships is especially significant and rich. Parents frequently attempt to regulate their children’s health-related habits and act like role models regarding behaviours that promote health. In addition, children’s and adolescents’ eating habits are influenced by elements of the home eating environment, including the frequency and caliber of family meals as well as the accessibility and availability of both good and unhealthy foods. The home food environment is directly influenced by parents, who frequently serve to be the nutritional gatekeepers in a household (Sohail et al., 2024).

Nurses have an important role in addressing the impact of family actions on teenagers' eating habits, through health education, family-centered interventions, and community advocacy. Nurses can educate families and adolescents about balanced nutrition, emphasising the risks of poor dietary habits such as obesity and diabetes (Lupu et al., 2025). By conducting workshops in schools and community centers, nurses raise awareness about how family behaviours shape adolescent eating patterns (Baral et al., 2025; López-Gil et al., 2024). Additionally, nurses can work directly with families to modify unhealthy food environments at home, promoting the availability of wholesome foods including vegetables, fruits, and whole grain products and offering parents guidance on how to set a good example (Oudat & Okour, 2025; Rathi et al., 2025). In schools, nurses can collaborate with health teams to implement nutrition programs, conduct dietary screenings, and refer at-risk adolescents to specialists (Talens et al., 2025). Beyond individual and family interventions, nurses can advocate for policies that improve access to healthy foods in Karbala and address socioeconomic barriers to proper nutrition (Ibrahim & Said, 2023).

Significance of the Study

There are an estimated 1.3 billion teenagers in the world today, accounting for 16% of the total population. There are differences in how the adolescent period is defined; the UN defines it as the time between 10 and 19 years of age, while the WHO broadens the definition to include those from 10 to 24 years of age (Heslin & McNulty, 2023). Although adolescence is seen as a healthy stage of life, there is a considerable amount of disease, damage, and mortality throughout this time. A large portion of this is treatable or avoidable. Furthermore, adolescence is a time of increased nutritional needs, the majority of which are greater than those of adults in proportion to body weight and energy requirements. Despite the critical importance of adolescence in the human life cycle, adolescent health concerns are often overlooked, with global health and nutrition policies frequently neglecting their specific needs. The Lancet Commission on Adolescent Health and Wellbeing has referred to adolescent nutrition as a "hidden crisis," drawing attention to this urgent issue (Heslin & McNulty, 2023; Talukdar et al., 2024).

Moreover, consuming at least five different servings of fruit and vegetables each day is recommended by current UK recommendations, making it one indicator of a healthy diet. But according to research, only 8% of children aged 11 to 18 are fulfilling this recommendation; this percentage has not changed much over the previous nine years. Similar to physical activity, dietary habits developed in youth can persist into adulthood (Allcott-Watson et al., 2024; Baral et al., 2025).

Besides, adolescence is a critical time for the growth of healthy behaviours, and developing healthy habits during this time can have long-lasting impacts on a person's general welfare (Majid et al., 2011; Zhang et al., 2024).

METHODOLOGY

Study Design and Setting

This study utilised a cross-sectional design and employed stratified sampling to ensure representative participation. The target population consisted of secondary school students enrolled in governmental secondary schools located within the city centre of Holy Karbala, under the jurisdiction of the Education Directorate.

Study Sample

The study population comprised teenagers aged 10–19 years enrolled in government secondary schools in Holy Karbala, encompassing a total of 20 schools. The Steven Thompson equation was employed to determine the sample size for a population with a known quantity, utilising a probability simple random stratified sampling procedure at a 95% confidence level and a standard deviation of 0.5. Upon using the equation, the sample size was determined to be 373 teenagers.

The Instrument of Study

A questionnaire format comprising two sections was designed to cover all aspects of the study:

Section One: Demographic Characteristic

Consisting of numerous items classified as adolescent's demographic information include age, sex, adolescent’s parents’ age, educational level of adolescent’s parents, and parents’ occupation.

Section Two: Family behaviour:

Assessment the family behaviours include 2 parts to assess family behaviours comprising 21 items. The content validity of the questionnaire is determined by a committee of experts who assessed its appropriateness and clarity in relation to the study’s objectives. The reliability was assessed using Cronbach’s alpha test, yielding values exceeding the critical threshold of 0.70, thereby indicating that the questionnaire is reliable for measuring these variables.

Data Collection

After the administrative approval, data was gathered during May 2024 through filling the Eating Habits Questionnaires (EHQs) by secondary school students (Neumark-Sztainer et al., 2010).

Scoring System

The total score with family behaviours classified as good, moderate, or poor according to the following distribution (Facina et al., 2023; Islam et al., 2024):

• Poor family behaviours with total score between 21 and 34.

• Moderate family behaviours with total score between 35 and 48.

• Good family behaviours with total score between 49 and 63.

Ethical Consideration

This research received ethical approval from the Nursing College Domestic Committee, College of Nursing, University of Babylon, Iraq with reference number 27 on 23rd April, 2024.

RESULTS

The results of the data analysis presented systematically in tables and figures, and are in accordance with selected study objectives:

Demographic Data:

Table 1: Sample Distribution According to Their Demographic Characteristics (N= 373)

N = Number, % = Percentage

Table 1 Demonstrate the highest percentage of them (53.1%) are teenagers (16 - 18≤ years old). Females (56.8%) outnumber males (43.2%).

Table 2: Sample Distribution According to their Parents' Age (N= 373)

Table 2 shows the highest percentage fathers' ages range from 36-50 years (67%). Similarly, the highest percentage mothers (66.5%) are within the same 36-50-year range. In addition, the fathers have a broader age distribution (30-78 years) compared to the mothers (25-65 years).

Family Behaviours of Adolescents

Table 3: Distribution of The Sample According to their Behaviours in their Home (N= 373)

The Table 3 illustrate that the highest percentage of them 46.4% never have Fruits and vegetables available, but 69.2% always served vegetables for dinner, is quite prevalent 50.9% indicating its always present fast food, 60.9% sometimes have fruit juice available, while 76.9% always serve milk during meals. In addition, 43.2% sometimes present chips or other meals light salty, chocolate or other sweets and use bread (such as whole wheat).

Table 4: Distribution of the Sample According to their Family's Behaviour Mealtimes

Table 4 presents the distribution of the study sample regarding their family’s mealtime behaviours, revealing some notable trends. The highest proportion (48.3%) strongly agreed that they enjoy eating meals with their family. Additionally, 56.6% agreed that they are expected to be at home for dinner. Conversely, 52.3% disagreed with the statement that teenagers should eat every food offered to them, even if they do not like it.

Table 5: The Differences in Family Behaviours of Adolescents According to Fathers and Mothers' Age and Education

T: Independent sample (t) test, F: One Way ANOVA test; NS (Not Significant): P-value >0.05, HS (Highly Significant): P-value

<0.01, S: P-value <0.05

Table 5 displays that there is a high statistically significant differences (P=0.002) in family behaviours according to father's educational level. Nonetheless there was NO statistically significant differences in family behaviours (P>0.05) according to all other variables.

Table 6: Differences in Family Behaviours of Adolescents According to Fathers and Mothers' Occupation

T: Independent sample (t) test, F: One Way ANOVA test; NS: P-value >0.05, HS: P-value <0.01, S: P-value <0.05

Table 6 shows a statistically significant difference (P=0.002) in adolescents’ family behaviours based on their father’s occupation. However, no statistically significant differences (P > 0.05) were observed in family behaviours with respect to all other variables.

Table 7: The Association between Family Behaviours and Eating Habits of Adolescents

M: mean score, SD: standard deviation R: person test, HS: P-value <0.01

Table 7 display a significant moderate positive correlation (r = 0.335, P < 0.01) exists between the two variables, indicating that higher levels of family behaviours among adolescents enhance the quality of their eating habits.

DISCUSSION

Findings from the present study, as shown in Table 1, indicated that more than half of the adolescents were aged between 16 and ≤18 years, and over half were female. This may be linked to Iraqi cultural norms that allow males to stay late at work, potentially increasing their likelihood of dropping out of school. Furthermore, as adolescence is a critical period for identity formation and self-assertion, males are often more inclined than females to rebel, particularly regarding parental decisions. These results are consistent with the study by Selman, Hussain, and Mera (2024) on the nutritional status of adolescents in Babylon Province, Iraq, which reported a mean age of 16.4 ± 0.4 years among 500 high school students.

The findings as demonstrated in Table 3 related to a family’s eating behaviour at home and its impact on adolescents’ eating behaviour indicate that two-fifths of them never have fruits and vegetables available, and more than two-thirds always serve vegetables for dinner, in addition, half of them always present fast food and three quarters always serve milk during meals. For a variety of reasons, teenagers frequently choose fast food. It's practical, simple to get to, and frequently accommodates the busy times of adolescents between social events, other interests, and school. Perhaps the taste and flavour of fast food are among the many factors that attract adolescents to it. As well, fast food is often heavy in fat, sugar, and salt, making it attractive to them. The fast food may be pleasurable because these components have the ability to cause pleasure reactions in the brain. Moreover, teenagers enjoy having milk with their meals, possibly because the protein and other nutrients it contains support healthy growth and development. Also, dairy products include high-quality protein, which is necessary to power muscles and keep adolescents active (Sharobidinovna, Baxtiyor & Muslimbek, 2025).

Therefore a child’s behaviour is greatly influenced by the family’s everyday behaviours (Wu, 2024). Children can learn to form lifelong good eating habits with the assistance of their parents. In the line, Braune Adams and Winpenny (2024) found in study that there was a significant correlation between parental and teenage fruit vegetable intake across the board. Additionally, this supported by a different study (Liu 2023), that was carried out in Hong Kong, China, this study found that parental practices may have an impact on adolescents’ knowledge of healthy eating. Also, revealed that the perceived value of eating healthily and the relevance of health in food matters are generally viewed favourably by parents. Similarly, the research by Kontele et al. (2023) illustrates a correlation between the increased prevalence of eating disorder behaviours in adolescents and the presence of similar behaviours in their parents, which considered as evidence exists regarding the influence of family eating behaviours on adolescents’ dietary habits.

Furthermore, the researchers discovered according to Table 4, some interesting trends regarding adolescents’ family’s behaviours around mealtimes, where it showed that the highest percentage of participants strongly agree that they enjoy eating meals with their families and more than half of them they are expected to be at home for dinner. Correspondingly, it showed that most adolescents have good level of family behaviours regarding eating behaviours. Mealtime is an excellent opportunity to teach basic manners, foster communication, and avoid behavioural eating disorders. When families have meals together, their children feel more supported, comfortable, and protected, and this family cohesion is protective for both physical health and mental wellbeing (Spaumer & Mavhandu-Mudzusi, 2025).

The outcome aligns with the research that demonstrated how frequent family dinners might offer teenagers tangible examples of portion control and balanced nutrition in an organised setting, this may relate to the family meals may help prevent disordered eating behaviour's chaotic eating patterns while also promoting the establishment of regular eating habits, additionally, having meals together could serve as a forum for candid conversation, offering a chance to voice worries and encourage constructive criticism of eating patterns skill that can be particularly helpful during adolescence. Even though it has been widely acknowledged that family meal participation helps reduce disordered eating behaviours among teenagers (López-Gil et al., 2024). Moreover, in the line with another study identified family actions that could influence adolescents’ knowledge, attitudes, and practices regarding healthy eating, positive perspectives from parents concerning the availability of nutritious food, oversight in dietary choices, and the promotion of healthy eating habits (Liu et al., 2023). Furthermore, these results are consistent with a study conducted in the United Arab Emirates by Sohail which presents new research on the Home Food Environment (HFE) among adolescents in the country and its impact on their eating habits and family meal patterns, this study showed that HFE has a major influence (Sohail et al., 2024).

According to the outcome of the existing research as shown in Table 5 regarding parents’ level of education, parents’ eating patterns and their children’s eating behaviours, the findings indicated a significant impact of family behaviours on the eating habits of adolescents, particularly in relation to the father's level of education. This aligns with the findings of studies conducted by Yasin, Hassan and Ateye (2024), which demonstrated that additional factors, such as the education level of parents, can significantly influence adolescents’ eating habits, where those with higher education levels are better equipped to acquire and apply the knowledge necessary for maintaining a healthy diet. Conversely, the present study showed that there were no statistically significant differences in family behaviours related to adolescents’ eating habits based on the educational level of mothers. In contrast to the same study which indicated that adolescents with mothers lacking formal education were considerably more prone to malnutrition.

Regarding parents’ occupation, the findings of the current study as clarified Table 6 demonstrated that the occupation of the father had a significant impact on the family behaviours of adolescents. Whereas may related to what is known that the vocations of parents or fathers are closely linked to the family’s socioeconomic standing, which can significantly affect adolescents' eating habits by affecting the availability and consumption of fruits, vegetables, and foods high in energy. Therefore, healthier eating habits in teenagers are typically associated with higher parental financial standing (Svolos et al., 2025). Similarly, Zaborskis et al., (2021) conducted a study across 41 countries, revealing that family income had a significant effect on the eating habits of teenagers, extensive studies have shown that adolescents from low-income households consume fewer nutritious meals compared to their peers from high-socioeconomic status families.

Concerning association between family behaviours and eating habits of adolescents, the present study results in Table 7 indicated that higher levels of family behaviours among adolescents enhance the quality of their eating habits. Thus, it is evident that there is a noteworthy connection between the eating habits of teenagers and the behaviours exhibited within their families, the eating habits and attitudes of adolescents regarding health are significantly shaped by their parents. As children mature, the dynamics within the parent-child relationship evolve, influencing the ways in which parents guide their young children’s behaviours (Kalogirou & Gentaz, 2025).

Research conducted by Braune, Adams and Winpenny, (2024) indicates a significant correlation between the eating habits of adolescents and those of their parents, suggesting that parents maintain a positive influence on their children. Another study (Liu et al., 2023) assessed 48 qualitative studies regarding the home food environment and the role of parents, revealing that numerous investigations have explored how families foster healthy eating over the past few years (2016–2020), these studies highlighted the importance of educating adolescents about the benefits of nutrition, promoting cooking skills, and engaging in discussions about food during mealtimes, additionally, it was disclosed how guardians impart knowledge about nutritious eating habits to their descendants through their understanding. In addition, another investigation reinforced the findings that the home food environment and parental role modelling significantly influence teenage eating patterns, elucidating the ways in which these elements shape adolescents’ KAP (Knowledge, Attitude, and Practice) concerning their eating behaviours , the significant relationship between family behaviours and the eating habits of adolescents is evident (Liu et al., 2021).

Limitation

The cross-sectional methodology used in the study makes it difficult to determine a causal link between adolescent eating habits and family behaviours. The evidence of behavioural influences over time might be more robust in longitudinal research. In addition, the study was limited to Karbala, where the family dynamics and eating habits, which may be influenced by cultural norms; its conclusions might not hold true for other countries with distinct nutritional, cultural, and economic customs.

CONCLUSION

The study reveals that the elevated levels of positive family behaviours on teenagers improve the quality of their eating habits. Long-term longitudinal designs may be used in future studies to monitor the changes in family impacts on eating habits as teenagers grow into adults. This would make it easier to comprehend how dietary habits change or endure overtime. Moreover, Future nursing research can examine the effects of authoritative, authoritarian, permissive, and uninvolved parenting styles on adolescents' food preferences, portion control, and nutrition-related attitudes.

Recommendation

The study recommends the importance of nurses’ role to serve as key figures in promoting long- term healthy eating behaviours among adolescents by combining education, counselling, advocacy, and evidence-based strategies, as well as to improve awareness concerning appropriate preventive measures that can change their unhealthy habits.

Conflict of Interest

The authors declare that they have no competing interests.

ACKNOWLEDGEMENT

The participants' patience and cooperation are greatly appreciated, and the authors are truly grateful for their efforts, which were instrumental in the successful completion of the task. Additionally, the leadership team of the Educational Karbala Directorate of Education in Karbala City is the intended recipient of this correspondence. The authors would like to extend their sincere gratitude to each and every one of them.

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