A DESCRIPTIVE STUDY TO ASSESS THE KNOWEDGE OF HIGH



RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

BANGALORE, KARNATAKA

PROFORMA FOR REGISTRATION OF SUBJECTS FOR

DISSERTATION

|1 |NAME OF THE CANDIDATE AND ADDRESS |MR. SAM B |

| | |The Capitol college of nursing |

| | |No.1,9th cross R.B.I. layout |

| | |J.P. Nagar 7th Phase |

| | |Bangalore -78 |

|2 |NAME OF THE INSTITUTE |The Capitol college of nursing |

|3 |COURSE OF STUDY & SUBJECT |1ST year M.Sc. nursing |

| | |medical and surgical nursing |

|4 |DATE OF ADMISSION |04.06.2012 |

|5 |TITLE OF THE TOPIC |A descriptive study to assess the knowledge and |

| | |attitude regarding junk foods among adolescents in |

| | |selected schools of Bangalore with a view to develop |

| | |an information pamphlet. |

6. BRIEF RESUME OF THE INTENDED WORK

INTRODUCTION

“We are living in a world today where lemonade is made from artificial flavors and furniture polish is made from real lemons”

- Alfresh E Newman

Good nutrition is very essential in development of children both Physically and mentally. Children must know what they eat; it affects their growth and behavior. Changes in our society have intensified the need for food skills, to the extent that they need to become part of the child's basic education for good health and survival. Most people have forgotten that the primary reason for eating is nourishment. In many ways, our culture is structured to foster poor eating habits. Television commercials and supermarkets are propagating a wide variety of enticing junk foods, attractively packaged and often tagged with tempting offers1.

Nutritional intake during adolescence is important for growth, long term health promotion and development of life ling eating behavior. Nutritional intake during this period may have long term health implications. Meal patterns of adolescents are often chaotic. Several physical, psychological and behavioral changes may affect food habits during adolescence and have long term consequences on adult health status.

In India even Chinese food sold in road side stalls is Junk food, because they contain high amount of Monosodium Glutamate (MSG) which is a flavor enhancer and this MSG is recognized as a health hazard if taken in larger quantities. The evidence for this is described below.

Diet plays an important role both in maintenance of health and prevention of several chronic diseases, including obesity, coronary heart disease, and certain types of cancer, stroke, and type 2 diabetes. Obtaining various nutrients the body need's for its normal functioning depends on the quality and quantity of food one eats. One has to choose healthy foods rich in nutrients. In recent years consumption of "junk foods" has increased in many western countries as well as in urban population of developing countries like India. In many houses one can find factory-made foil-rapped cheese, blended butter, ice cream packs, pastries and other so called "fast foods". High consumption of these junk foods leads to many health hazards. To help prevent diet-related chronic diseases, the investigator has proposed that healthy eating behaviors should be established in childhood and maintained during adolescence.

People need to apply some common sense and decide for themselves what is right for them and what’s not. And it has been proven that high fat/sugar foods leads to obesity, increase in cholesterol, high blood pressure and cardiac problems. So everybody must keep certain amount of awareness about food nutrition so that healthy choices can be made.2

6.1 NEED FOR THE STUDY

“We live in an age when Pizza gets to your home before the police”

- Jeff Arder

Helping our little ones develop a broad palate and accept new foods is a necessary part of getting nutrients from a variety of food sources in to them.

Changes in our society have intensified the need for food skills to the extent that they need to become a part of child’s basic education for good health and survival. Most people have forgotten that the primary reason for eating is nourishment. Junk food comprises of anything that is quick, tasty, convenient and fashionable. Good nutrition is a high priority students must know what they eat affects, how they grow, feel and behave.3

Even though the parents has been put a leadership control over adolescents, companies like Mc Donald’s and other fast food companies spend billions of dollars a year on ad campaigns that target mostly adolescents, with the goal of taking that leadership away from the parents and shifting it on to the youths themselves. In this way, the ads not only promote the consumption of Junk food, with all the baneful health consequences we are witnessing today.4

Junk food are typically ready to eat convenience foods containing high levels of saturated fats, salt or sugar and little or no fruit, vegetables or dietary fiber and are considered to have little or no health benefits. Common junk food includes salted snack foods like chips (crisps), candy, gum, most sweet desserts, fried fast food and carbonated beverages (sodas) as well as alcoholic beverages. 5

The food habitats in India have changed due to the western influence and the usage of foods is also on the rise and has been a part of everyday life.

Eating frequent fast food causes teens and young adults to gain more weight and they face an increased risk of developing obesity. The incidence of child obesity has more than tripled in the past 30 years. The prevalence of obesity among adolescents aged between 12 to 19 years has been increased from 5.0% to 18.1%. Obesity is the result of caloric imbalance and it is mediated by genetic, behavioral, and environmental factors. Childhood obesity has both immediate and long-term health impacts.6

A survey was conducted by Association of chambers of commerce and industries in 25 private and public school canteens in five major cities – Ahmadabad, Mumbai, Kolkata, Chennai including Chandigarh, among 5000 adolescents. The survey disclosed that 53% of children in Chandigarh spend an average of Rs. 700 to 1000 every month on junk food in school canteens. Another alarming finding was that 59% of the food served in canteens was junk food. It revealed that kids prefer to snack on junk food which is heavy in fats, salt and sugar and warns that if the trend continues, the kids are set to develop lifestyle diseases.7

An alarming trend on the rise is that of junk food. It is of the utmost importance that children do not over indulge in junk food. Empty calories in soft drinks and fatty foods promote obesity, responsible for many of the health problems plaguing the planet.

Obesity can have a deep effect on a child’s life, increasing risk of numerous health problems. Such as heart disease, hypertension and stroke, type2 diabetes, high level of cholesterol and sleep apnoea. Obese children also face a higher risk of developing liver diseases, orthopedic problems and asthma.8

A study was conducted by Tracee Cornforth on young adults of age 18 to 30 years to find the effect of eating fast food for teens. The study selected 3,031 young black and white adults. The participants were asked about how often they eat breakfast, lunch or dinner at fast food restaurants. Data was collected by questionnaire and by doing physical examination. The result revealed that adverse impact on participants weight and insulin resistance was seen in both blacks and whites who ate frequently at fast food restaurants. The study concluded that blacks visited fast food restaurants more frequently than whites.9

Adolescents are not capable of understanding that the advertising is intended to manipulate their feelings and alter their behavior.There is no better time than now to built a supportive environment for nurturing children and endowing them with a legacy of good health.10

As health professionals are engaged directly in the largest preventable health crisis, faced by the country, being an investigator would like to utilize this opportunity to impart the ill-effects of junk food.

Owing to the investigator, he is witnessed many adolescents having more choice or taste towards the junk foods, when compared to healthy food being unaware of the ill effects of those yummy items they choose. Being an investigator would like to assess the knowledge of adolescents regarding junk food and update their level of knowledge by providing informational booklet.

6.2 REVIEW OF LITERATURE

Review of literature is a key step in research process. It refers to extensive, exhaustive and systemic examination of publications relevant to the research project. The researcher analyses existing knowledge before delving into a new area of study while conducting a study,when interpreting the results of the study,and when making judgments about application of a new knowledge on nursing practice. The review of literature is defined as a broad, comprehensive in depth, systematic and critical review of scholarly publications, unpublished scholarly print materials, audio visual materials and personal communication.11

An extensive review of literature to the research study topic was undertaken to gain deeper understanding and insight into the problem. Several text books, journals, reports, articles, circulations and websites were referred to collect maximum information to the study.

• Literature related to junk foods.

• Literature related to knowledge regarding junk foods in adolescents.

• Literature related to attitude regarding junk foods in adolescents.

➢ Literature related to junk foods

A double blind cross sectional study was conducted to determine the integral role of caffeine in the flavor profile of soft drinks, by examining the effect of caffeine. Study was conducted in an academic research centre in USA with 25 adolescents, regular consumers of cold soft drinks. The findings showed that only 8% of a group of regular cold soft drinks consumers could detect the effect of the caffeine concentration in various soft drinks. It was also found that higher the rate of consumption of caffeinated soft drinks, more likely reflect the mood-altering and physical dependence producing effect as a central nervous system active drug.12

An experimental study on factors related to top 10 Junk foods consumption at 8 to 16 years of age in Haidian district of Beijing. The purpose of the study was to study the current situation of ten types of Junk food consumption among children and adolescent. The study selected 1019 children. A questionnaire survey was done to collect data. The result revealed that one month prior to the study 97.50% of children and adolescent had eaten at least one type of Junk food and 15.88% of them had eaten all types of them. The study concluded that eating Junk food is a popular event among children and adolescent and the education strategies on nutrition should be developed and launched in order to help children develop their own healthy eating behaviors13.

A study to test the hypothesis that fast food consumption adversely affects dietary factors linked to obesity risk the study selected 6212 children in adolescents of age 4 to 19 years, in United States. Survey was done to collect the data. The result revealed that 30.3% of total sample reported consuming fast food. Adolescents ate more total energy and had poorer diet quality on days with compared with without fast food. The study concluded that consumption of fast food among children in the United States seems to have an adverse effect on dietary quality in ways that plausibly could increase risk for obesity14.

➢ Literature related to knowledge regarding junk foods among adolescents

A cross sectional study to evaluate the consumption of beverage and soft drinks by adolescents of a public school in SaoPaulo,Brazil. The study selected 71 adolescents aged between 14 to 17 years from both genders. Data was collected by questionnaire. The result revealed that the most frequent consumed beverage was industrialized fruit juice (38.1%), soft drinks (28.6%) and natural fruit juices (22.2%) and main place were home (38.2%) school (22.1%). The study concluded that sweet beverage intake was frequent among adolescents specially soft drinks and were consumed at home and at school. The nutrition education program should aim to stimulate the intake of more healthy beverages by adolescents15

A study to determine the prevalence of consumption of fast food among adolescents and their knowledge regarding the food they eat. Study was conducted on 10 different schools comprising of 2636 adolescents. The data was obtained by questionnaire. The result revealed that 50% of the adolescents watched fast food being advertised on television and 70% were not aware of the nutritional context of this food consumed by them. The study concluded that children in urban schools liked Junk food but they preferred to have these in between meals and believed that food advertised was healthy16.

An experimental study about the effect of nutrition education on the knowledge and practice of adolescents regarding Junk food intake. The study was conducted on 487 students in two control and treatment groups. Data was collected by questionnaire. The results revealed that nutrition education plays a crucial important role in improvement of knowledge and practice particularly in school17.

A study to test the hypothesis that fast food consumption adversely affects dietary factors linked to obesity risk the study selected 6212 children in adolescents of age 4 to 19 years, in United States. Survey was done to collect the data. The result revealed that 30.3% of total sample reported consuming fast food. Adolescents ate more total energy and had poorer diet quality on days with compared with without fast food. The study concluded that consumption of fast food among adolescents in the United States seems to have an adverse effect on dietary quality in ways that plausibly could increase risk for obesity.18

➢ Literature related to attitude regarding junk foods in adolescents.

A study to determine whether adolescents will modify their ordering behavior if calorie and fat nutrition information is posted on the restaurant menu. The study selected 106 adolescents aged 11 to 18 years and were asked to order a dinner of their choice from 3 different restaurant menus. The result revealed that 75 did not change any of their orders, 31 did change some orders and only 9 changed their orders. The study concluded that the provision of calorie and fat content information on the menu did not modify the food ordering behavior for the majority of adolescents.19

A cross-sectional survey to examine associations between children’s regular TV viewing habits and their food related attitudes and behavior and an experiment assessing the impact of varying combinations of TV advertisements for unhealthy and healthy foods on adolescents dietary knowledge attitude, and intentions. The study selected 919 grade five and six students from different schools in Melbourne, Australia. Data was collected by survey method. Result revealed that ads for nutritious foods promote selected positive attitudes and beliefs concerning these foods. The study concluded that changing the food advertising environment on children’s TV to on where nutritious foods are promoted and Junk foods are relatively unrepresented would help to normalize and reinforce healthy eating.20

STATEMENT OF THE PROBLEM

“A descriptive study to assess the knowledge and attitude regarding junk foods among adolescents in selected schools of Bangalore with a view to develop an information pamphlet”.

6.3 OBJECTIVES OF THE STUDY

1. To assess the knowledge of adolescents regarding junk foods.

2. To assess the attitude of adolescents regarding junk foods.

3. To determine the co-relation between knowledge and attitude regarding junk foods in adolescents.

4. To determine the association between demographic variables with knowledge and attitude regarding junk food in adolescents.

6.4 OPERATIONAL DEFINITION

Assess: In this study assess refers to assessment of knowledge and attitude regarding junk foods in adolescents.

Knowledge: In this study knowledge refers to the correct response given by school students to the questionnaire regarding Junk foods in selected adolescents.

Junk food: In this study it refers to the food items which can be quickly prepared in the fast food counters or at home by using artificial preservatives, ketchup and salts which are harmful to health and of low nutritional value.

Adolescents: In this study it refers to both male and female students, who are studying in selected schools between the age group of 12-16 years,

Information pamphlet: In this study, informational booklet refers to systematically prepared health package which includes information regarding definition, types, effects, tips to promote healthy eating, junk food; which can be easily understood by school students irrespective of their knowledge.

6.5 RESEARCH HYPOTHESIS

H1: There will be significant difference in the knowledge and attitude regarding Junk food among adolescents studying in selected schools.

H2: There is a significant association between demographic variables with knowledge scores of adolescents studying in selected schools.

6.6 ASSUMPTIONS

1. Increase in knowledge of adolescents regarding junk foods.

2. Increase in attitude of adolescents regarding junk foods.

3. Knowledge on Junk food closely associated with some demographic characteristics such as age, sex, school division, residence location, parent occupation, etc. among adolescents.

4. Information booklet enhances the knowledge regarding Junk food among adolescents.

6.7 LIMITATIONS

- The study is limited to adolescents studying in Bangalore.

- The study is limited to adolescents aged between 12-16

6.8 VARIABLES

Research variables are the concepts of various levels of abstractions that are entered, manipulated and collected in a study.

Demographic variables: age, sex, school division, residence location, parent occupation.

Dependent variables: Knowledge and attitude of adolescents who are studying in selected schools of Bangalore regarding Junk food.

Independent variable: Information pamphlet.

7.0 MATERIALS AND METHODS OF THE STUDY

This study is designed to compare the knowledge and attitude regarding Junk food among adolescent students studying in Bangalore.

7.1 SOURCES OF DATA

The data will be collected from adolescents studying in selected schools, Bangalore.

7.1.1 RESEARCH DESIGN

Research design selected for the present study is non experimental method.

7.1.2 RESEARCH APPROACH

A descriptive survey approach will be used.

7.1.3 RESEARCH SETTING

The study will be conducted in selected schools, Bangalore.

7.1.4 POPULATION/SAMPLE

The population of the present study includes adolescents’ aged between12-16 years and are studying in selected schools, Bangalore.

7.2 METHODS OF DATA COLLECTION

The data collection procedure will be carried out by using self administered questionnaire.

7.2.1 SAMPLING TECHNIQUE

Purposive sampling technique will be used for the present study.

7.2.2 SAMPLE SIZE

The sample consists of 80 adolescents aged between 12-16 years.

7.2.3 CRITERIA FOR SAMPLE COLLECTION

INCLUSION CRITERIA

o Adolescents aged 12-16 years, studying in selected schools, Bangalore.

o Adolescents who know to speak and read English.

o Both male & female students aged 12-16 years studying in selected schools, Bangalore.

EXCLUSION CRITERIA

o Adolescents who are not willing to participate in the study.

o Adolescents who are not available during data collection.

7.2.4 TOOLS FOR DATA COLLECTION

The structured questionnaire is used to collect the data from Adolescents under 2 sections.

Section A: Questions related to demographic variables

Section B: Questions which aims to assess the knowledge and attitude related to Junk food.

7.2.5 PLAN FOR DATA ANALYSIS

The data collected will be analyzed by means of descriptive and inferential statistics.

Descriptive statistics

Mean standard deviations and mean percentage of subjects will be used to analyze the level of knowledge regarding Junk food.

Inferential statistics

The chi square test will be used to find out the association between socio demographical variables and knowledge score.

7.2.6 TIME AND DURATION OF THE STUDY

The time and duration of the study will be limited to 4 weeks as per the guidelines of university.

7.3 DOES THE STUDY REQUIRED ANY INVESTIGATION OR INTERVENTION TO BE CONDUCTED ON PATIENT OR OTHER HUMAN OR ANIMAL? IF SO, PLEASE DESCRIBE BRIEFLY?

Yes, since the study is descriptive study, information pamphlets to be used.

7.4 HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR INSTITUTION?

Yes, the study will be conducted after the approval from the research committee. Permission will be obtained from the concerned head of the institutions. The study subjects will be confidentiality and anonymity of the data collected from them.

8.0 REFERENCES

1. Raghunath .k.R. “Nutrition & Health. The vegetarian way, 1st Edition,

Sterling publisher, New Delhi, 2002.

2. Is Junk food healthy? Available from



3. Children and Junk food – available from

from:

4. John robbin. Is Mc. Donald’s betraying our kids by barrabing them with Junk food ads?

Avaible from:

5. Junk food.wikipedia.

Available from:

6. Frank Diaz, Raising Excellent kids in Insane world: fear of food. Available from: -food-pait-1.html

7. Rajan walia, study on 59% high schools serve Jank food, April 28,2011

Available from:

8. Harmful effects of junk food.

Available from:

9. Tracee cornforth.Eating fast food means weight gain, Insulin resistance for teens.2009 July 19. from:

10. Children and Junk food

Aviable from

11. Camilla chermont P.Estima, Sonia Tucunduva Philippi, Erica Lie Araki, Greisse Viero S.Leal, Marcelle Flores Martinez, Marle dos Santos Alvarenga. Beverage and Soft drink consumption by adolescents from a public school. Revista Paulista de Pediatria volume 29 number 1 Sao Paulo January 2011. Available from .

12. Griffith RR, Veronica EM. Is caffeine flavouring agent in cold soft drinks? J Arch Fam Med. 2000 August; 9(8):727-34.

13. Zhu SP, Ding YJ, LU XF, Wang HW, Yang M, Wang KX, Chao XD, Zhao Z. A study on factors related to top 10 Junk food consumption at 8 to 16 years of age, in Haidian district of Beijin. Zhonghua Liu Xing Bing Xue Za Zhi 2008 August; 29(8):757-62. Available from

14. Shanthy A.Bowman, Steven L. Gortmaker, Cara B.Ebbeling, Mark A.Pereira, David S.Ludwig. Effects of fast food consumption on energy intake and diet quality among children in a National household survey. Official journal of the American academy of pediatrics. Volume 113 Number 1, January 1, 2004 page number 118-118. Available from

15. Camilla chermont P.Estima, Sonia Tucunduva Philippi, Erica Lie Araki, Greisse Viero S.Leal, Marcelle Flores Martinez, Marle dos Santos Alvarenga. Beverage and Soft drink consumption by adolescents from a public school. Revista Paulista de Pediatria volume 29 number 1 Sao Paulo January 2011. Available from

16. Manpreet Kaur. Jaypee’s International Journal of clinical pediatric Dentistry 2008 September-December 1(1): 13-16.

17. ZanJan. The scientific journal of Zanjan University of Medical sciences, June 2005 volume 13, number 51.

18. Shanthy A.Bowman, Steven L. Gortmaker, Cara B.Ebbeling, Mark A.Pereira, David S.Ludwig. Effects of fast food consumption on energy intake and diet quality among children in a National household survey. Official journal of the American academy of pediatrics. Volume 113 Number 1, January 1, 2004 page number 118-118. Available from

19. Yamamoto JA, Yamamoto JB, Yamamoto BE, Yamamoto LG. Adolescent fast food and restaurant ordering behavior with and without calorie and fat content menu information. Journal of adolescent Health 2005 November; 37(5): 397-402. Available from

20. Dixon HG, Scully ML, Wakefield MA, White VM, Crawford DA. The effects of television advertisements for Junk food versus nutritious food on children’s food attitudes and preferences. Journal of Soc Sci Med 2007 October; 65(7):1311-23. Available from .

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|9 |SIGNATURE OF THE CANDIDATE | |

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|10 |REMARKS OF THE GUIDE | |

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|11 |11.1 NAME AND DESIGNATION OF GUIDE | |

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| |11.2 SIGNATURE | |

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| |11.3 CO-GUIDE | |

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| |11.4 SIGNATURE | |

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| |11.5 HEAD OF THE DEPARTMENT | |

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|12 |12.1 REMARKS OF THE PRINCIPAL. | |

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| |12.2 SIGNATURE | |

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