ObjectiveTo investigate demographic and lifestyle factors associated with adherence to the Mediterranean diet (MD) in Israeli adolescents.DesignCross-sectional.SettingSchool-based.SubjectsSchoolchildren (n 5268) aged 11-19 years answered self-administered questionnaires on food consumption, eating habits and lifestyle; a subset (n 578) also completed 24 h food recalls.ResultsUsing a modified KIDMED index, 255 % of the students had poor, 552 % had average and 193 % had good MD adherence. Jewish middle-school children had the highest proportion (282 %) of poor MD adherence. Olive oil usage, derived from 24 h food recalls, was 181 % in Jewish families v. 711 % in Arab homes. In Jewish boys, the odds (OR; 95 % CI) of having poor MD adherence was higher in those who watched television/videos/listened to music for 2 h/d (125; 098, 158) and those who sometimes/don't read food labels (169; 131, 218). In Jewish girls, the odds for having poor MD adherence was significantly higher in those whose mother's schooling was < 12 years (206; 141, 300) and those who sometimes/don't read food labels (135; 108, 169). In Arab boys, watching television/videos/listening to music for 2 h/d was significantly associated with poor MD adherence (189; 116, 307). In Arab girls, no aerobic activity or ball games weekly was associated with poor MD adherence (138; 091, 209).ConclusionsIsraeli adolescents had overall a high rate of poor MD adherence. Jewish middle-school children were at the highest risk. Interventions aimed at increasing physical activity, reducing sedentary time, improving mother's education and promoting reading of food labels are recommended.