{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T10:03:49Z","timestamp":1785405829621,"version":"3.56.0"},"reference-count":54,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T00:00:00Z","timestamp":1785369600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Int. J. Environ. Res. Public Health","IJERPH"],"abstract":"<jats:p>Background: Evidence on adolescents\u2019 knowledge and practices related to healthy eating and food hygiene in Kazakhstan remains limited. This study aimed to assess knowledge and behaviors associated with healthy eating and food hygiene among adolescents in Karaganda, Central Kazakhstan. Methods: A cross-sectional study was conducted among 382 students aged 11\u201318 years from six schools. Data were collected using a bilingual questionnaire and analyzed using Chi-square tests and multivariable logistic regression. Results: Girls were significantly more likely than boys to demonstrate knowledge of healthy eating and food hygiene practices. According to parental reports, 61.5% of adolescents consumed fruit daily, whereas daily fast-food consumption was reported in 7.7% of boys and 7.5% of girls. Food-outsourcing company reports showed that complete meals and drinking water were available in all participating schools; however, dairy products were available in only half of the school cafeterias. Conclusions: The study identified sex- and age-related differences in adolescents\u2019 knowledge and practices regarding healthy eating and food hygiene. The findings highlight the importance of combining nutrition education with improvements in the school food environment and greater parental involvement to promote healthier dietary behaviors among adolescents.<\/jats:p>","DOI":"10.3390\/ijerph23080997","type":"journal-article","created":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T09:32:13Z","timestamp":1785403933000},"page":"997","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Healthy Eating and Food Hygiene Among Adolescents in Central Kazakhstan: A Cross-Sectional Study"],"prefix":"10.3390","volume":"23","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3849-6107","authenticated-orcid":false,"given":"Ulpan","family":"Kuandyk","sequence":"first","affiliation":[{"name":"School of Public Health, Karaganda Medical University, 40 Gogol Street, Karaganda 100008, Kazakhstan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2087-3824","authenticated-orcid":false,"given":"Alua","family":"Omarova","sequence":"additional","affiliation":[{"name":"Department of Scientific Work, Karaganda Medical University, 40 Gogol Street, Karaganda 100008, Kazakhstan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nailya","family":"Delellis","sequence":"additional","affiliation":[{"name":"Department of Health Science, The Herbert H. & Grace A. Dow College of Health Professions, Central Michigan University, 1280 E Campus Dr., Mount Pleasant, MI 48859, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,30]]},"reference":[{"key":"ref_1","unstructured":"World Health Organization (2026, February 07). Adolescent Health. Available online: https:\/\/www.who.int\/health-topics\/adolescent-health."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Maneschy, I., Moreno, L., Rup\u00e9rez, A., Jimeno, A., Miguel-Berges, M., Widhalm, K., Kafatos, A., Molina-Hidalgo, C., Molnar, D., and Gottrand, F. (2022). Eating Behavior Associated with Food Intake in European Adolescents Participating in the HELENA Study. Nutrients, 14.","DOI":"10.3390\/nu14153033"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1186\/s44167-022-00001-5","article-title":"Movement Behaviours, Breakfast Consumption, and Fruit and Vegetable Intake among Adolescents","volume":"1","author":"Hamilton","year":"2022","journal-title":"J. Act. Sedentary Sleep Behav."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1016\/j.nut.2017.03.011","article-title":"Adolescents\u2019 Unhealthy Eating Habits Are Associated with Meal Skipping","volume":"42","author":"Rodrigues","year":"2017","journal-title":"Nutrition"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"913","DOI":"10.1093\/advances\/nmac018","article-title":"Social Media and Children\u2019s and Adolescents\u2019 Diets: A Systematic Review of the Underlying Social and Physiological Mechanisms","volume":"13","author":"Sina","year":"2022","journal-title":"Adv. Nutr."},{"key":"ref_6","unstructured":"Centers for Disease Control and Prevention (CDC) (2026, July 05). Percentage of Adolescents Meeting Federal Fruit and Vegetable Intake Recommendations\u2014Youth Risk Behavior Surveillance System, United States, 2017, Available online: https:\/\/www.cdc.gov\/mmwr\/volumes\/70\/wr\/mm7003a1.htm."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"629","DOI":"10.1136\/archdischild-2011-301528","article-title":"Water, Sanitation, Hygiene and Enteric Infections in Children","volume":"98","author":"Brown","year":"2013","journal-title":"Arch. Dis. Child."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Chattopadhyay, A., Sethi, V., Nagargoje, V.P., Saraswat, A., Surani, N., Agarwal, N., Bhatia, V., Ruikar, M., Bhattacharjee, S., and Parhi, R.N. (2019). WASH Practices and Its Association with Nutritional Status of Adolescent Girls in Poverty Pockets of Eastern India. BMC Womens Health, 19.","DOI":"10.1186\/s12905-019-0787-1"},{"key":"ref_9","first-page":"196","article-title":"Hygienic Culture of Students in the Conditions of Secondary Educational Institutions: A Literature Review","volume":"26","author":"Kuandyk","year":"2024","journal-title":"Sci. Healthc."},{"key":"ref_10","first-page":"29","article-title":"Strategies for Enhancing Hygiene Culture among Students in Secondary Educational Institutions: A Literature Review","volume":"4","author":"Kuandyk","year":"2024","journal-title":"J. Health Dev."},{"key":"ref_11","unstructured":"Bolatova, Z. (2026, February 25). Assessing Access to Sanitation in Rural Schools. Medicine and Ecology. Available online: https:\/\/qmu.edu.kz\/upload\/medialibrary\/nauka\/zhurnal\/2020\/Journal4-20.pdf."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Bick, S., Ezezew, A., Opondo, C., Leurent, B., Argaw, W., Hunter, E., Cumming, O., Allen, E., and Dreibelbis, R. (2024). Impact of a School-Based Water and Hygiene Intervention on Child Health and School Attendance in Addis Ababa, Ethiopia: A Cluster-Randomised Controlled Trial. BMC Med., 22.","DOI":"10.1186\/s12916-024-03558-x"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Mbakaya, B.C., Lee, P.H., and Lee, R.L.T. (2017). Hand Hygiene Intervention Strategies to Reduce Diarrhoea and Respiratory Infections among Schoolchildren in Developing Countries: A Systematic Review. Int. J. Environ. Res. Public Health, 14.","DOI":"10.3390\/ijerph14040371"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Trandafir, A.-V., and Lotrean, L. (2025). Education for Improving Awareness and Practices Regarding Hand Hygiene among Romanian School Children. Sustainability, 17.","DOI":"10.3390\/su17010304"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"894","DOI":"10.1111\/tmi.12329","article-title":"Burden of Disease from Inadequate Water, Sanitation and Hygiene in Low- and Middle-Income Settings: A Retrospective Analysis of Data from 145 Countries","volume":"19","author":"Bartram","year":"2014","journal-title":"Trop. Med. Int. Health"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1016\/j.pmedr.2017.04.011","article-title":"Hand Washing with Soap and WASH Educational Intervention Reduces Under-Five Childhood Diarrhoea Incidence in Jigjiga District, Eastern Ethiopia: A Community-Based Cluster Randomized Controlled Trial","volume":"6","author":"Hashi","year":"2017","journal-title":"Prev. Med. Rep."},{"key":"ref_17","unstructured":"World Health Organization (2024). Diarrhoeal Disease, World Health Organization. Available online: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/diarrhoeal-disease."},{"key":"ref_18","unstructured":"World Health Organization (2023). Progress on Household Drinking Water, Sanitation and Hygiene 2000\u20132022: Special Focus on Gender, World Health Organization. Available online: https:\/\/data.unicef.org\/resources\/jmp-report-2023\/."},{"key":"ref_19","unstructured":"UNICEF, and Global Alliance for Improved Nutrition (GAIN) (2019). Food Systems for Children and Adolescents: Working Together to Secure Nutritious Diets, UNICEF."},{"key":"ref_20","unstructured":"World Health Organization (WHO), and United Nations Children\u2019s Fund (UNICEF) (2021). Investing in Our Future: A Comprehensive Agenda for the Health and Well-Being of Children and Adolescents, WHO. Available online: https:\/\/iris.who.int\/handle\/10665\/350239."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Kuandyk, U., Omarova, A., and Delellis, N. (2025). Knowledge, Attitudes, and Practices of Hygiene among Children in Schools of Central Kazakhstan: A Cross-Sectional Study. Front. Public Health, 13.","DOI":"10.3389\/fpubh.2025.1595672"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"5506","DOI":"10.4103\/jfmpc.jfmpc_1016_20","article-title":"Nutritional Status and Personal Hygiene Practices of Primary School Children: A Cross-Sectional Study from Meghalaya, India","volume":"9","author":"Bhattacharyya","year":"2020","journal-title":"J. Fam. Med. Prim. Care"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1186\/s12966-023-01432-2","article-title":"Understanding School Food Systems to Support the Development and Implementation of Food-Based Policies and Interventions","volume":"20","author":"Bryant","year":"2023","journal-title":"Int. J. Behav. Nutr. Phys. Act."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1186\/s13690-025-01679-0","article-title":"Effects of Parental-Involved Physical Activity and Nutrition Interventions for Young Adolescents Aged 10\u201313 Years: A Meta-Analysis","volume":"83","author":"Robbins","year":"2025","journal-title":"Arch. Public Health"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Mohammadi, S., Su, T.T., Jalaludin, M.Y., Dahlui, M., Azmi Mohamed, M.N., Papadaki, A., Jago, R., Toumpakari, Z., and Majid, H.A. (2020). School-Based Intervention to Improve Healthy Eating Practices among Malaysian Adolescents: A Feasibility Study Protocol. Front. Public Health, 8.","DOI":"10.3389\/fpubh.2020.549637"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1186\/s12966-024-01668-6","article-title":"School-Based Healthy Eating Interventions for Adolescents Aged 10\u201319 Years: An Umbrella Review","volume":"21","author":"Samad","year":"2024","journal-title":"Int. J. Behav. Nutr. Phys. Act."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1177\/02601060221136184","article-title":"Effects of Public-Private Partnership on Diet-Related Obesity Risk Factors among School-Aged Children: A Systematic Literature Review","volume":"29","author":"Harrison","year":"2023","journal-title":"Nutr. Health"},{"key":"ref_28","unstructured":"UNICEF (2026, March 25). UNICEF and the National Healthy Nutrition Center Summed Up the Results of a Study on Evaluation of School Meals in Three Regions of Kazakhstan. Available online: https:\/\/www.unicef.org\/kazakhstan\/en\/press-releases\/unicef-and-national-healthy-nutrition-center-summed-results-study-evaluation-school."},{"key":"ref_29","unstructured":"World Health Organization (2021). Implementing School Food and Nutrition Policies: A Review of Contextual Factors, WHO. Available online: https:\/\/www.who.int\/publications\/i\/item\/9789240035072."},{"key":"ref_30","unstructured":"World Health Organization (2026, July 05). Guideline: Sugars Intake for Adults and Children. Available online: https:\/\/www.who.int\/publications\/i\/item\/9789241549028."},{"key":"ref_31","unstructured":"World Health Organization (2026, July 05). Guideline: Sodium Intake for Adults and Children. Available online: https:\/\/www.who.int\/publications\/i\/item\/9789241504836."},{"key":"ref_32","unstructured":"World Health Organization (2026, July 05). Water, Sanitation and Hygiene in Schools. Available online: https:\/\/www.who.int\/europe\/activities\/promoting-water-sanitation-and-hygiene-in-health-care-facilities\/ensuring-water-sanitation-and-hygiene-in-schools."},{"key":"ref_33","unstructured":"World Health Organization (2026, July 05). Policies and Interventions to Create Healthy School Food Environments: WHO Guideline. Available online: https:\/\/www.who.int\/publications\/i\/item\/9789240118324."},{"key":"ref_34","unstructured":"Food and Agriculture Organization of the United Nations (2026, July 05). School Food Environment and School Meals. Available online: https:\/\/www.fao.org\/platforms\/school-food\/technical-resources\/guidance-and-other-resources\/school-food-environment-and-school-meals\/en."},{"key":"ref_35","unstructured":"Ministry of Health of the Republic of Kazakhstan (2026, July 05). On Approval of the Sanitary Rules \u201cSanitary and Epidemiological Requirements for Educational Facilities\u201d; Order of the Minister of Health of the Republic of Kazakhstan No. \u049aP \u0414CM-76, Available online: https:\/\/adilet.zan.kz\/rus\/docs\/V2100023890."},{"key":"ref_36","unstructured":"Ministry of Health of the Republic of Kazakhstan (2026, July 05). On Amendments to the Order of the Minister of Health of the Republic of Kazakhstan No. \u049aP \u0414CM-302\/2020 of 21 December 2020 \u201cOn Approval of Nutrition Standards in Healthcare and Educational Organizations\u201d; Order of the Minister of Health of the Republic of Kazakhstan No. 16, Available online: https:\/\/adilet.zan.kz\/rus\/docs\/V2500035778."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1509\/jmkr.38.2.269.18845","article-title":"Index Construction with Formative Indicators: An Alternative to Scale Development","volume":"38","author":"Diamantopoulos","year":"2001","journal-title":"J. Mark. Res."},{"key":"ref_38","unstructured":"World Health Organization (2016). Growing Up Unequal: Gender and Socioeconomic Differences in Young People\u2019s Health and Well-Being, WHO Regional Office for Europe. Available online: https:\/\/www.who.int\/europe\/publications\/i\/item\/9789289051361."},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Deslippe, A., Bergeron, C., and Cohen, T. (2023). Boys and Girls Differ in Their Rationale behind Eating: A Systematic Review of Intrinsic and Extrinsic Motivations in Dietary Habits across Countries. Front. Nutr., 10.","DOI":"10.3389\/fnut.2023.1256189"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"nzab083","DOI":"10.1093\/cdn\/nzab083","article-title":"Girl-Powered Nutrition Program: Key Themes from a Formative Evaluation of a Nutrition Program Co-Designed and Implemented by Adolescent Girls in Low- and Middle-Income Countries","volume":"5","author":"Dyke","year":"2021","journal-title":"Curr. Dev. Nutr."},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Gund, M., Unshelm, C., Hannig, M., and Rupf, S. (2022). Nutritional and Oral Hygiene Knowledge versus Reported Behavior of Children and Adolescents\u2014A Cross-Sectional Interview-Based Study. Int. J. Environ. Res. Public Health, 19.","DOI":"10.3390\/ijerph191610055"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"nzaa094","DOI":"10.1093\/cdn\/nzaa094","article-title":"Adolescent Girls\u2019 Nutritional Status and Knowledge, Beliefs, Practices, and Access to Services: An Assessment to Guide Intervention Design in Nepal","volume":"4","author":"Cunningham","year":"2020","journal-title":"Curr. Dev. Nutr."},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Jena, S., Parida, J., Panda, A., Behera, S.S., Pradhan, A., Patra, P., Pati, S., Kaur, H., and Acharya, S.K. (2023). Knowledge, Practices and Influencing Factors Defining Unhealthy Food Behavior among Adolescents in India: A Scoping Review. Front. Psychol., 14.","DOI":"10.3389\/fpsyg.2023.1161319"},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Wang, D., van der Horst, K., Jacquier, E., Afeiche, M., and Eldridge, A. (2018). Snacking Patterns in Children: A Comparison between Australia, China, Mexico, and the US. Nutrients, 10.","DOI":"10.3390\/nu10020198"},{"key":"ref_45","unstructured":"World Health Organization (2026, July 05). Five Keys to Safer Food Manual. Available online: https:\/\/www.who.int\/publications\/i\/item\/9789241594639."},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Wawrzyniak, A., and Traczyk, I. (2026). Understanding the Gap Between Nutritional Knowledge and Dietary Behavior Among Adolescents with Different BMI Statuses. Nutrients, 18.","DOI":"10.3390\/nu18142287"},{"key":"ref_47","unstructured":"Glanz, K., Rimer, B.K., and Viswanath, K. (2015). Health Behavior: Theory, Research, and Practice, Jossey-Bass. [5th ed.]."},{"key":"ref_48","unstructured":"Alyafei, A., and Easton-Carr, R. (2026). The Health Belief Model of Behavior Change. StatPearls, StatPearls Publishing."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1146\/annurev.publhealth.29.020907.090926","article-title":"Creating Healthy Food and Eating Environments: Policy and Environmental Approaches","volume":"29","author":"Story","year":"2008","journal-title":"Annu. Rev. Public Health"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"444","DOI":"10.1177\/0379572119848287","article-title":"Global Patterns of Adolescent Fruit, Vegetable, Carbonated Soft Drink, and Fast-Food Consumption: A Meta-Analysis of Global School-Based Student Health Surveys","volume":"40","author":"Beal","year":"2019","journal-title":"Food Nutr. Bull."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"1767","DOI":"10.1017\/S1368980008004394","article-title":"Socio-Environmental, Personal and Behavioural Predictors of Fast-Food Intake among Adolescents","volume":"12","author":"Bauer","year":"2009","journal-title":"Public Health Nutr."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"e13813","DOI":"10.1111\/obr.13813","article-title":"Facilitators and Barriers to Healthful Eating among Adolescents in High-Income Countries: A Mixed-Methods Systematic Review","volume":"25","author":"Louey","year":"2024","journal-title":"Obes. Rev."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1016\/j.ajcnut.2024.11.006","article-title":"School-Based Nutrition Education Programs Alone Are Not Cost Effective for Preventing Childhood Obesity: A Microsimulation Study","volume":"121","author":"Kenney","year":"2025","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"968","DOI":"10.1111\/obr.12224","article-title":"Effect of Changes to the School Food Environment on Eating Behaviours and\/or Body Weight in Children: A Systematic Review","volume":"15","author":"Driessen","year":"2014","journal-title":"Obes. Rev."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/23\/8\/997\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T09:33:38Z","timestamp":1785404018000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/23\/8\/997"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,30]]},"references-count":54,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["ijerph23080997"],"URL":"https:\/\/doi.org\/10.3390\/ijerph23080997","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,30]]}}}