Introduction: Diet quality is an important determinant of health; however, many Indonesian adults have poor dietary intake, with low fruit and vegetable consumption and high intake of fats and fried foods. Breakfast plays a crucial role in shaping diet quality and health outcomes, but practices vary widely across populations. Urban adults are more exposed to processed foods and eating out, while rural adults rely on staple-based diets. This study explored the association between breakfast practices and overall diet quality among Indonesian adults in urban and rural areas. Methods: Data from the Indonesia Food Barometer 2018 were analysed for 770 adults aged 26–45 years from six provinces. Breakfast practices, including consumption, location, companion, activity, and preparation, were assessed alongside socioeconomic characteristics (age, gender, job, education level, and wealth index). Diet quality was measured using the Diet Quality IndexInternational. Statistical analyses included chi-square, Mann–Whitney, and Kruskal–Wallis tests and linear regression. Results: In rural areas, gender and breakfast activity were significantly associated with diet quality (p<0.05). In urban areas, age and breakfast consumption were significant factors (p<0.05). Across both settings, breakfast-related practices showed significant associations with diet quality. Conclusion: Associations between breakfast practices and diet quality differed between urban and rural adults, underscoring the importance of contextspecific strategies. Interventions to improve diet quality should therefore be tailored to local dietary behaviours and environments.

Introduction: Processed food consumption—including sweet snacks, sugary beverages, salty snacks, fatty foods, and instant noodles—remains prevalent among children under five in Jakarta. The 2023 Indonesian Health Survey and 2022 Indonesian Nutritional Status Survey reported high rates of consumption and a significant number of wasting cases, potentially linked to poor dietary intake. These trends are especially concerning in urban areas like Jakarta, where children are increasingly exposed to a complex food environment filled with highly accessible and aggressively marketed unhealthy foods. Understanding the role of parental food environment is critical to addressing early childhood nutrition challenges. Methods: This qualitative study was conducted in two densely populated subdistricts of Central Jakarta. In-depth interviews were carried out with 16 mothers of children under five, while triangulation was achieved through additional interviews with three grandmothers. To enrich the narratives, mothers were asked to recall their children’s snack consumption over the past month, and observations of nearby food outlets were also recorded. All data were analysed thematically using NVivo 14. Results: Most mothers allowed processed food consumption due to children’s preferences or difficulty refusing requests. Local shops and mini markets frequently tempted children with sweets, leading some mothers to attempt restrictions. However, inconsistent enforcement, particularly by fathers and grandmothers, undermined these efforts. Marketing strategies such as mascots, discounts, and repeated exposure further reinforced children’s demands. Conclusion: Mothers struggled to manage children’s snack demands due to high accessibility, but regulating purchases with consistent support from all household caregivers can help reduce unhealthy food consumption.

Introduction: The nutritional status of children with Attention-Deficit/Hyperactivity Disorder (ADHD) and Down Syndrome (DS) is influenced by multiple food environment determinants. However, the precise relationship between food environment determinants and nutritional outcomes in these children remains unclear. This study aimed to understand the food environment determinants that are associated with the intake and nutritional status of these children in Malaysia, Lao PDR, and Indonesia. Methods: This cross-sectional study involved 7- to 18-year-old students with ADHD and DS in three Southeast Asian countries. Sociodemographic characteristics, dietary habits, and repeated 24-hour food recall data were collected through a structured questionnaire. Anthropometric data were obtained through direct measurements and analysed using the WHO AnthroPlus software. Further analyses were done using descriptive statistics and chi-square tests. Results: Total participants were 284 children, comprised of 37.7% with ADHD and 62.3% with DS; 62.3% of the children were boys and 37.7% were girls. Among the food environment determinants collected during the study, monthly household income and school food assistance status had significant associations (p<0.05) with BMI-for-age z-score category and total energy, protein, zinc, and calcium intakes. While the country, type of residence, and type of school had significant associations with total energy, protein, zinc, and calcium intakes. Conclusions: Food environment determinants, particularly household income and access to school food assistance, significantly influence the nutritional status and intake of children with ADHD and Down Syndrome. Thus, strengthening inclusive nutrition programmes may improve outcomes for this vulnerable group in Southeast Asia.

Introduction: Optimal complementary feeding practices after six months are crucial for child growth and development. The COVID-19 pandemic may have disrupted factors influencing these practices, including food security and social support. This study aimed to investigate factors affecting the minimum acceptable diet (MAD) among Indonesian infants aged 6–11 months during the pandemic. Methods: A cross-sectional online survey was conducted as part of the multinational COVID-19 Mom-Infant Study. Convenience sampling recruited 403 mothers living in Indonesia (aged ≥18 years) with infants aged 6-11 months. The Household Food Insecurity Access Scale (HFIAS), UK COVID-19 New Mums questionnaire, and Demographic and Health Survey were used to assess food security, psychosocial and social support, and MAD. Multivariable logistic regression identified MAD determinants. Results: Most mothers were 25-34 years old, had a high level of education, were from middle- to high-income households, were not working, and resided on Java Island. The prevalence of MAD was 74.2%, while 26.6% of households experienced food insecurity. Primary support came from husbands. Bivariate analyses indicated that child’s age, maternal education and employment, maternal mood, household income and food security, husband’s support, and support group were associated with MAD. However, only household food security remained significantly associated with MAD in multivariate analysis (aOR=2.155; 95% CI =1.239–3.750; p=0.007). Conclusion: Household food security was crucial for sustaining infant feeding during the pandemic, particularly in high socioeconomic and urban settings. Targeted interventions should focus on strengthening both the food environment and caregiver’s capacity through adaptive food access strategies and communitybased support.

Introduction: Nutrition education (NE) is a promising intervention in promoting behavior change. However, in developing countries where it is not included in the national curriculum, many barriers arise. The study aimed to explore the teachers’ perceived barriers of implementing a nutrition education program for adolescents in rural Indonesian schools. Methods: A qualitative participatory action research approach was applied in three selected schools in Bogor, Indonesia. Focus group discussion was used as the main method of data collection, involving 12 teachers who have implemented the Health and Nutrition Program for Adolescents. Triangulation was conducted through observation and feedback questionnaire from students. Data from multiple sources were coded, categorized, and thematically analyzed. Results: Three themes and six subthemes emerged, these include 1) capacity of teachers (lack of training and lack of nutrition knowledge), 2) school support (time constraints and lack of funding), and 3) external environment (unhealthy street vendors and parent’s lack of nutrition awareness). These identified barriers could be minimized by establishing a strong commitment of school principals, the inclusion of street-food vendors and parents, and also ensuring sufficient training of teachers. Conclusion: This study highlights the need for schools and program implementers to identify potential barriers prior to commencing NE and also strengthen opportunities within it. The barriers found in this study emphasizes the need for advocacy, sufficient training of teachers, and consideration of the external food environment. Further studies are suggested to confirm these findings, involving more informants and different settings, such as in the urban population.

Introduction: The primary reason that compels working mothers to decrease their ability to continue to breastfeeding successfully is their return to work. Attempts to continue breastfeeding at work encounters several difficulties. This study aims to provide an overview of the workplace environment and how facilities at the workplace affect breastfeeding in Indonesia. Methods: We used a qualitative approach to provide a detailed picture of the influence of workplace support for working mothers to perform breastfeeding. We enrolled working mothers (n=18) in Jakarta, as participants and obtained the following information from them: parity, type of family and type of work. Results: The findings provided the general overview of the workplace environment and identified three factors that affected breastfeeding: seeking information during pregnancy, expression of breast milk at office facilities and the problem faced by working mothers. Conclusion: Although the breastfeeding performance of most working mothers in this study comprised exclusive breastfeeding, some fed their infants with formula milk. This study suggests that working mothers who continue to breastfeed after returning to work need the support of their employers, co-workers and others in the workplace to ensure the provision of health facilities and the protection and dissemination the rights of breastfeeding working mothers that might lead them to discontinue their breastfeeding practice.

Introduction: Dietary diversity is a global challenge in complementary feeding. Despite more women joining the workforce in developing countries, there are limited studies on the beliefs of working mothers and their experiences in relation to the provision of dietary diversity as recommended by the World Health Organization. Methods: This qualitative study explored the behavioural, normative and control beliefs of working mothers on dietary diversity practices, based on the Theory of Planned Behaviour (TPB). A total of 25 mothers of different occupational levels were recruited from workplaces in Jakarta. Results: Working mothers at the lower occupational levels showed a lack of understanding of the importance of dietary diversity and reported poor practices. These included the late introduction of animal protein as a food source, and few types of feeding instant foods. Due to their limited knowledge of nutrition, these working mothers tended to accept poor dietary diversity practices as normal. Conclusion: Working mothers at the lower occupational levels practised poor dietary diversity owing to work-related factors. Efforts should be undertaken to provide correct nutritional information related to complementary feeding at workplaces, especially to working mothers in the unskilled occupations.

Introduction: Urbanisation in Indonesia has been associated with a transition in nutrition which has been, in part, marked by an increased purchasing of readyto-eat, energy-dense, nutrient-poor foods. Women are responsible for purchasing and preparing food for the family. Their purchasing behaviours differ in various environments and population groups. This qualitative study was undertaken to explore the food environmental factors that influenced food purchasing behaviour of women who were the household food gatekeepers. Methods: The study was conducted in a slum area in East Jakarta. Eighteen overweight-obese and nonobese women who fulfilled the study’s inclusion criteria were recruited for interviews that used a semi-structured questionnaire. Emic observations were conducted in order to identify typical food purchasing activities. The data were coded and categorised using qualitative data analysis and research software (Atlas.ti 7 for Windows). Results: Most of the women purchased ready-to-eat foods rather than cook at home, either for the family or their own consumption. Several food environmental factors influenced women’s purchasing behaviour, including time and cost efficiency, food availability, family, exposure to ready-to-eat foods and food store marketing strategies. These factors led to the consumption of unhealthy foods that were high in fat, carbohydrate, sugar and salt that some of which may cause obesity. Conclusion: Purchasing unhealthy food was observed to be strongly linked with food-related environmental factors. This study provides an understanding of women’s food purchasing behaviour and highlight potential ways to foster healthier purchasing behaviour among urban slum dwellers.

Introduction: Food marketing influences consumers’ food choices leading to unplanned food purchasing. Methods: This study used a mixed methods approach to investigate the association between food marketing exposure and approval of food marketing strategies among household food providers in Jakarta. Responses from 279 survey participants to questions on exposure and their approval of marketing strategies were analysed. An additional 16 informants who fulfilled the inclusion criteria were recruited for the in-depth interview. Logistic regression was conducted to assess the relationship between the categorical predictor variable (“exposure to active or passive marketing”) and the categorical outcome variable (“approval response to food marketing strategies”). Results: Almost half of the respondents reported not having exposure to active marketing in the past month, whereas approximately one-third had experienced such exposure 1-2 times. Most of the respondents disapproved the marketing of fast foods and sugar-sweetened foods. The highest disapproval was for the placement of vending machines carrying such foods in schools (69.9%). Respondents who were exposed to active marketing at least once in the previous month were 1.99 times more likely (AOR; 95% CI: 1.07-3.73) to approve the marketing of unhealthy foods. Conclusion: Exposure to food marketing promotion appeared to influence approval of marketing strategies among household food providers in Jakarta. In-depth interviews provided supportive evidence for the quantitative results. A mixed methods approach is suggested for larger studies to confirm these findings.

Introduction: Prevalence of obesity among pre-school children in Indonesia is increasing. Since food advertisements reach all age groups, this study was conducted to assess the association between food marketing exposure and children’s consumption of confectioneries at home. Methods: Two hundred and forty caregivers of children aged 3-5 years attending 25 early childhood education centres in Central Jakarta, were interviewed in this cross-sectional study. A structured food frequency questionnaire was used to determine food marketing exposure and child dietary consumption. Chi-square tests compared consumption of confectioneries with different levels of marketing exposure. Results: Out of a total 240 caregivers, most were mothers of the study children (79.2%) and other family members (19.2%). The majority of the caregivers did not work (81.7%), and <15.0% had graduated from university, while 42.0% lived with extended family members. The top ten confectioneries consumed by the children included chocolate wafer crisp, chocolate stick and soft candy. Among the most common food marketing practices were as advertisements on public transport, print and electronic media. The significant associations between four food marketing practices and consumption of eight types of confectioneries were key findings of this study. Receiving food promotion through short message service (SMS) was not significantly associated with consumption of the top ten confectioneries. Conclusion: A positive association was found between food marketing practices and consumption of confectioneries by pre-school children in Central Jakarta. An appropriate policy on food advertisements that targets children combined with parental food education is recommended for improving food consumption habits of young children.