School principals' perceptions of adolescents' eating behaviors in two Spanish cities: a qualitative study based on the neo-ecological theory

Understanding of the social and environmental factors that shape adolescents' eating behaviors is a prerequisite for developing effective and evidence-based public health interventions. School principals, given their profound comprehension of the internal and external dynamics of schools, serve as key informants in this context. Our aim was to investigate, through the lens of neo-ecological theory, the perceptions of school principals regarding adolescents' eating behaviors in two Spanish cities. We conducted 12 interviews with key informants -seven women and five men- who worked as school principals of socioeconomically diverse schools in Madrid and Bilbao. The analysis employed a neo-ecological theoretical framework in conjunction with Corbin and Strauss's grounded theory coding strategies. At the microsystem level, the absence of family meals and the social media-driven beauty standards shaped adolescents' eating behaviors. At the mesosystem level, interactions between home and school food environments played a key role. At the exosystem level, schools faced structural barriers to implementing health promotion strategies. At the macrosystem level, the food industry exerted influence through food delivery services and the promotion of unhealthy foods, affecting adolescents' dietary choices both at school and at home. These findings highlight the need for public health interventions to go beyond the school and family environments, addressing the growing impact of virtual environments and the food industry on adolescents' eating behaviors.