Factors Associated With Unhealthy Food and Beverage Trends Among Adolescents in Israel: Results From the 2014 – 2023 Health Behavior in School-Aged Children Survey

Objectives: Adolescence is a critical developmental period for establishing dietary habits that influence long-term health. Monitoring trends in healthy and unhealthy food and beverage consumption can inform public health interventions. This study examined nine-year trends in dietary behaviors among Israeli adolescents and evaluated sociodemographic factors associated with these patterns. 

Methods: A repeated cross-sectional analysis used Israeli Health Behaviour in School-aged Children (HBSC) surveys from 2014, 2019, and2023including39,130students ingrades 8, 10, and 12. Dietary intake was assessed using an eight-item food frequency questionnaire. Foods were grouped into healthy eating (vegetables and fruits), unhealthy eating (salty snacks, sweetened snacks, fast food), and unhealthy drinking (sugarsweetened beverages, diet drinks, energy drinks). Adjusted linear regression estimated covariate-adjusted means by survey year, controlling for sex, grade, socioeconomic status, and country of birth. 

Results: Although vegetable and fruit consumption was higher in 2019 than in 2014 (12.8[95% CI 12.5-13.2], 14.1[13.7-14.5], p< 0.001 for 2014-2019), this pattern was not sustained in 2023. Unhealthy food consumption was higher across survey years (8.8[8.4-9.2] in 2014, 11.6[11.2-12.1] in 2019, 12.8[12.4-13.3] in 2023; p< 0.001). Unhealthy drinking was lower in 2023 than in 2019 (6.1 vs. 6.8 weekly occasions; p< 0.001), possibly following the national tax on sweetened beverages. Boys reported lower healthy eating (β=-1.416,p< 0.001) but higher unhealthy drinking (β=1.071,p< 0.001). Higher socioeconomic status was associated with healthier patterns.

Conclusions: Overall dietary patterns among Israeli adolescents were less favorable over time, largely reflecting higher frequencies of unhealthy food consumption. Targeted public health strategies are warranted. Population-level measures such as taxing sugar-sweetened beverages may help reduce unhealthy beverage consumption.