Daily unhealthy food purchase and associated factors among adolescents in urban Dire Dawa, eastern Ethiopia: A community-based cross-sectional study.

Background: Unhealthy food consumption is a growing concern among adolescents in low- and middle-income countries. Evidence on unhealthy food purchase in eastern Ethiopia remains limited. This cross-sectional study assessed the prevalence of daily unhealthy food purchase and associated factors among adolescents in urban Dire Dawa, eastern Ethiopia.

Methods: A community-based cross-sectional study was conducted from October to November 2024 among 475 adolescents (aged 10-19 years) in urban kebeles of Dire Dawa, using multistage sampling. Daily purchase of unhealthy foods was assessed using a 5-point frequency scale and dichotomized as daily versus less than daily. Bivariable and multivariable logistic regression identified associated factors. Ordinal logistic regression was performed as sensitivity analysis.

Results: Daily purchase of unhealthy foods was reported by 70 adolescents (14.7%; 95% CI: 11.6 to 18.2%). The most commonly purchased items were cakes (18.1%), traditional sweets (17.1%), and burgers (17.1%). In multivariable analysis, high availability of unhealthy foods (AOR = 3.42, 95% CI: 1.87 to 6.25), vendor influence (AOR = 2.56, 95% CI: 1.48 to 4.42), peer influence (AOR = 2.13, 95% CI: 1.24 to 3.66), poor nutrition knowledge (AOR = 2.01, 95% CI: 1.18 to 3.42), and high family income (AOR = 1.89, 95% CI: 1.08 to 3.31) were significantly associated with daily purchase. Ordinal regression confirmed similar direction, with peer influence remaining significant. Limitations include the cross-sectional design, omission of sugary beverages, and urban-only sample.

Conclusions: Approximately one in seven adolescents in urban Dire Dawa reported daily purchase of unhealthy foods. Food environment factors, particularly availability and vendor influence, were the strongest predictors. Interventions should prioritize regulating unhealthy food availability near schools, strengthening nutrition education, and leveraging peer networks. Policies should address imported ultra-processed foods and sugary beverages.