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NANYANG RESEARCH PROGRAMME

After-School Snacking Habits of Teenagers in Singapore

Celeste Chua

River Valley High School

Dr Soo Li Mei, Johannah

National Institute of Education

ABSTRACT

There is a growing trend of obesity among teenagers in Singapore despite the numerous health initiatives implemented by schools and the government. Obesity can be linked to our food consumption habits, especially the additional calorie intake through snacking. This paper seeks to understand the factors affecting teenagers’ choice of snacks and the effective ways to promote healthy after-school snack consumption habits among teenagers. A total of 243 teenagers in Singapore, aged 13 to 18 years old, were surveyed using an online questionnaire. Taste of snack, price, and convenience of obtaining the snacks are found to be the top factors affecting the type of snack intake. Teenagers snack to relieve stress and satisfy their hunger due to early and short breaks in schools. During the Circuit Breaker period, reasons for snacking more changed to boredom and increased convenience. Most teenagers are concerned about the health issues when snacking unhealthily but only half prefer to eat healthy snacks to unhealthy snacks as unhealthy snacks taste better and are cheaper. Some of the proposed strategies include innovating to make healthy snacks more appetising, lowering their prices, and making them more convenient for purchase. This is crucial to build a healthier younger generation.

Keywords: after-school snacking, teenagers, attitude

1 INTRODUCTION

A study in the United Kingdom found that 64% of young people snack outside of mealtimes, with most of these snacks being high in fat, sugar and salt, such as cakes, biscuits and chocolates [1]. Snacking can cause excessive intake of calories which can lead to a person being overweight or obese. In Singapore, the proportion of overweight children in our mainstream schools, aged 6 to 18 years, has increased from 11% in 2013 to 13% in 2017 [2].

Moreover, 70% to 80% of children who are obese remain obese when they grow into adults [3]. This is a worrying sign as obesity poses serious health complications to teenagers, especially when they reach adulthood such as Type 2 diabetes, high blood pressure and cardiovascular diseases [4]. Obese teenagers can also encounter psychosocial issues such as peer discrimination and having poor self-esteem [5]. Hence, it is crucial to reduce unhealthy snacking among teenagers.

This research investigates the factors affecting teenagers’ choice of snacks and the effective ways to promote healthy after-school snack consumption habits among teenagers through surveys. This research hypothesises that peer influence, taste of snacks, price and convenience of purchase are the main factors that may influence snacking habits. Results from this research can help the schools in educating students in choosing and consuming healthy snacks, as well as promoting the sales of snacks in schools.

2 AIMS/OBJECTIVES

To investigate the factors affecting teenagers’ choice of snacks and the effective ways to promote healthy after-school snack consumption habits among teenagers.

The objectives of this paper are:

• Describe the attitude, in terms of affection, behaviour and cognition, towards snacking.

• Define the snacking habits of Singapore students, during normal time and Coronavirus Disease 2019 (COVID-19) Circuit Breaker period.

• Determine the effect of age, gender, pocket money and Body Mass Index (BMI) on snacking choices.

• Determine teenagers’ awareness of healthier choice initiatives.

• Determine the effective channels to promote healthy snacking.

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3 LITERATURE REVIEW

I. FACTORS AFFECTING SNACK CHOICE

Peer Influence

Peers’ behaviour can affect students’ snack consumption. Teenagers are more likely to purchase the snacks that their friends buy, especially for close friends who are stronger role models for each other [6]. For example, when their friend buys an unhealthy snack after school, they will also be tempted to do the same so that they will not lose out, i.e., be socially accepted by their peers, particularly during puberty [6]. Teenagers are also likely to follow a trend. One such trend is the bubble tea craze which led to more than 37 bubble tea chains operating in Singapore [7]. Bubble tea appeals to teenagers and they will often post about the drinks via social media, influencing their friends to drink it. Thus, popular snack trends will lead to more teenagers consuming those snacks.

Taste

Healthy snacks are often perceived as not taste appealing and consumers have no positive feelings towards them [6]. Humans have a natural liking for food with sugar, fat and salt and will choose to consume unhealthy snacks to better satisfy their cravings and obtain a satiety effect [8]. Moreover, it is sometimes too appetising for teenagers to exercise self-control and limit their unhealthy snacking as their taste system will adapt to the taste of unhealthy snacks. For example, studies have shown that if people consume more fats, their responses to fats naturally reduce and they will need to consume more to reach the same level of satisfaction as before [8]. Therefore, it makes it even harder for teenagers to cut down on unhealthy snacking and switch to healthier snacks which are usually less tasty.

Convenience

Besides, teenagers who attend schools which are located near fast-food restaurants are more likely to consume unhealthy snacks than other students whose schools are further away from fast-food restaurants. In the United States, a study showed that a youth had 1.06 times of being overweight and 1.07 times of being obese if the youth's school was near a fast-food establishment [9]. When schools are located nearer to a fast-food restaurant, students do not need to travel far to buy fast-food snacks. Thus,

the increased convenience and ease of obtaining fast-food snacks make it tempting for students to consume fast-food snacks. Even without the temptation of snack outlets, the availability of snacks at home will also encourage consumption. Family members can act as role models and supporters for healthy snack consumption [6]. This is especially important during the COVID-19 circuit breaker period where most people were not allowed to come out of their homes and snacking at home became more frequent. Thus, snacking was mostly influenced by the type of snacks at home. This paper will investigate if the convenience to purchase snacks affects the snack consumption among teenagers in Singapore.

Emotional Eating

Emotional eating can lead to unhealthy snacking. Under long periods of stress, our bodies produce cortisol, a hunger-inducing hormone. This affects teenagers’ food preferences and causes their bodies to react favourably when they consume food that are high in fat or sugar, or both [10]. Moreover, research has pointed out that snacking may provide comfort or distraction from negative emotions associated with stress [11]. Hence, some may often snack on comfort food to relieve their stress. In addition, some comfort food can make teenagers happier when they are upset. For example, high fat food such as ice-cream may activate chemicals in the body that create a sense of contentment [12]. Hence, it is hard to resist unhealthy comfort food when they act as an immediate mood lifter once teenagers start eating them, increasing the tendencies of over snacking.

Price

Price of snacks affects snacking choices. In a large study involving 12 high schools and 12 worksites, price reductions on low-fat vending machine snacks of 10%, 25%, and 50%, increased sales of these items by 9%, 39%, and 93%, respectively [13]. When healthier snacks are sold at lower prices, teenagers are more inclined to purchase them. Moreover, some shops have incentives such as memberships and reward systems to incentivise teenagers to continue patronising their shops. For example, customers can use Starbucks cards to pay for their snacks and accumulate points to get rewards. Some bubble tea shops also offer student discounts. For instance, at a bubble tea shop, Liho, the student price for a cup of milk tea with pearls is $2 which is cheaper than the usual price of $3.10, attracting students to buy.

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II. CURRENT MEASURES ON SNACKING

Healthy Eating Guidelines

In Singapore, the Health Promotion Board has implemented dietary guidelines for Singaporeans to follow. Singaporeans are encouraged to choose healthier snack options such as wholegrain foods, fruit and vegetables, dairy, or calcium-rich foods [14]. There is also a Healthier Meals in Schools Programme which encourages healthier food and beverage choices in schools. Under this programme, canteen vendors will follow a set of food guidelines such as cutting down on fat, sugar, and salt in their food. Canteen vendors need to incorporate food from the four main food groups: brown rice, wholemeal bread, meat and others, vegetable, and fruit [15]. This can help students cultivate a habit of eating healthily and hopefully they will be able to continue this practice outside of school. This paper will investigate if the programme is effective in cultivating healthy after-school snacking habits among teenagers.

Healthier Choice Initiatives

There are Healthier Choice Symbols found on around 3500 different packaged food products to indicate that they are the healthier options in a specific area, such as higher in calcium or lower in sugar. This makes it easier for consumers to select food products which are better for their health and the symbol empowers them to make informed food choices [16]. This is evident from the sales of food products with the Healthier Choice Symbol growing at 9% annually [17]. Additionally, Singapore will be banning advertisements of pre-packaged drinks with high sugar content. This can reduce the influence and temptation of buying high sugar content drinks. There will also be mandatory front-of-pack labels for medium to high sugar content drinks by 2021. This paper will find out if teenagers are aware of these current health initiatives.

Private Company Initiatives

There are efforts to create healthy snacks while keeping its savoury taste. For example, Nu-Tek Salt Advancement Formula Potassium Chloride has blocked the bitterness of traditional potassium chloride, allowing companies to achieve higher sodium reduction by replacing salt with the better tasting potassium chloride [18]. However, healthy snacks are often more expensive, and teenagers may not have the money to buy them. Fast-food restaurants such

as McDonalds and Kentucky Fried Chicken are also offering healthier options. Teenagers can order salad or steamed corn as a side dish instead of deep-fried side dishes such as French fries and order grilled chicken instead of fried chicken. This allows teenagers to eat healthily at fast-food restaurants, but they may not be willing to choose healthier options because of the taste. Drink companies such as Pokka also sell healthier packet drinks with less or no sugar.

Theoretical Framework

To determine teenagers’ attitude towards snacking, the Affection, Behaviour and Cognition (ABC) attitude model will be used [19]. Affection involves a person’s emotions towards snacking, Behaviour is about how an attitude affects a person’s actions towards snacking and Cognition involves a person's knowledge and belief leading to the reasons for snacking.

4 METHODOLOGY/MATERIALS

I. SAMPLE

Teenagers aged 13 to 18 years old (yo) (n = 243) were surveyed using a questionnaire via Google form about their general after-school snacking habits during normal time and circuit breaker period. In addition, among the 243 teenagers, 20 of them were randomly recruited, with teenagers from each age group to complete a one-week food recall diary. In total, there were 37 (15.2%) from the lower secondary levels, aged 13 to 14, 56 (23%) from the upper secondary levels, aged 15 to 16, and 150 (61.7%) from the Junior College levels, aged 17 to 18. There were 52 (21.4%) boys and 191 (78.6%) girls surveyed. There were six participants who were underweight (2.5%), seven participants who were overweight (2.9%) and 228 normal BMI participants (93.8%). Two of the participants did not report their BMI.

II. INSTRUMENT

The questionnaire comprised four main sections: (1) personal particulars (age, BMI, and gender), (2) snacking habits, (3) perception and attitude towards snacking, and (4) circuit breaker period snack consumption. Under the snacking habits section, factors affecting their type of snacks, the amount of snacks they consumed in a week and the location where they bought or obtained the snacks from were asked. In addition, the questionnaire also measured teenagers’ receptiveness towards

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proposed solutions and awareness of current health initiatives in section 3. The one-week food recall diary served to elicit in depth details about their snacking habits. Details of the instrument are appended in Appendix 1.

III. PROCEDURE

Upon ethics approval granted on 22 October 2020, the online survey was administered from 31 October 2020 until 7 January 2021. Data collected were analysed using descriptive and inferential statistics such as the Chi-Square Test before drawing conclusions.

5 RESULTS AND DISCUSSION

I. ATTITUDE TOWARDS SNACKING

A – Affection towards snacking

Half of the teenagers surveyed (50.2%) prefer eating healthy snacks while the other half (49.8%) prefer eating unhealthy snacks. Among those who prefer unhealthy snacks, most of them (94.2%) reasoned that they tend to eat unhealthy snacks as they taste better than healthy snacks. This concurs with the survey result for the item “Which is the most important consideration when choosing your snacks”, where taste was selected as the top consideration. It also concurs with the literature review that humans have a general liking for food with sugar, fat, and salt [8].

Most of the teenagers who prefer healthy snacks (75.4%) mentioned that it is because they are health conscious and are afraid that they may gain weight. Unhealthy snacks are usually higher in calories than healthy snacks, thus increasing the chances of weight gain if the body does not burn the same amount of calories consumed over time [20]. For those who participate in sports-related Co-curricular Activities (n=4), they will have to maintain a healthy weight to perform well in their sports. Additional weight (in the form of nonessential fat) provides greater resistance to athletic motion and can limit endurance, balance, coordination, and movement capacity [21]. Thus, teenagers who play sports will be more weight conscious, prompting them to snack more healthily.

In general, teenagers can be more susceptible to body image issues, causing them to be more concerned about their weight [22]. This is made worse with the advent of social media. Social media has made it easier for teenagers to view

many different posts and they tend to compare their appearances negatively with peers and celebrities [23]. “A person who subscribes too much to social media can begin to believe that every human body, particularly his own, is supposed to be reed thin, with a thigh gap and has the ability to touch the belly button going from behind the body," said Dr Lee, a senior consultant psychiatrist at Promises, a mental health clinic [22]. Body image issues also surface when there are stressors, such as teasing, bullying in school, or dieting practices within the family [22]. Hence, teenagers who are on a diet or fear getting teased for being overweight will prefer healthy snacks.

There are 13 teenagers (5.3%) who mentioned that they feel less guilty when eating healthy snacks, thus choosing to consume them. This suggests that they know the consequences of consuming too much unhealthy snacks and would prefer to snack healthily. Translating the sense of guilt into actions to snack healthily is crucial as guilt snacking can encourage weight gain. When a person feels bad about what he is eating, the hypothalamus will transmit negative signals. This negativity effectively discourages metabolic activity, slowing digestion and causing his body to store more calories as fats rather than burning them as energy [24]. This gives rise to a self-fulfilling prophecy when someone is more likely to get fat when he thinks that he will get fat while snacking unhealthily.

Only 63.1% and 21.5% of the teenagers who prefer healthy snacks consume fruit juices, fruits and vegetables and seed, nuts and grains at least once a week respectively. This shows that there is still a handful who prefer healthy snacking but do not put it into practice on a regular basis. More needs to be done to encourage frequent healthy snacking.

B – Snacking behaviours On average, almost all the teenagers (96.7%) snack at least once or twice a week during the weekday period, among which 9.9% of them snack daily. There are only 3.3% of teenagers who do not snack. Hence, snacking makes up a substantial part of their diet. More than half of the teenagers (56.4%) spend at least 10% of their pocket money on snacks. The average amount spent on snacks for teenagers with low pocket money (less than $31) is $3.97±3.1 , moderate ($31-$70) is $9.76±6.2 and high (more than $70) is $23.9±18.2. r(240) = .69, p = .00. Three respondents did not indicate their pocket

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money. This suggests that teenagers with more pocket money tend to spend more on snacks as they have more spare money after spending on meals in school.

Fruit Juice, Fruits and Vegetables Among the snacks that teenagers eat at least once a week, fruit juice, fruits and vegetables are ranked at the top at 53.5% (Figure 1). However, only 4.6% of them chose nutrition as the most important factor to consider when choosing their snacks, although many (77.8%) were aware and concerned that unhealthy snacking will lead to poor health in the long run. Titbits The second most popular snack among teenagers is titbits (49.8%). Moreover, 20% of the teenagers who completed the food recall diary stated that they consumed titbits at least twice in that particular week. There are also 65.4% of them who eat at least one small packet of titbits (75 g to 80 g) at one time. This could be due to the wide variety and availability of titbits in Singapore. There are many different types of titbits ranging from potato chips to chocolates, giving teenagers many options to choose from and indulge in, catering to the likings of most teenagers. Titbits can also be easily bought from convenience shops or supermarkets which are often located near schools or homes. Hence, teenagers do not have to deviate from their travel routes from school to home to purchase titbits after school. Due to its high calorie content, titbits provide higher food reward than healthy snacks [25]. Food reward is the momentary value of a food to the individual at the time of ingestion [26].

High calorie food stimulates greater activation of brain reward circuitry than low calorie food, potentially contributing to high calorie snack consumption for hedonic reasons, rather than homeostatic needs [27]. The impact of high-reward food can be so powerful that people can spontaneously overeat by up to 54% above their maintenance calories when they have easy access to such food [26]. Thus, the high calorie content in titbits makes them more appetising, causing teenagers to consume them frequently. Another reason for snacking on titbits more often than other snacks can be because of its high sugar, fat, and salt levels. This concurs with the finding in the literature review where humans need to consume more of such snacks to achieve the same level of satisfaction as their taste system adapts [8]. Hence, it is hard to resist the temptation of consuming titbits. The additional calories do not necessary benefit the overall health of the consumers. Bread/Sandwiches Bread/sandwiches are the third most popular snack with 47.9% of the teenagers choosing it. This can be due to bread’s high satiety effect which is able to satisfy their hunger since bread contains carbohydrates which the body digests and absorbs slowly, especially for whole-wheat bread [28]. This concurs with the result from the item in the survey where hunger was listed as the second and third most important reason for snacking after school. As the saying goes, “A hungry man is an angry man”, research has shown that staying hungry can evoke unpleasant emotions in a person [29]. Hence, teenagers would want to stop their hunger to be in the right mood.

0 10 20 30 40 50 60

Blended coffee

Seeds, nuts, grains

Ice cream

Fast-food snacks

Cakes, pastries, cookies

Sweetened packet drinks

Bubble tea

Bread/Sandwiches

Tidbits

Fruit juice, fruits and vegetables

Teenagers, %

Snacks

Figure 1: The types of snacks which teenagers eat at least once a week

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Sweetened Packet Drinks Almost half of the teenagers (40.3%) drink sweetened packet drinks at least once a week. This can be due to the hot weather in Singapore and the drinks can act as a quick refresher for teenagers after a hot day in school. Moreover, it can be easily purchased from convenience shops and even in school canteens. Packet drinks also has a sweet taste which appeals to teenagers’ sweet tooth. Sweet drinks can contribute to weight gain. For children and adolescents, a recent meta-analysis estimates that for every additional 355 ml (12 oz) serving of sugary beverage consumed each day, BMI

increases by 0.08 units [20]. The good news is

surprisingly, most teenagers (69.8%) mentioned that they will sometimes, mostly, or always choose the low sugar or no sugar versions instead of the regular version. This suggests that most of them are aware that healthier options of drinks exist. Fast-food Snacks Among the teenagers, only around a third (26.5%) of them consume fast-food snacks at least once a week. Although it contains high fat and salt levels which is similar to titbits, fast-food snacks are more expensive than titbits. It is also not as convenient to purchase as titbits since it requires teenagers to go to a fast-food restaurant which is usually located in a shopping mall. Moreover, with the ongoing COVID-19 pandemic, teenagers will less likely travel to specially eat fast-food snacks especially if it is not on their way home. Another way they can order fast food is through delivery, but the cost would be higher, deterring them from eating fast-food snacks regularly. Almost a quarter of them (23.9%) will sometimes, mostly, or always upsize their fast-food snacks. This does not reflect consuming more with bigger serving size and increased calories. However, this statement needs to be validated. C – Cognition: Comparing the Reasons for Snacking during Normal Times and COVID-19 Circuit Breaker Period Reasons for snacking during normal times Teenagers were asked to choose freely from a drop-down list of items to select the reasons for snacking after school. The top three reasons are to relieve stress, satisfy hunger due to lunch break being too early and breaks being too short to eat sufficiently (Figure 2). There are 20 teenagers who voted for all three of the above options. Quite a few of them (n = 28) voted for

both “Eat to relieve stress” and “Hungry as lunch breaks are too early”. A few teenagers (n = 11) voted for both “Eat to relieve stress” and “Hungry as lunch breaks are too short”, and 10 teenagers voted for both “Hungry as duration of breaks are short” and “Hungry as lunch breaks are too early”.

Figure 2: The number of teenagers and their reasons for snacking after school (N=243)

Eat to relieve stress The most popular reason is to relieve stress by snacking where almost half (47.3%) of the teenagers chose it. This is most likely due to the stressful education climate in Singapore. Singapore values meritocracy where the education system rewards students based on their achievements. Over the years, meritocracy has worked well to sieve out scholastically inclined students and develop them into prominent leaders and captains of various industries [30]. This, in turn, reinforces the belief that doing well in school equates to doing well in life, breeding a highly competitive environment. This puts a lot of pressure on students to excel in examinations and get into top schools. This results in academic-based stress being a commonly cited issue that afflicts many students at the Institute of Mental Health [30]. Hence, they use snacking to distract them from their negative emotions as it is a natural way to distress since stress promotes hunger and cravings which concur with the finding on emotional eating in the literature review. Hungry as lunch break is too early Among the teenagers, 46.9% mentioned that they snack because they are hungry after school as the scheduled lunch breaks are too early. Secondary schools often end late at around 3 pm and Junior Colleges end around 4 pm while lunch timings are around 12 pm. There is around a three to four hours’ time gap

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between lunch break and dismissal timing which is sufficient for teenagers to digest their food [31]. Therefore, they would naturally be hungry after they end school and purchase snacks outside of schools as most of the canteen stalls will be closed after school. Hungry as duration of breaks are short

A fifth of the teenagers (18.5%) expressed that the duration of breaks are too short for them to eat sufficiently. In schools, the recess timing is around 30 minutes and lunch timing is often around 30 to 45 minutes which are inclusive of the time to queue up and travel to and from classrooms. This may leave them with around 20 minutes to consume their food. Research suggests that fast eaters tend to feel less full than slow eaters due to a lack of chewing and awareness, which are linked to feelings of fullness [32]. Thus, even though they may have eaten a full meal during lunch break, they can still feel hungry easily due to the fast speed of eating. Moreover, some students may choose to take a quick snack instead of eating a proper meal for lunch due to the limited amount of time to eat sufficiently, increasing their likelihood of being hungry and snacking after school.

Reasons for snacking during Circuit Breaker period

Prior to COVID-19 Circuit Breaker times, the top three reasons are to relieve stress, satisfy hunger due to lunch break being too early and breaks being too short (Figure 2). However, during the Circuit Breaker period, the reasons for snacking more during that period are different. The reasons changed to mainly “the ability to eat while attending lessons” and “feeling bored at home”. More than half (57.6%) snack more as they can snack during lessons. Students were all studying from home and snacks are easily accessible at home, making it

more tempting for them to snack. During lessons, they can snack freely whenever they feel hungry, without the teacher knowing by being out of the camera sight. Moreover, almost half of the teenagers (49.4%) snack more due to increased boredom. Most Singaporeans live in public housing apartments, and they have limited space at home. During the circuit breaker period where everyone had to stay at home most of the time, teenagers will feel bored easily as they are confined to an average space of 27 m2 per person [33]. This led to 73.3% of them who indicated that they snacked more during the circuit breaker period.

II. FACTORS AFFECTING SNACK CHOICE

Taste

From the results of the survey, the most important factor that affects teenagers’ choice of snacks is taste as shown in Figure 3 where 60% of the teenagers have selected it. This concurs with the findings in the literature review that humans have a general liking for savoury snacks [8]. The result also suggests that most teenagers will choose snacks based on taste rather than their nutrition values which only 3.7% of them selected as the most important factor. Instant gratification or hedonic pleasures gained from the taste of the snacks is preferred to achievement of long-term health benefits. This could be due to them having the optimistic bias that Type 2 diabetes and cardiovascular diseases only occur at an older age [34]. Thus, they may think that it is fine to snack on whatever they want now. These results are worrying as unhealthy snacks usually taste better than healthy snacks due to its high salt and sugar content and teenagers will prefer unhealthy snacks when comparing based on taste. This may affect their health adversely in the long run.

0 10 20 30 40 50 60 70

Attractive packaging

Popular/Trendy

Ease of eating

Incentive

Peer pressure

Nutrition

Convenient to buy

Price

Taste

Teenagers, %

Facto

rs

Figure 3: The most important factor affecting teenagers’ choice of snacks

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There are more girls than boys who selected taste as the most important factor, 59.2% girls compared to 44.2% boys, Χ2(1, N=243) = 3.7, p = .05. Although the differences in their ranking of taste were marginally significant, research has shown that women are able to pick up subtle nuances of flavour better than men, thus females are more sensitive to taste than men biologically [35]. This can perhaps account for why girls value taste more.

Albeit a small sample, interestingly, almost all (77%) the underweight and overweight teenagers while only half (55.3%) of normal BMI participants indicated taste as their most important consideration when choosing snacks. None of the over/underweight chose “nutrition” as the most important factor. Underweight teenagers may think that they are far from the risk of having Type 2 diabetes or cardiovascular diseases as these illnesses are usually associated with obesity. Hence, they will prioritise taste and eat what they like, perhaps even using snack consumptions to gain some weight. Price

A third of them (38.4%) chose price as their second most important factor affecting choice of snacks. This is no surprise as most teenagers are not working and are given a fixed amount of pocket money by their parents (average $46, i.e., $6 to $7 per weekday). If a student consumed two meals at school in a day, it would cost about $5 to $6, leaving them with around $2 for other purchases. A cup of bubble tea and a McDonalds’ snack box cost around $3 and $5 respectively. Hence, they cannot afford to splurge on expensive snacks. This is evident from 43.6% of them spending less than 10% of their pocket money on snacks and the median is spending 10% to 20% of their pocket money on snacks. This factor also agrees with the finding in the literature review that teenagers were more likely to buy the cheaper options of snacks.

As they grow older, they receive an increase in pocket money from $30 to $50, hence price becomes a less important factor. Fewer teenagers in the 17 - 18 yo age group (26.9%) indicated that price is their most important factor when choosing snacks as compared to younger ones (15 - 16 yo, 30.8%; 13 - 14 yo, 43.2%), Χ2(2, N=243) = 3.4, p = .19. However, this result is not significant.

More girls than boys selected this option, 37.7% compared to 23.1%, Χ2(1, N=243) = 3.9, p = .04.

Research shows that adult females tend to be more cautious about money spending than men [36], thus this could possibly explain the teenage behaviours.

There is a decreasing trend for the percentage of teenagers that chose price as the pocket money increases. More teenagers (37.9%) with low pocket money (less than $31) indicated that price is the top consideration when choosing snacks as compared to 26.4% of moderate ($31-$70) and 0% of high pocket money (above $70), Χ2(3, N=243) = 12.9, p = .00. This may be because teenagers with lower pocket money, i.e., lower disposable income to buy snacks, can only afford cheaper snacks. Convenience

Convenience in purchasing snacks is another important consideration. Teenagers often have busy schedules with lessons ending at around 3 pm, followed by heavy after-school assignments, Co-curricular Activities, and tuition. Hence, to save time, 65.4% of them usually consume the snacks available at home and 56.4% of them purchase their snacks on their way home from school. This concurs with the result on convenience in the literature review where teenagers will obtain their snacks from places nearer to their schools.

In addition, this survey result suggests that parents do play a huge role in influencing the type of snacks available at home to ensure that teenagers snack healthily. This is evident during the circuit breaker period where all students have home-based learning instead, and half of them (57.6%) attributed the fact that they snack more because they can snack while attending lessons and 46.9% indicated that they snack more as their parents stock up the snacks at home. In terms of age, gender, pocket money and BMI differences, no obvious trends or patterns are noticed.

Peer influence

Peer influence is not one of the main factors affecting their snack choices with only 2.1% of teenagers selecting it. This may suggest that teenagers in Singapore prioritises their own likings over blindly following what their friends are snacking on.

Top three factors affecting snack choice for teenagers who are over/underweight

There are little differences between the factors affecting food choices among teenagers in the

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three weight groups (overweight, normal and underweight based on their BMI). The most important factor affecting snack choice for overweight and underweight teenagers is taste, followed by convenience to purchase snacks and price for both groups.

III. EFFECTIVE CHANNELS TO PROMOTE HEALTHY SNACKING

Schools

All schools can sell healthy snacks such as fruits, nuts and less or no sugar drinks at the school cafe or canteen after school. Nuts contain unsaturated fats which help to lower low-density lipoprotein cholesterol and raise high-density lipoprotein cholesterol. Research has shown a consistent 30% to 50% lower risk of myocardial infarction or cardiovascular disease associated with eating nuts several

times a week [37]. If the canteen vendors are

not willing to work so late, the healthy snacks can also be sold through vending machines. The machines can be placed at easily accessible venues such as near the school gates or staircases to make it more convenient for students to grab a snack before heading home. Selling fruits and nuts will be well received by the students as 64.5% and 43.8% of them will buy the fruits and nuts after school at least once a week respectively. A cup of fruits and a packet of nuts can be priced at $1 and $0.60 as most students said that the prices are affordable. These fulfil the two important factors which affects teenagers’ snack choices: price and convenience. Moreover, when the vending machines or canteen vendors sell only healthy snacks, there will not be unhealthy snacks to tempt them. This reduces the visibility of higher reward food, encouraging them to purchase healthy snacks.

Annual healthy snacks food fairs can be held in schools. Students can taste test the different healthy snacks available, exposing them to a wider variety of healthy snacks. They can also purchase whichever snacks that appeal to their likings and the vendors can tell them the shops to purchase such snacks from if they choose to buy the snacks next time. However, the prices of the healthy snacks may not be affordable especially for students from low-income families. This is evident from 28% of teenagers who highlighted that the prices of healthy snacks need to be lowered. This can be mitigated by giving snack vouchers to ensure that all students can snack healthily. When more students are exposed to a wider variety of

healthy snacks, they will more likely continue consuming them outside of school.

Almost half (47.3%) did not know that there is a different category for each healthier choice symbol and 47.9% did not know about the upcoming new nutrition front-of-pack label for high salt or sugar packet drinks. This suggests that there is a lack of awareness of health initiatives among teenagers as they are seldom exposed to such information and may not find such information on their own accord. These information often appear in newspapers, but teenagers seldom read newspapers due to hectic schedules and the perception of reading newspapers being boring. Another reason could be that schools do not frequently reinforce the various health initiatives and how they help in teenagers’ selection of healthy snacks. Hence, there is a need to increase education on the different healthier choice symbols and other health initiatives in schools.

Schools can teach it during Food and Consumer Education and/or Character and Citizenship Education lessons every year to ensure that the information gets reinforced yearly. As nearly all teenagers (96.7%) snack at least one to two times a week, it is important for them to know how to make use of the healthier choice symbols to make informed snack choices. It should be noted that food labelled with the “healthier choice symbol” are not necessarily a wholesome product. If they only have one “healthier choice symbol”, it means that they are only more nutritious in one particular aspect, such as being lower in sugar or sodium, as compared to food products in the same category [38,39]. Therefore, students should look out for food products that are labelled with more than one category of the “healthy choice symbol”, such as being lower in sugar as well as in sodium.

Apart from relying on healthier choice symbols, students should also be taught to scrutinise the information printed on the label to get a better picture of how nutritious the snack is. They can have a better idea of what ingredients are used and the presence of any artificial flavouring or preservatives [39]. Even after knowing how to select healthier snacks, students may find it hard to change their preferences and choose to only consume healthier snacks. Hence, schools can produce a mind map to advise and even prescribe students on which snacks they should eat under different conditions. For example, if they are hungry as it is four hours past their last meal, they can snack on blueberries. Occasionally, if they are snacking to rest their

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tired brain, they can snack on “stress relieving” food like chocolates.

Currently, almost half of the students use snacking to relieve stress which can be undesirable if they consume unhealthy snacks too frequently. Schools can teach healthier ways of distressing such as meditation, Yoga, and simple exercises and teachers can also explain the harmful effects of emotional eating. Schools can also allow for an additional 15-minute break between lunch and dismissal or allow students to snack in class. This can minimise the chances of them being hungry after school and snacking unhealthily outside of school. Private Companies Among the teenagers, 42.1% snack on bubble tea at least once a week (see Figure 1) and 20% of the teenagers who completed the food recall diary mentioned that they drank bubble tea at least twice in that week. Bubble teas are convenient to buy as they are located near schools. Their sweetness and trendiness appeal to teenagers. However, due to their ease of customisability without any additional cost incurred for selecting any sugar level, teenagers tend to select a higher sugar level to suit their taste. The survey results showed that 40.4% usually choose the 50%, 75% or 100% sugar level. To discourage them from choosing higher sugar levels, there can be an increase in price as the sugar level goes up (negative reinforcement). Alternatively, if they choose a lower sugar level, they may be able to get a discount (positive reinforcement). Since teenagers are concerned about the price of the snacks because of their limited pocket money, having an increase in price for higher sugar levels will encourage them to opt for the lower sugar levels. Afterall, the bubble teas are generally already quite sweet without additional sugar.

Government Initiatives

For the item “What will motivate them to choose healthier snacks”, 15.6% and 6.2% of teenagers responded that being more health conscious and exposed to more variety of healthy snacks will motivate them, respectively. Hence, health promotion initiatives can explain the various health benefits of consuming healthy snacks instead of unhealthy snacks. Initiatives can make use of social media platforms to promote the different types of healthy snacks. This should be effective as almost all teenagers in Singapore use social media. Moreover, 11.6% of the teenagers

mentioned that they will consume healthy snacks more if the snacks are easily obtained at readily accessible locations. The government can incentivise more retail outlets to partner with start-ups companies to produce healthy snacks.

More than a third of the students (35.8%) indicated that having tastier “low fat, low salt, low sugar and high fibre” food will motivate them to consume healthy snacks. Food producers should innovate more to make healthy snacks more appealing to their consumers. If government subsidies can be provided to fund such research and development, producers might be more motivated to make snacks tastier and healthier.

6 CONCLUSION

In summary, this project investigated on teenagers’ attitude towards snacking in terms of affection, behaviour and cognition, factors affecting their choice of snacks and strategies to promote healthy after-school snacking habits among teenagers. Teenagers know the definition of healthy snacking but are not doing it because of the gratification, such as satiety, and stress relief, that they obtained from snacking. Most of the findings and results agree with the hypothesis, such as taste, price, and convenience being the top factors that affect their choice of snacks, except peer influence. Healthy snacks need to be tastier, cheaper, more widely available and made trendy to teenagers to encourage healthy snacking among them. More education and awareness are also required to increase their health consciousness and make better informed snack choices.

Further research may consider investigating more about the feasibility of the proposed strategies from other stakeholders’ point of views such as schools and bubble tea shops through interviews. A larger sample size can also be collected across more schools to survey more overweight and underweight students. This can aid in understanding their attitude towards snacking and craft more targeted strategies to encourage them to snack healthily. More students can also record down what they snack each day over one month for a better reflection of their snacking habits. With more efforts put in place to promote healthy snacking, teenagers will be more motivated to cultivate healthier snacking habits. This will reduce their risks of developing diet-related diseases in adulthood, moving towards a healthier Singapore population.

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ACKNOWLEDGEMENTS

I would like to express my heartfelt gratitude to my supervisor, Dr Soo Li Mei, Johannah for her invaluable guidance and advice, and my Teacher-Mentor, Dr Koh Jin Tai Kelvin for his constant support. I would also like to sincerely thank all my survey respondents for taking valuable time out to participate in my survey.

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Appendix 1: Survey questions

Section 1: Personal Particulars 1. What is your age?

- 13-14 years old - 15-16 years old - 17-18 years old

2. What is your gender? - Female - Male

3. What is your current height in meters?

4. What is your current weight?

5. How much allowance/pocket money do you get a week?

Section 2: Snacks Intake (this food recall diary is only included in the survey for the 20 students only)

Please recall the snacks you ate after school and before dinner last week 6. Please recall the snack(s) you ate after school and before dinner last week on MONDAY?

- Bubble tea - Sweetened packet/canned drink - Blended coffee (e.g., frappuccino) - Fruit juice, fruits and vegetables - Tidbits (e.g., potato chips, chocolate bars) - Seeds, nuts, grains - Cereal bars - Fast-food snacks (e.g., nuggets, french fries) - Ice cream - Cakes, pastries, cookies - Bread/sandwiches - Others: - No, I didn’t have a snack

7. Please recall the snack(s) you ate after school and before dinner last week on TUESDAY?

- Bubble tea - Sweetened packet/canned drink - Blended coffee (e.g., frappuccino) - Fruit juice, fruits and vegetables - Tidbits (e.g., potato chips, chocolate bars) - Seeds, nuts, grains - Cereal bars - Fast-food snacks (e.g., nuggets, french fries) - Ice cream - Cakes, pastries, cookies - Bread/sandwiches - Others: - No, I didn’t have a snack

8. Please recall the snack(s) you ate after school and before dinner last week on

WEDNESDAY?

- Bubble tea - Sweetened packet/canned drink - Blended coffee (e.g., frappuccino)

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- Fruit juice, fruits and vegetables - Tidbits (e.g., potato chips, chocolate bars) - Seeds, nuts, grains - Cereal bars - Fast-food snacks (e.g., nuggets, french fries) - Ice cream - Cakes, pastries, cookies - Bread/sandwiches - Others: - No, I didn’t have a snack

9. Please recall the snack(s) you ate after school and before dinner last week on THURSDAY?

- Bubble tea - Sweetened packet/canned drink - Blended coffee (e.g., frappuccino) - Fruit juice, fruits and vegetables - Tidbits (e.g., potato chips, chocolate bars) - Seeds, nuts, grains - Cereal bars - Fast-food snacks (e.g., nuggets, french fries) - Ice cream - Cakes, pastries, cookies - Bread/sandwiches - Others: - No, I didn’t have a snack

10. Please recall the snack(s) you ate after school and before dinner last week on FRIDAY?

- Bubble tea - Sweetened packet/canned drink - Blended coffee (e.g., frappuccino) - Fruit juice, fruits and vegetables - Tidbits (e.g., potato chips, chocolate bars) - Seeds, nuts, grains - Cereal bars - Fast-food snacks (e.g., nuggets, french fries) - Ice cream - Cakes, pastries, cookies - Bread/sandwiches - Others: - No, I didn’t have a snack

In the questionnaire, the above Section 2 is replaced with question 6 (refer to below) which is placed under Section 2: Snack Habits

Section 2: Snack Habits (the numbering of the sections is according to the questionnaire) 6. Select the snack(s) that you eat at least once a week after school and before dinner during weekdays?

- Bubble tea - Sweetened packet/canned drink - Blended coffee (e.g., frappuccino) - Fruit juice, fruits and vegetables - Tidbits (e.g., potato chips, chocolate bars) - Seeds, nuts, grains - Cereal bars - Fast-food snacks (e.g., nuggets, french fries) - Ice cream - Cakes, pastries, cookies - Bread/sandwiches - Others:

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7. When you drink bubble tea, which sugar level do you usually choose?

- 0% - 25% - 50% - 75% - 100% - I don’t snack on bubble tea

8. When you snack on the Fast-food side dishes (e.g., fries, nuggets, mashed potatoes etc), do you UPSIZE or opt for the bigger portion of the snack?

- Yes, always - Mostly - Sometimes - Rarely - No, not at all - I don't eat Fast-food side dishes

9. When you drink packet/canned beverages (e.g., soft drinks - canned cola, packet barley/chrysanthemum/green tea etc.), will you choose the low sugar/sugarless instead of the regular version?

- Yes, always - Mostly - Sometimes - Rarely - No, not at all - I don’t drink packet/canned beverages

10. When you snack on chips and crackers (potato chips, nachos, fish skins), how much do you usually eat at one time? Assuming 1 large packet is 150 to 160 g.

- More than 1 large packet - 1 large packet - ¾ large packet - ½ large packet (about 1 small packet) - ¼ large packet - I don’t snack on potato chips

11. Select the MOST (1st) important consideration when you are choosing your snacks?

- Price (I can afford it) - Tasty - Convenient to buy - Nutritious - Peer pressure - Ease of eating/drinking - Availability of incentive (Student discounts, reward systems e.g., Koi/Starbucks Card) - Attractive packaging - Popular and trendy - Others:

12. Select the SECOND MOST (2nd) important consideration when you are choosing your snacks?

- Price (I can afford it) - Tasty - Convenient to buy - Nutritious - Peer pressure

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- Ease of eating/drinking - Availability of incentive (Student discounts, reward systems e.g., Koi/Starbucks Card) - Attractive packaging - Popular and trendy - Others:

13. Select the THIRD MOST (3rd) important consideration when you are choosing your snacks?

- Price (I can afford it) - Tasty - Convenient to buy - Nutritious - Peer pressure - Ease of eating/drinking - Availability of incentive (Student discounts, reward systems e.g., Koi/Starbucks Card) - Attractive packaging - Popular and trendy - Others:

14. Why do you snack after school? (You may choose more than one option)

- Hungry as lunch breaks are too early - Hungry as food portions sold in school are small - Hungry as duration of breaks are short to eat sufficiently - Peer pressure - Eat to relieve stress - Do not want to go home immediately - Others:

15. On average, how often do you snack on weekdays (after school to before dinner)? - Every weekday - 3 to 4 weekdays - 1 to 2 weekdays - Never

16. On average, what percent of your weekly pocket money do you spend on snacks?

- More than 30% - 21% to 30% - 10% to 20% - Less than 10% - None

17. Where do you usually buy/get your snacks from? (You may choose more than 1 option)

- Shops nearer to schools - Shops nearer to your home - Shops on the way home from school - Detour to go to the shop that is not on your way home from school - Available at home

Section 3: Perception and Attitude towards Snacking

18. Do you prefer eating healthy or unhealthy snacks?

- Healthy snacks - Unhealthy snacks

19. Why did you choose healthy/unhealthy snacks in the previous question?

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20. Are you concerned about the health issue when snacking unhealthily?

- Yes - No

21. Why did you answer yes/no in the previous question? 22. If your school canteen sells fruits/fruit juice/salad at the end of EVERY school day, how likely will you buy before you head home?

- Everyday - 3-4 times a week - 1-2 times a week - Never

23. If the price is $1 for a cup of fruits (see picture below), is the price reasonable for you? (the height of the cup is around 12cm)

- Yes - No, too expensive

24. If your school canteen sells nuts/breakfast cereals at the end of EVERY school day, how likely will you buy before you head home?

- Everyday - 3-4 times a week - 1-2 times a week - Never

25. If the price is $0.60 for a packet of mixed nuts (see picture below), is the price reasonable for you?

- Yes - No, too expensive

26. What will motivate you to choose healthier snacks?

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27. How many of these healthier choice symbols (see picture below) are you familiar with?

- All of them - A few of them - I didn’t know there is a different one for each category - None of them

28. Have you heard about the new regulation that all pre-packaged and non-alcoholic drinks with a high sugar or saturated fat content will be required to display a nutrition label with Grade ranging from A to D, D being the unhealthiest, by the end of 2021?

- Yes, I know - I vaguely know - No, I don't know

Section 4: Circuit Breaker Period Snack Consumption 29. During the recent circuit breaker, do you snack more than usual?

- Yes - No

30. If you snack more during the circuit breaker period, why is this the case? (You may choose more than one option)

- There are snacks stock up at home - I can eat while doing my work during Home-Based Learning - I am bored at home - Not applicable, I did not snack more

31. Did you put on weight during the circuit breaker period?

- Yes - No

Section 5: Important (please read) 32. I certify that the information given in this form is true, complete and accurate.

- Yes