The importance of healthful eating and physical activity for preventing obesity and decreasing disease risk is well established(Reference Forouzanfar, Alexander and Anderson1). However, young people in Singapore, as elsewhere, tend to adopt dietary behaviours, such as not meeting recommended daily servings of fruit and vegetables(Reference Lim, Tham and Müller-Riemenschneider2) and frequently eating at ‘Western’ fast-food venues(Reference Naidoo, van Dam and Ng3), associated with excessive weight gain(Reference Lanoye, Brown and LaRose4,Reference Nelson, Story and Larson5) . While 13·1 % of Singaporean adults in their 20s (18–29 years) have high-risk BMI of ≥27·5, according to BMI cut-offs for Asian populations(6), this proportion almost doubles to 22·4 % for adults who are in their 30s (30–39 years)(7). Similar patterns of weight gain have been observed internationally such as in Europe, Australia and the USA(Reference Nikolaou, Robinson and Sim8). As losing weight and maintaining weight loss is challenging, preventing excessive weight gain is important for having a healthy body weight. Emerging adulthood, a developmental period typically defined as an age between 18 and 25 years, is also a time of increasing autonomy, when social identities are explored, and habits which are likely to be long standing in nature develop(Reference Lanoye, Brown and LaRose4,Reference Nelson, Story and Larson5) . High value is also placed on fitting in and finding friends as young people transition from secondary to tertiary education(Reference Wilcox, Winn and Fyvie-Gauld9,Reference Madge, Meek and Wellens10) . This period, therefore, presents an important opportunity for health-directed dietary and physical activity interventions.
The role of environmental factors, including the affordability, availability, accessibility and marketing of food, that can influence dietary behaviours are increasingly recognised(Reference Turner, Aggarwal and Walls11,Reference Friel, Hattersley and Ford12) . Growing evidence also suggests that social influences may have a strong impact on young adults. Social networks can influence food and activity choices via interacting pathways of peer influence(Reference Deliens, Deforche and De Bourdeaudhuij13–Reference Leahey, Gokee LaRose and Fava15), social support(Reference Deliens, Deforche and De Bourdeaudhuij13,Reference Deliens, Clarys and De Bourdeaudhuij14,Reference Standiford16) and social norms(Reference Holm, Lauridsen and Lund17). Peers can positively affect dietary practices and physical activity by supporting health-promoting practices to achieve weight loss goals(Reference Leahey, Gokee LaRose and Fava15), and by extending invitations to participate in sports or cooking meals together(Reference Deliens, Deforche and De Bourdeaudhuij13,Reference Deliens, Clarys and De Bourdeaudhuij14) . Conversely, peers may discourage health-promoting practices by engaging in sedentary social activities or dissuading physically active social pursuits(Reference Deliens, Deforche and De Bourdeaudhuij13,Reference Deliens, Clarys and De Bourdeaudhuij14) . Social support, including the types of information and resources shared within social networks, can also influence the dietary and activity behaviours of network members(Reference Deliens, Deforche and De Bourdeaudhuij13,Reference Deliens, Clarys and De Bourdeaudhuij14,Reference Maher, Ryan and Kernot18) . Further, social norms influence multiple aspects of consumption such as whether it is socially acceptable to dine alone and to use mobile devices during mealtimes(Reference Holm, Lauridsen and Lund17). Social norms also influence dietary choices as people tend to model their food choice and consumption based on their companions, such as mirroring others’ portion sizes and food choices and women eating less in the presence of men(Reference Higgs and Thomas19).
These interacting pathways of peer influence, social support and social norms which play out in real life may be amplified in digital spaces as young adults are concerned with how they are perceived on social media and are receptive to social influences. As social media engagement becomes more pervasive, social networks have expanded and can have transformative effects. Globally, social media use is highly prevalent, with those aged 18–34 making up the majority of social media users across various social media platforms(20). Singapore is a multi-ethnic, high-income, urban nation located in Southeast Asia with a representation of 3 major Asian ethnic groups, Chinese, Indians and Malays. Eating out is a pervasive norm with 77·3 % of Singaporeans usually having either breakfast, lunch or dinner outside and is supported by a highly accessible food environment catering to a diverse range of palates and budgets(Reference Naidoo, van Dam and Ng3). In Singapore, 84·4 % of the population were active social media users in 2021(20). These aspects suggest that social networks, both real and virtual, can have a strong influence on the food and activity choices of the Singaporean population. Most studies that explore this phenomenon are based on Western populations(Reference Holm, Lauridsen and Lund17,Reference Higgs and Thomas19,Reference Stok, Renner and Clarys21) with some in university settings(Reference Deliens, Deforche and De Bourdeaudhuij13,Reference Deliens, Clarys and De Bourdeaudhuij14) and few in Asian settings.
This study is part of a larger qualitative cross-cultural study on social, ethical and moral perspectives of young adults around the consumption of food and physical activity in Europe and Singapore. We have investigated young adults’ perceptions of the social environment on their food and activity choices through a qualitative approach, in an English-speaking Asian context. The findings may help inform current and future health interventions directed towards young adults.
Methods
Study design
A qualitative study design was utilised to explore and gain in-depth insights of factors that influence young adults’ dietary and physical activity practices(Reference Mack, Woodsong and MacQueen22). Purposive sampling was used to facilitate the recruitment of participants similar in age and life experiences who were knowledgeable and experienced with the phenomena being studied(Reference Mack, Woodsong and MacQueen22). As the study is exploratory in nature, the use of focus group discussions (FGD) allowed for the collection of a wide range of viewpoints and subsequent exploration of expressed viewpoints through synergistic interactions between group participants(Reference Mack, Woodsong and MacQueen22). The 32-item consolidated criteria for reporting qualitative studies (COREQ) checklist was followed for the preparation of this paper(Reference Tong, Sainsbury and Craig23).
Study setting
The study was conducted in English amongst students from the National University of Singapore (NUS) and Republic Polytechnic (RP). Differing from polytechnics in the USA and the UK, most Singaporean polytechnics admit students who have completed lower secondary schooling at around 16 years of age. RP is a diploma-granting higher education institute with an enrolment of 13 566 students(24), most of whom live off-campus, typically at parental homes. NUS is a degree-granting institute with approximately 40 000 students, a quarter of whom are postgraduates(25). Approximately 10 000 students live on campus, usually during their first and second years of undergraduate study.
Participant recruitment
To be included, participants had to be full-time students at either RP or NUS, at least 18 years of age, own and use a smartphone and be Singaporean citizens or permanent residents. We excluded participants who were pregnant or breastfeeding.
We purposively recruited students at NUS using email blasts and at RP using onsite recruitment and friend referrals. A total of 163 students (62 men and 101 women) expressed their interest via email or text messages and 112 students (47 men and 65 women) were screened while 51 students (15 men and 36 women) were not screened due to the following reasons: decided not to participate following their expression of interest, unable to be reached following their expression of interest or FGD numbers had been reached. Of the screened participants, 103 students (44 men and 59 women) were eligible, and 9 students (3 men and 6 women) were not eligible. We were unable to schedule discussions for 57 students (25 men and 32 women) who were eligible. This was due to: them not wanting to join the study following their expression of interest, scheduling conflicts or a decision we made that the study had reached thematic saturation. A total of 46 students (19 men and 27 women) of mixed academic disciplines participated in the study. Recruitment ended when discussions between JL, ZT and SAR deemed data saturation had been reached.
Study procedure
Prior to the start of FGD, participants were asked to fill out a short demographic survey to collect information on their age, height, weight, gender, ethnicity, marital status, institution of study, faculty, course of study, year of study and their use of social media platforms (Facebook, Instagram, Twitter and Weblogs).
FGD were conducted between March and May 2017 at designated conference rooms at the institutions. Separate discussions were conducted with men and women as some topics such as body image were considered sensitive. Among men (n 19), 2 FGD with 8 and 7 participants took place at NUS and 1 FGD with 4 participants took place at RP. Among women (n 27), 2 FGD took place at NUS with 7 and 8 participants and 2 FGD took place at RP with 6 participants each. Where possible, friends were not scheduled in the same focus group. The discussions were facilitated by JL and ZT, who were female postgraduate students trained in qualitative methodologies and had no prior relationships with the participants. All participants provided verbal informed consent prior to participation.
A discussion guide was developed and piloted by the study team, and included topics on social media use, factors influencing food and physical activity behaviours and mobile application preferences. For the purposes of this paper, social media is defined as internet-based platforms where users can create individual profiles, contribute and access searchable digital content (e.g. content intended to inform, entertain or sell products) and form online connections with other social media users(Reference Carr and Hayes26). Discussions lasted 90 min on average. Debrief sessions took place after the focus groups between JL, ZT and SAR. Data saturation was discussed between JL, ZT and SAR and seemed to have been reached despite a small number of focus groups. All FGD were audio-recorded, transcribed verbatim by a contracted transcription company and verified by focus group facilitators. Member checking was not conducted to limit the burden on participants(Reference Mays and Pope27).
Thematic analysis
Each transcript was reviewed and coded using thematic analysis which allows for using both inductive and deductive approaches(Reference Braun and Clarke28). With the deductive approach, transcripts were coded for themes that were identified from the literature(Reference Deliens, Deforche and De Bourdeaudhuij13,Reference Deliens, Clarys and De Bourdeaudhuij14,Reference Higgs and Thomas19,Reference Stok, Renner and Clarys21) . With the inductive approach, additional themes were added if relevant during the coding process allowing for the inclusion of unanticipated themes. Each transcript was coded by JL and ZT independently. Upon the completion of coding, JL and ZT compared, reviewed and finalised themes. Further discussions of the themes and the relationships between them took place between JL, ZT and SAR to develop a mind-map that illustrated the relationships between themes (Fig. 1)(Reference Braun and Clarke28). Nvivo software (version 11, QSR International, Australia) was used to organise and analyse the transcripts. To maintain confidentially, all participants have been assigned codes.
Thematic relationship to illustrate the role of real and virtual social influences on food and activity behaviours
Frequency of social media use of young men (n 19) and women (n 27)
Results
Participant characteristics
A large proportion of participants were ethnic Chinese (80·4 %, n 37) which is broadly reflective of the national profile (Chinese: 74·3 %, Malays: 13·5 %, Indians: 9·0 %, Others: 3·2 %)(29). All participants were studying full time, of ages ranging 19–24 years old, and all were unmarried (Table 1). Participants represented a wide spread of study majors and years of tertiary education. Close to 40 % (n 18) of participants were overweight according to Asian criteria (BMI ≥ 23 kg/m2) (Table 1). All participants engaged with at least one social media platform with Facebook being the most popular (n 43, 93·5 %) followed by Instagram (n 40, 87·0 %), Twitter (n 20, 43·5 %) and Weblogs (n 14, 30·4 %). Facebook and Instagram had high usage (Fig. 2). Participants were all able to speak and express themselves freely in English with the occasional use of colloquial Singaporean English (Singlish).
Participant characteristics across 7 focus groups by gender
* Numbers do not add to 100 % due to missing data. Polytechnics usually offered 3-year diplomas while NUS usually offered 4-year degrees.
† Includes: Accountancy, Business Administration.
‡ Includes: Communications and New Media, Economics, Geography, Political Science, Psychology, Sociology, Undeclared Arts and Social Science student.
§ Includes: Medicine, Pharmacy, Health Management and Promotion, Outdoor and Adventure Learning, Biomedical Science, Computer Science (includes Information Technology related courses), Engineering.
‖ Includes: Environmental Science.
Percentages may not add up to 100 % due to rounding.
Our findings are presented under 4 main themes as shown in Fig. 1: needs met by social media engagement, sources of influence on social media, real-world family and peer influences on health-promoting habits and the role of norms. The relationships between each of the themes and how they ultimately influence young adults’ food and activity behaviours are described under each of the themes.
Theme 1. Needs met by social media engagement
Most participants had social media accounts that they used daily, with Facebook (daily use: men: 78·9 % ; women: 59·2 %) and Instagram (daily use: men: 78·9 % ; women: 66·7 %) being the most popular (Fig. 2). This high use was motivated by a need to connect and be informed of events and interests in the lives of family and friends and of news in the world. Through social media, participants interacted with people within and outside their close social networks to share content and promotional deals, and to pick up new skills. Illustrative quotes for this theme are presented in Table 2.
Quotes for theme 1: needs met by social media engagement
Subtheme T1·1 Platform for maintaining and forming connections
Keeping in touch with friends and family on social media by being up to date with events and interests was one of the main reasons why the participants had social media accounts even if they were not visibly active on their own accounts. Through their digital persona, participants sustained relationships and created social capital through interactions with their social networks. Participants also used social media to connect with people and entities outside their social networks especially when seeking new information thus effectively expanding their social networks. For instance, participants recalled following a personal trainer on social media to view free exercise programmes that they may also share with their social networks.
Subtheme T1·2 Source of information and recommendations
Participant responses suggest that the content they are exposed to often serve to pique their interest in certain ideas based on which they may conduct their own research. While participants recognised the limitations of digital sources of information, they also described ways of managing this, as D01 (male, 21, chemical engineering) describes, ‘Usually I’ll source a few different websites, ’cause a lot of uh, sensationalist news now.’ Although participants were often suspicious of the veracity of the content on social media, they admitted that there were also times when they shared information based solely on headlines. Nonetheless, several participants reported using social media sites as inspiration for eating healthfully, cooking or being active, even though they may not always follow this through with long-term behaviour change.
Social media served as a platform where participants actively searched and shared recommendations on activities and price promotions for future social occasions. Some examples voiced by participants included ‘buy one get one free’ deals from a coffee shop chain, gym promotions and discounted buffets. The types of information shared also generally reflected the interests of their friends in a social group. Young adults in Singapore also turn to social media accounts of influential and prolific bloggers for information on food and activities. While recognising that some of these may be industry-sponsored posts, they were nevertheless regarded as being somewhat persuasive. Opinions of friends, however, were more trusted when these differed from influencers. Consequently, content shared with friends had the effect of being a personal recommendation, which may have a stronger influence than marketing advertisements as participants tend to trust posts from their social network.
Subtheme T1·3 Platform for expression and validation
Social media serves as a platform for young adults to express themselves and showcase their experiences. Some participants talked about how sharing information on social media was the primary motivator for going to food places or events, many of which were planned as part of social gatherings. A degree of ‘fear of missing out’ also provided motivation for participants to eat specific foods and participate in activities that were trending with their friends. By sharing their own experiences of trendy activities on social media, participants sought to gain validation from their peers. In general, there seems to be a need to stay informed, and a sense of unease related to missing out on news, events in friends’ lives, trends, promotions and recommendations. However, friends’ posts were not always positively regarded, and achievements such as gym workouts or completing a run were viewed by some participants as being pretentious or ‘annoying’. Seeking validation from others or facilitating accountability were perceived as motivations for why peers share physical activity achievements. Participants also seemed disinclined to post their own physical activity achievements widely, describing this information as something they might not want anybody to know, unless it was with a specific group, such as a training group that shared the same interest. Sometimes, posts by peers or fitness instructors may motivate participants to exercise, though at times, some participants described feeling negatively due to comparing themselves with the person in the post.
Theme 2 – Sources of influence on social media
Whilst on social media platforms, participants described encountering various sources of influences including from institutional entities such as food companies, gyms and government organisations and influences from peers. Illustrative quotes for this theme are presented in Table 3.
Quote for theme 2: sources of influence on social media
Subtheme T2·1 Exposure to companies on social media
Participants were aware of how food companies used advertisements to influence their food and activity choices. They discussed social media influencers posting sponsored content, with some recalling experiences of friends who write sponsored posts, resulting in inadvertent exposure to food advertising due to their social networks. Perceptions towards sponsored posts tend to be negative as participants believe that the people who write sponsored posts are ‘doing it for the money’ (A04, female, 20, life science) or exposure. Moreover, most of the participants agree with the sentiment expressed by C08 (female, 23, Faculty of Arts and Social Sciences; undecided academic discipline) on commercial advertising campaigns, ‘I think in general, like, commercials, all that, like, I think they’re just trying to lure customers. Yeah, it’s just a money-making business lah.’. (Note: ‘lah’ is a commonly used particle, typically used at the end of sentences or words as part of colloquial Singaporean English (Singlish) whose meaning is different (can place emphasis, affirm, and dismiss what is said) depending on the tone, syntax, and context.) Thus, many participants actively browse past advertisements on social media unless they spot promotional deals such as discount codes and coupons.
Meanwhile, some participants install Adblockers on browsers to avoid seeing any advertisements. However, this does not mean that participants are entirely unexposed to commercial advertisements, as they will still be exposed to their friends’ posts and social media activity, which may also initiate a discussion or activity related to the advertised products and services. Nonetheless, social media continued to be a resource for finding promotional deals for products and experiences for many participants. However, personal interest, friends’ influence and promotional deals had more influence on whether they chose to engage with marketing campaigns.
Subtheme T2·2 Exposure to government health campaigns on social media
Government health campaigns on social media were met with mixed reception. One of the most discussed campaigns was the annual nationwide National Steps Challenge™ organised by the Singapore Health Promotion Board. Participants received free pedometers to track step counts and used a mobile application called ‘Healthy 365’ to record their step counts in exchange for incentives. Participants recalled that the campaign was heavily advertised on social media and in real life. Much of the discussion centred around barriers to participation, including technical issues with pedometers and the mobile application, and ways to inflate the step count to get the incentives. Whilst many participants stopped using the pedometer and mobile application after the incentives were discontinued, some participants continued their use as they got used to being more active. Overall, at least during the challenge, many participants and their friends and family took part in more activity.
Another government health campaign that was frequently discussed was the ActiveSG campaign. With ActiveSG, patrons can visit affiliated gyms at SGD2·50 (USD 1·88) per session and book recreational facilities at very low prices. Additionally, an annual monetary credit of SGD100 was provided by the government to use at these facilities(30). Many participants recalled being first exposed to the campaign on social media through sponsored posts, which also served as reminders to use their credit. While some participants made use of the credit and facilities, others did not due to lack of time, poor accessibility, the gyms being overcrowded or having old equipment and the perception that social gatherings generally do not involve physical activity. Similar to the National Steps Challenge™, long-term maintenance of physical activity habits once gifted credit has been used was questioned.
Healthy eating social media campaigns hosted by the government also elicited critical responses. A campaign which required students to add a hashtag on social media in exchange for a SGD2 discount on a ‘healthier’ choice lunch item was faulted for not incentivising a wider range of more healthful meals or for discount redemption being troublesome. Participants who engaged with this campaign primarily did so for the discount, while others did not want to be affiliated with a health campaign on social media. Another heavily promoted health campaign on social media and at food outlets was ‘Healthy Plate’ where more healthful food portions were promoted. ‘Healthy Plate’ was also perceived as having limited success by participants as they tend to eat whatever portions they wanted and felt that at least on campus, they did not have many healthful options. General perceptions towards health campaigns amongst most participants concur with sentiments expressed by D06 (male, 24, sociology), ‘I think sometimes like all these health tips, right, it’s a bit too, uh, like it assumes like you have a choice lah. But sometimes we are really just limited by our circumstances’.
Participants largely appeared to trust information from government entities, such as the Singapore Health Promotion Board and Singapore Ministry of Health, referring to contents of health campaigns, or product endorsements as a benchmark for what they considered healthful in their discussions. However, at times, due to the way some health messages were framed and interpreted by the participants, some participants expressed apprehension about its veracity. For instance, participants voiced that caloric content of food items were inflated in a government-endorsed food-tracking mobile application to scare them into being more health conscious and were generally not helpful to them. Conversely, some participants talked about improvements in family members’ food literacy and preferences due to health promotion efforts. For instance, after one participant’s mother learned about healthful alternatives through government campaigns, the family’s diet incorporated these switches for more healthful meals at home, in addition to reading nutritional content labels. Consequently, that participant continues to follow these beneficial changes outside of the home as well.
Subtheme T2·3 Social media and peer influence
The influence of peers was evident by the narratives participants recounted on the types of content they were exposed to, engaged with and shared amongst their networks. While in some instances, posts by friends initiated or reinforced health-promoting behaviours, a more commonly shared experience was being tempted by shared posts with new and promotional food deals as experienced by F06 (female, 18, aviation management), ‘Like yeah, you get tempted by your friends like Instagram post like, they’ll post like, uh, “try this place”, “it’s a new place”, then they post the food, then like, you [are] also like tempted to go and buy’. Social media also provides an avenue to explore other content of interest as algorithms suggest content to users based on personal interests and their friends’ use. However, some participants shared that this may work against their goals of making healthier lifestyle choices. Nonetheless, responses of the participants suggest that they purposefully use social media to seek information on trends, experiences, promotional deals and recommendations within and beyond their immediate social network. Generally, shared promotional deals and recommendations often result in related social activities in real life, such as a group outing to visit a newly opened café offering promotions, demonstrating how shared information on social media influences food and activity choices in reality.
Theme 3: Real-world family and peer influences on health-promoting habits
Apart from interactions on social media, participants discussed how real-life interactions with their social networks influence their perceptions and practices around food and physical activity. Friends and family can influence behaviour in several ways such as by providing information, serving as role models, shaping perceptions about body image and acting as arbiters of accountability. Illustrative quotes for this theme are presented in Table 4.
Quotes for theme 3: real-world family and peer influences on health-promoting habits
Subtheme T3·1 Role modelling
Peers who incorporated healthy meals and exercise into their daily routine were often represented positively by participants as being a ‘role model’ or ‘disciplined’. When friendship groups are interested in health-promoting practices, participants may also find themselves eating healthier. Likewise, when friends are also interested in exercise, they can influence participants as D05 (male, 21, economics) comments, ‘I think friends are important uh. Like if your friends exercise then you nothing to do, “Okay lah, I’ll follow you ah”.’ While this was true for several participants, there are also those who remain unmotivated due to personal barriers.
Peers were variably described as providing motivation to engage in healthy behaviours or serving as sources of temptation. While peer behaviours were sometimes described as being aspirational, incongruity between personal aspirations, perspectives and practices was sometimes observed. For instance, while D07 (male, 24, political science) thinks that having free time means that you can have a healthier lifestyle and that it is a sign of discipline to maintain these practices he also thinks that ‘eating healthy is a bit, is a bit sad? Like everyday life is so stressful and you’re eating healthy, it’s kind of not helping?’.
In other situations, peers may entice individuals to make unhealthy food choices by saying words to the effect of ‘It’s just once in a while’. Some participants reported strategies to maintain healthier food practices even when friends had different food preferences such as eating before the gathering or choosing a healthier alternative when dining with friends at fast-food restaurants. However, most of the time, participants found it hard to resist the temptations of enticing food and their friends’ invitation.
Subtheme T3·2 Health literacy and practices
Participants described how family members’ health literacy and practices can influence their behaviour. For example, some participants explained that they have no choice but to eat late at the behest of their family members, a practice which they feel adversely affects health. Similarly, peers may also be a source of information on health-promoting practices when they are interested in health-related information. For instance, a participant became motivated to curb her sugary drink intake when she found out that her physically fit friend did not drink sugary beverages to maintain her figure. Though at times, some participants may oppose their peers’ ideas on health, such as with G01 (male, 19, information technology) who is interested in bodybuilding, ‘I have talked to, like, a few of my female friends who are, like, into dieting and stuff also. So, like, um, what usually their mind-set was that lesser calories equals to a healthier diet so that they don’t gain weight and stuff, yeah. So, like, this doesn’t really make any sense lah because… they just have like this very broad idea that calories is bad, so… [trails off]’
Subtheme T3·3 Recognition, accountability and body image
Positive self-image and personal development were partly attributed to having a supportive group of friends who motivated, validated and recognised young adults’ health-promoting efforts. In general, having supportive friendships improved participants’ body image. Participants who lost weight or kept up healthy practices attributed it to a supportive group of friends that is respectful of participants’ individual preferences. Participants also felt positively about these friendships especially if they have had past struggles with exercise and weight gain. In general, joining sports clubs, interest groups, having a goal or joining competitions also encouraged more exercise. Male participants reported joining friends to train for annual fitness tests post-conscription. This demonstrates how friendship groups can have considerable influence, holding members of the group accountable for their health behaviours.
Outside of friendship groups, some participants described their family and relatives as ‘mirrors’ that compel them to reflect on their appearance. Such comments may have an impact on how participants perceived themselves, especially if the comments are negative. There was a gendered aspect on food practices in the family, in particular with regards to portion sizes, with young men being encouraged to eat more and young women cautioned against eating large servings. Gendered perceptions were also visible with regards to exercise as women remarked that they preferred to exercise with friends with whom they felt comfortable revealing their untidy selves, especially if they struggled with exercise. Most participants, both men and women expressed that they would be more likely to exercise, and to do so more vigorously, when accompanied by a friend.
Theme 4: Role of norms
The activities that participants took part in and accounts of their peers’ behaviours revealed social norms that influence daily living and health-promoting practices. Illustrative quotes for this theme are presented in Table 5.
Quotes for theme 4: role of norms
Subtheme T4·1 Student priorities – studying and socialising
Valuing academic achievements as a priority appeared to be a common mindset in most men and women, with a male participant, who served in the nationwide compulsory conscription, quoting ‘Now I am a full-time student, not a soldier’ to demonstrate his priority as a tertiary student taking precedence over other activities. Along with studies, other priorities may include part-time jobs that the students take on to support themselves. Several participants described prioritising time to rest or study over taking part in exercise. Some participants who chose to take part in physical activity noted that it cuts into their time for sleep.
Socialising was also perceived as a priority and participants reported spending time to form and maintain connections and friendships during this phase of life. Thus, peer influences on dietary behaviours may be particularly pronounced as commensality or shared eating facilitates occasions for young adults to forge new and strengthen existing friendships. For instance, NUS participants who lived on the university campus expressed that it is a norm to have late-night suppers with other students, especially as first year students. These suppers provided a way to socialise and form friendship groups despite the unhealthy practice of eating calorie-dense foods, which were perceived as being the only options available at late hours. Upon forming friendship groups, participants reported feeling less pressure to join suppers, which were positively viewed by some participants as saving time and money.
Thus, these priorities influence the amount of time participants have to take part in health-promoting activities, especially when they often prioritise studying over exercise and eating healthfully. This can result in phases of inactivity and unhealthy eating during exam periods and more activity and healthier eating during non-exam periods.
Subtheme T4·2 Gym culture
Some virtual norms and behaviours for exercise are also enacted in real life. Many participants described online and real-life gym culture as being showy, obnoxious and alienating to those who do not take part. These negative social experiences reinforce barriers to physical activity. Many women described gyms as male-dominated spaces, resulting in a perceived hostile environment for women, especially if they were to exercise alone. Participants also shared negative experiences such as when their friend was fat-shamed by other patrons, which resulted in participants never going back to the gym. However, some women shared experiences where they felt better able to exercise in the gym if they went with a friend or once they noticed that fellow gym-goers were more focused on their personal performances.
Discussion
This study explored young adults’ perspectives of social environments, both real and virtual in relation to their food and physical activity choices. Our results suggest that social media influences dietary and activity choices through pathways of meeting physiological and social needs, creating or reinforcing norms and serving as sources of influences from peers, family and commercial and governmental entities. Real-world social connections similarly served as sources of information, role modelling and determinants of body image. Participants seemed to navigate these 2 worlds in a complementary manner and when presented with conflicting views such as whether a popular café has tasty food, the opinions from real-world sources, i.e. close social networks, generally took precedence.
Comparable to other studies(Reference Madge, Meek and Wellens10,Reference Spies Shapiro and Margolin31) , the high prevalence of our participants’ social media use was driven by the need to connect with others, express themselves and seek validation. Social media complements traditional ways of bonding with friends and families and facilitates new connections with others on a virtual platform that fuels interactions with online content. Social media is also an efficient platform to share and promote information, create social capital and set the scene for social norms that persist in real life, such as gym culture. Simultaneously, social media was viewed as a platform that informs users of current trends, a way of seeding trends and creating normative behaviours. In general, the types of information viewed and shared reflect the interest of individuals and their social networks, especially as social networks tend to be homophilic since similarity breeds connection(Reference McPherson, Smith-Lovin and Cook32). However, the high frequency of use also suggests that there is an underlying ‘fear of missing out’ on trends and events(Reference Franchina, Vanden Abeele and van Rooij33).
Consistent with results from a study in European adults, our participants also reported using sources apart from social media as alternate channels of information(Reference Kuttschreuter, Rutsaert and Hilverda34). While our participants valued content from reliable sources, they also admitted to instances where they shared content based on the headline without perusing the content. Experimental evidence suggests that apart from the perceived credibility of the news publisher, social network tie-strengths can also influence the credibility of the news shared, with closer ties being more influential(Reference Samuel-Azran and Hayat35). In line with these findings, we observed that our participants were more likely to trust shared food and product recommendations from their close social networks at face value rather than those from social media influencers. Nevertheless, the source of information was still important with governmental sources being regarded as more legitimate and less likely to be fact-checked by participants as compared with unreferenced articles of interest.
Commercial marketing campaigns often target young adults with aims to promote sales, recognition and brand loyalty – often successfully(Reference Buchanan, Kelly and Yeatman36). Our results suggest that marketing campaigns that use price promotions, leverage on the latest trends and present trusted sources for recommendations were more successful amongst young adults. These campaigns seemed to initiate or influence more food-based rather than activity-based social occasions. Virtual recommendations of eateries or foods triggered activities in real life and were followed up by sharing these activities on virtual spaces, thus fuelling trends. Several contextual factors may act together to facilitate this in Singapore, as elsewhere. The wide range of eating outlets with a competitive retail food industry(37) means that various foods are available to suit a range of budgets and there are usually new places to discover. With over 75 % of adults eating out daily, eating out is socially acceptable and can be viewed as normative behaviour in Singapore(Reference Naidoo, van Dam and Ng3).
Clever marketing by food companies by use of social influencers and native advertising also makes it harder to distinguish paid advertisements from genuine recommendations(Reference Qutteina, Hallez and Mennes38). Our participants were aware of the persuasive elements of social media algorithms and marketing content. However, social media engagement seems to sustain trends that are stimulated in part by the ‘fear of missing out’. Simultaneously it provides content to share with social networks and opportunities to participate in new experiences with their friends in real life, thus facilitating the spread of advertised content. Successful social marketing of modern manufactured foods and meals is closely related, historically at least, to the epidemic of obesity. Consequently, this has included a muddying of the water for consumers by appropriation of the language used for health promotion as the term ‘healthy’ has no real meaning when used in food marketing and where pursuit of health through healthful eating is often confounded with, or limited, to slimming(Reference Buckton, Lean and Combet39,Reference Celnik, Gillespie and Lean40) .
Unlike industry marketing campaigns, which were generally viewed with a level of mistrust, participants largely trusted government-endorsed media, a finding that is consistent with survey data(41) and bodes well for receptivity to health promotion efforts. Although there were no clear answers on how to improve young adults’ engagement with government health campaigns on social media, participants were receptive to government health campaigns in terms of viewing promoted content before deciding on whether to take part in promoted activities. While concerns about programme sustainability were raised, physical activity-related health campaigns seemed to have successfully used incentives to facilitate engagement to some extent. Our results diverges from a study which found that Scottish young adults viewed health campaigns as unengaging due to dissemination methods and messages that neither help overcome perceived barriers to health promotion nor were tailored to young adults(Reference Berry, Aucott and Poobalan42). Though, as suggested from our findings, improving some aspects such as the naming and usability of mobile applications, ease of access and engagement to promoted activities and the framing of health messages may help improve engagement for government health campaigns directed towards young adults.
Similar to young adults in the USA(Reference Vaterlaus, Patten and Roche43), our participants were also exposed to a wide range of diet and exercise-related content on social media which rarely resulted in them taking part in these activities in real life. Posts related to food were commonly shared, suggesting that young adults are highly interested in food-related topics. However, shared posts were mainly related to eatery or food recommendations which tended to promote high-calorie foods, presenting contradictory messaging to healthy eating campaigns. These observations are consistent with those of Holmberg and coworkers who found that Scandinavian teens typically shared calorie-dense, nutrient-poor foods on social media(Reference Holmberg, Chaplin and Hillman44). In contrast to commercial food posts, and resulting real-life activities, our participants expressed reluctance to share physical activity posts of their own achievements. The reasons for this hesitancy were similar to those observed amongst young adults in the USA who did not wish to post physical activity-related information due to a perceived lack of interest from their peers, not wanting to appear annoying and perceiving physical activity as a personal activity(Reference Pinkerton, Tobin and Querfurth45). Likewise, although posts related to physical activity promotion received more likes than posts on health education amongst Norwegian social media users, they were less likely to receive comments and shares(Reference Gabarron, Larbi and Årsand46). Similar to a study from the USA, we found that while peers’ physical activity posts can sometimes be motivational, comparing their appearance or activity level with those of the post can lead to some participants feeling negatively about themselves(Reference Burke and Rains47). Thus, due to their interest and use of social media, shared posts of young adults seem to compete with the dissemination and actualisation of health-promoting information and activities.
As young adults spend a lot of time with their social group, group preferences also have a marked influence on whether social media content affects lifestyle behaviours. This prioritisation of socialisation could be due to transitions in young adulthood where students shift from secondary schooling to an institute of higher education where in addition to students acclimatising to their new circumstances and studies, they also experience a need to form and maintain social bonds whilst they navigate this stage of life(Reference Lanoye, Brown and LaRose4,Reference Wilcox, Winn and Fyvie-Gauld9,Reference Madge, Meek and Wellens10) . Similar to young adults in Belgium(Reference Deliens, Deforche and De Bourdeaudhuij13,Reference Deliens, Clarys and De Bourdeaudhuij14) , our participants prioritised studying and social occasions over other activities, including physical activity and healthy eating. The role of commensality as a mechanism for facilitating the start and maintenance of new and existing social bonds is well recognised(Reference Higgs and Thomas19,Reference Fischler48) . Indeed, in our study, several discussions of social activities centred around eateries, many of which were promoted on social media platforms. Further, social eating is related to enjoying foods that are perceived as being tasty, which are usually foods that are low in nutritional content(Reference Raghunathan, Naylor and Hoyer49). Taste and cost are important drivers of food choice in budget-conscious young adults(Reference Deliens, Clarys and De Bourdeaudhuij14), and may have contributed to sharing of food posts that are related to these aspects.
The types of food-related posts may also be indicative of the eating behaviours of young adults(Reference Nguyen, Meng and Li50), especially as they can model their eating behaviours on those around them(Reference Deliens, Clarys and De Bourdeaudhuij14,Reference Higgs and Thomas19) . Consequently, young adults were more likely to eat calorie-dense foods if their friends did(Reference Higgs and Thomas19,Reference Munt, Partridge and Allman-Farinelli51) and these types of foods are also more likely to be promoted on social media(Reference Holmberg, Chaplin and Hillman44). Hence, the prioritisation of socialising can work against healthy eating. Although commercial advertising was viewed with cynicism, they were nevertheless persuasive and participants actively accessed social media for food-related promotional deals. Similarly, studies in China and Indonesia showed that the abundance of food-related posts on social media, such as price promotions, snacks and brand name food products contributed to increased intake of unhealthy foods amongst their youth(Reference Blum, Mellisa and Kurnia Sari52,Reference Zhang, Li and Veeck53) . Our findings emphasise the need for regulating the marketing of unhealthy foods on digital platforms. As young adults tend to view their close social networks as particularly trustworthy sources of information, measures to regulate the re-posting of unhealthy commercial food advertising to limit inadvertent exposure to unhealthy food marketing are important. In Singapore, whilst guidelines to limit unhealthy food advertising to children of 12 years or younger exist, these are limited in scope(54). Regulatory measures related to mandatory front-of-pack labelling and advertising prohibition for unhealthy beverages are being implemented and extending similar measures to food would be of value to consider(Reference Friel, Hattersley and Ford12,55) . Additionally, supporting the use of healthier ingredients by the foods service sector(Reference Friel, Hattersley and Ford12,55) can be further strengthened.
Similar to young women in the UK(Reference Standiford16), our participants often felt judged for their appearance and ability whilst participating in physical activity. Further, our participants were subjected to gender norms regarding dietary intake which can influence their self-image. Studies have found body image, food preferences and practices to be highly influenced by family(Reference Loth, MacLehose and Larson56,Reference Chng and Fassnacht57) . The combination of these gendered perceptions presents limitations on the circumstances under which women feel comfortable taking part in physical activity. Further, like their counterparts in the USA(Reference Vaterlaus, Patten and Roche43), our participants perceived gym culture presented on social media and in real life as obnoxious which deterred some women from going to the gym. Negative perceptions of gym culture may have also contributed to participants’ reluctance towards widely posting their own physical activity achievements as people who did so were perceived as being annoying or showy. Although changing the narrative around physical activity in the social media sphere may promote more physical activity as social media users who posted physical activity related posts were more committed to doing physical activity and had higher levels of physical activity(Reference Pinkerton, Tobin and Querfurth45,Reference Al Ali, Alkhateeb Ea and Bashtawi58) .
Overall, maintaining health-promoting activities was commonly perceived as challenging, unless the young adult has incorporated these practices into their daily life. Taking part in these activities may also form a part of a participant’s identity as a health-conscious individual. However, most of the participants who tried to incorporate exercise into their routines were likely to decrease time spent on studies, or more commonly, lose sleep. Nonetheless, our participants commonly perceived peers who manage to maintain health-promoting practices as role models which can help encourage the maintenance of these habits. These views were also expressed by middle-aged Canadian men, suggesting that these perceptions could be common amongst a broad range of age groups(Reference Houle, Meunier and Coulombe59).
Our study also demonstrated that virtual and real-life social environments can motivate individuals and their social networks to take part in health-promoting practices, although strong support is needed from their real-life social networks for these to be maintained. This is consistent with studies showing how supportive family and friends have a major influence on increasing physical activity and healthy eating(Reference Deliens, Deforche and De Bourdeaudhuij13,Reference Munt, Partridge and Allman-Farinelli51) . However, some participants who have supportive and accepting friend groups may not feel the motivation to take part in health-promoting activities because their currently comfortable social state supports continuing their less healthful behaviours. Ultimately, the interactions that take place between virtual and real-life social environments can influence lifestyle habits that take place in real life and affect health-promoting practices. The social media environment has massive potential to generate global changes in attitudes, among and driven by young people. Social movement for climate change, or against US gun laws, are recent examples, and the opportunity clearly exists for young people to harness social media to combat obesity and diet-related chronic diseases(Reference Nikolaou, Robinson and Sim8).
Strengths and limitations
This study is one of the few studies on understanding digital media influences on Asian young adults and is the first to investigate the influence of the social environment on young adults’ food and activity choices through a qualitative approach in an Asian context.
The use of qualitative methods allows in-depth insights into the research topic and the exploration of the factors that influence young adults’ dietary and physical activity practices. The inclusion of young adults, both men and women, from various academic backgrounds provided diverse perspectives to be explored. Further, the use of focus groups allows for interactive discussions which more closely simulates real-life conversations as compared with one-on-one interviews, and can present a broad range of viewpoints(Reference Mack, Woodsong and MacQueen22). Conversely, participants with contrary views may not be able to express their real thoughts in group settings. However, efforts were made by the facilitators to create inclusive environments. Study rigor was also improved by pilot testing the interview guide, coding by 2 authors (JL and ZT) and discussions about FGD content between JL, ZT, and SAR to maximise reflexivity. Due to the nature of qualitative methods, sample sizes were smaller than quantitative studies, however, as additional topics were not raised in the last few discussions, we deemed thematic saturation to have been achieved. With limited literature concerning the social influences on young adults’ food and activity choices in Asian countries, our focus was on exploring the range of opinions, ideas and themes which help elucidate and conceptualise factors of social influences(Reference Braun and Clarke60). Discussions about FGD content between JL, ZT and SAR also helped mitigate issues related to thematic saturation, such as reflexive discussions on collated data and derived themes. Our study does not consider the perspectives of young adults who are not studying at tertiary institutes. However, a majority of young adults in Singapore do attend a tertiary institution, with 80·4 % of 25–29-year-old Singapore residents attaining a university degree or a diploma and professional qualification in 2020(29). Also, as most participants were Singaporean Chinese, reflecting the ethnic mix in Singapore, the findings may not all be generalisable to other populations.
The personal interests and backgrounds of the participants may have affected the content of the focus group. For example, participants from health-related disciplines could have been influenced by course content, resulting in leading discussions or overcontribution. This issue was mitigated by having focus groups with students from mixed disciplines and facilitators ensuring that each participant had time to express their views.
Self-reported information such as height, weight and food choices were not verified by objective measures. Our study sample had a lower proportion of participants with high-risk BMI of ≥ 27·5 (6·5 %) as compared with national statistics of 13·1 % in adults aged 18–29 years(7). Although students were asked about their dietary choices, without tracking what participants actually ate, their nutritional intake was not measured. A previous study found that Singaporean university students were not eating healthfully(Reference Lim, Tham and Müller-Riemenschneider2) and this was also implied by the types of social media influences and resultant food choices that the participants discussed in our study.
Conclusion
Overall, our results highlight the growing influence that social media and digital social interactions have on young adults’ dietary and physical activity practices. The frequency of social media use is unlikely to decrease as it is an easily accessible medium and meets the multiple social, informational and utilitarian needs of young adults. The type of content accessed on social media also reflects the interests of individuals and their friendship groups, which influences their choice of real-life social activities and practices, creating and reinforcing trends in virtual spaces and real life. Tapping into the needs of young adults on social media, commercial food marketing campaigns utilising limited time offers, novel flavours or price promotions are often used to generate interest in trendy and affordable foods or eateries. This translates into food-based social activities in real life and competes with government health promotion messaging which is viewed as trustworthy but seems to be less persuasive. Prioritisation of studying and socialisation, and unhelpful cultural norms including those of gym culture in real life, also present important challenges to healthful behaviours. The presence of close and supportive social networks can also help overcome perceived barriers.
Taken together, our findings support the growing call for regulating digital marketing of unhealthy foods(Reference Friel, Hattersley and Ford12,61) and emphasises the importance of the food service retail sector’s contribution to the dietary behaviours of young adults. Regulatory approaches, such as those addressing barriers towards access and affordability of healthy food items and limiting the availability and accessibility of unhealthy food, are also important to improve dietary behaviours in young adults(Reference Friel, Hattersley and Ford12,Reference Munt, Partridge and Allman-Farinelli51) . Our findings also suggest that marketing strategies that meet young adults need for finding affordable food options, fitting-in and providing opportunities for socialising are particularly effective, and this can be informative for the design of government health promotion campaigns. Mitigating the negative perceptions of gym culture, addressing gendered norms around physical activity, and promoting the incorporation of physical activity in social gatherings, as done with food may be ways to encourage physical activity in young adults. Given the limited success in existing population-level obesity interventions, co-designing health campaigns with young adults for improved engagement and efforts to understand and improve digital platforms to support healthful choices(Reference Nikolaou, Robinson and Sim8) presents a valuable area of future research.
Acknowledgements
Acknowledgements: We would also like to acknowledge the contributions of our participants and the staff at Republic Polytechnic for operational support and without whom this study would not have been possible.
Financial support:
This paper presented collaborative research amongst the authors and was funded by the NUS Physical Activity and Nutrition Determinants in Asia (PANDA) Research Programme.
Conflict of interest:
There are no conflicts of interest.
Authorship:
J.L.: Conceptualisation, methodology, formal analysis, investigation, writing – original draft, visualisation, project administration, data curation, writing – review and editing. Z.T.: Conceptualisation, methodology, formal analysis, investigation, visualisation, project administration, data curation, writing – review and editing. R.M.v.D.: Conceptualisation, methodology, resources, writing – review and editing, funding acquisition. F.M-R.: conceptualisation, writing – review and editing, funding acquisition. M.E.J.L.: conceptualisation, writing – review and editing. C.K.N.: conceptualisation, writing – review and editing. S.A.R.: conceptualisation, methodology, resources, supervision, project administration, writing – review and editing.
Ethics of human subject participation:
This study was conducted according to the guidelines laid down in the Declaration of Helsinki and all procedures involving research study participants were approved by the NUS Institutional Review Board (NUS-IRB Reference Code S-17-007). Verbal informed consent was obtained from all subjects/patients. Verbal consent was witnessed and formally recorded.
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