RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES BANGALORE KARNATAKA

PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1. Name of the Candidate and : Ms. RADHA.M.

Address 1st Year M.Sc Nursing

Rajiv Gandhi College of Nursing,

IIT Campus, Near Meenakshi Temple,

Bannerghatta Road,

Bangalore-560 076.

2. Name of the Institution : Rajiv Gandhi College of Nursing

3. Course of Study & Subject : Degree of Master of Nursing

Community Health Nursing.

4. Date of Admission to Course : 04.06.2009

5. Title of the Topic : Effectiveness of planned teaching

Programme on knowledge and

attitude regarding health hazards

of junk foods among adolescent in

selected Urban High School, Bangalore

INTRODUCTION:

Adolescent is associated with search for independence. Identity and changes in lifestyle.

During childhood and adolescence most individuals develop and establish a lifestyle

within which a range of health behaviours is embedded. However, during adolescence,

young people take part in the process of separating from the parents, resulting in a

decrease in parental influence on health behaviours as age increases, unable to cope up

with the rapidly changing world. The bodies and mind of adolescence have taken a

battering.

Nutritional intake during adolescence is important for growth, long term health

promotion and development of life ling eating behaviour. Nutritional intake during this

period may have long term health implications. Meal patterns of adolescents are often

chaotic. Several physical, psychological and behavioural changes may affect food habits

during adolescence and have long term consequences on adult health status.

Teenager miss an increasing number of meals at home as they get older. Teenagers

identify time as the biggest barrier to eating properly. They perceive themselves as too

busy to worry about food, nutrition, meal planning or eating well. They form positive

associations with junk foods. Other factors includes mood, body image, concerns, habits,

media influences and life style choices.

Televisions and magazines has greater influence on adolescents eating habits. It is

estimated that by the time average children reach the teenage years, they have viewed

1,00,000 food commercials, most of with high concentration of fat and simple ChO.

More than 65% of food advertisements promote beverages and sweets. Marketing to

adolescents has become a multi billion dollars business. Approximately 23 million

teenagers spend 100 billions dollars annually for fast food and other snacks.

Teenagers are frequent visitors to fast food restaurants, different store, visits occur

immediately after school and next higher number during week day dinner time. It is

important to determine where they eat, how much they spend, and what they buy1. This

information is vital in helping and providing nutritional care plan for adolescents.

Junk food refers to fast foods which are easy to make, and easy to consume. They have

only fats lying in it causing ill effects on the health of the adolescents. The taste is the

most attractive feature in junk foods. But it there atleast little use of our body and health.

‘Muchael Jawbson Aptly’ wins the phrase junk food in 1972, as slang for foods of useless

/ rubbish / no nutritional value. There contents are rich in sodium salts and / or sugar and

fats which provide high calories yet useless in value. Junk food and diet does not go

hand in hand2. Perhaps this is the reason why junk foods are also called as empty calorie

foods. Nevertheless, junk foods are popular because of their simplicity to manufacture,

lons course their taste.

The difference between fast food, meal and a home cooked one is the sheer quantity of

calories and fat it delivers into the body. The United States ‘Department of Agriculture’

(2009) recommended daily intake for a normal adolescent is 2100 Kcalories and

maximum of 93g of fat. A meal at a fast food outlet-burger, fries, drink and dessert can

deliver almost all of that in a single servings3

Junk foods such as potato wafers and cheetos, do not even need cooking ion prefer to eat

them when people watch T.V. where it saves time and hurry eating pizzas and burgers as

they are several out door step nowadays.

Junk food has become a prominent feature of the diet of adolescents throughout the

world. Junk foods pose health risks both because of what they contain and what they

replace in diet. Even though Junk foods are tastier and easily available, it has become the

biggest supporter of cancer. Stuffed with loads of fat, these eatables increases the level

of cholesterol in the body and invite obesity, which is believed to be ‘Mother of Cancer’4

Most colors in fast foods are often inedible, carcinogenic and harmful to the body, they

can affect the digestive system and can lead to hyper activity and lapses of concentration

in children. Children suffering from learning disabilities are often advised against eating

food with artificial coloring

Studies suggest that one soda contains 9 Teaspoons of sugar, gives more added sugar

than its recommendation.

There are over 500 Kcalories and 40% of daily recommended fat in quarter-pound cheese

burgers.

In large fries there are 510 more calories plus 47% g of daily recommended fat. All these

acts as a base for childhood obesity5

6.0 Brief Resume for Intended work

6.1 Need for the study:Adolescence, is a period of rapid growth and personal development. The growth and

development of adolescents depends to a large extent on their nutrition The complex

myriad of physiological as well as psychological changes, accompanied by rapid growth

and increase in physical activity, create special nutritional needs that are higher during

adolescence than at any other time in life. Failure to consume adequate diet at this time

can potentially retard physical growth, intellectual capacity and delay sexual maturation1

Nutritional status of adolescents is highly influenced by varied eating patterns. The

eating pattern of adolescents first increasingly gained attention in western countries in

recent years claiming that they have a poor diet2. Particular areas of concern have

included intake of more dietary fats in comparison to fruits and vegetables. Owing to

globalization and urbanization in developing countries, adolescent-eating behaviour is

now here also coming under the spotlight3

Both undernourishment and overnourishment in young people are increasing problems in

both developing and developed contries4. Snacking is a well-established eating pattern

amongst adolescents; especially those in the higher socio-economic strata. Teenagers are

typically fond of eating ‘junk’ food, not only for its taste, but because of peer group

habits. Although, snacks can be a source of needed nutrients and calories, but it can lead

to overweight too5 . At the other end of spectrum are teens who are undernourished due to

eating disorders. Many adolescents feel pressurized to be ideally thin like models in

movies or magazines. Some girls embrak on their first diet even before leaving

elementary school6.

Because of young age (22%) structure of India’s population being adolescents (7) , the

needs of the adolescents should be considered as important to improve the health status of

the nation.

Studies conducted in metropolitan cities like Chennai, Bangalore states that 70% of the

mortality in adulthood is linked to habits picked up during the adolescence period

especially the poor eating habits 8. It was estimated that eating junk food is the second

leading cause for most of the adolescent health problems.

A study carried out in Bangalore 2009 states that anemia in adolescent boys were found

to be 42% which is quite high because of junk food consumption 9.

An comparitative studies in Metropolitan cities (2008), Study suggest that childhood

obesity is a major public health issue worldwide. It is well accepted that unhealthy eating

patterns are partially responsible for the increase in childhood obesity. However, there is

relationship between fast food and soft drink consumption and children happiness. In

particular, they studied the effects of fast food and soft drink consumption on childrens

body weight and their happiness. A National wide Survey was carried in 2001 using the

data from the national the data from the National Health Survey in India, the authors

looked at the fast food and soft drink consumption, body weight and level of happiness of

2,366 children aged between 12 to 15 years old. Fast foods included French frieds, Pizza

and humbergers, soft drinks including soda and other sugar sweetened beverages. 30%

age of children in the study sample were over weight or obese and 19% sometimes are

often felt unhappy, sad or depressed. So the study’s key findings was that children who

ate fast food and drank soft drinks were more likely to be over weight, and favourable

attitude towards junk food consumption10

Unhealthy eating habits is often associated with childhood obesity leads to many diseases

including 3 leading causes of death: heart diseases, cancer and stroke.

Now a days most of the parents dream is to have the chubby child, for eg. Mother

consumption of fast food and soft drinks predict her child’s eating habits. Most of the

parents do not understanding the ill effects of poor eating habits, hence they forced their

child to eat junk foods. Studies finding suggest that consumption of fast food and soft

drink leading to childhood obesity 11

A cross sectional study conducted in Chennai using an unquantified food frequency

questionnaire and anthropometric data suggests that fifty adolescents between 12 to 15

years old were selected from Schools. The consumption of junk foods were significantly

higher in urban areas about 24.2% respectively. Studies shows that junk food makes up

quarter of adolescent diet in Urban cities 12

A cross sectional study conducted by Dr. R. Narasimhan (2009) states that junk foods

may be partly responsible for increases in asthma. Survey noticed that prevalence of

asthma was more in urban children whose diet is influenced by junk foods13

The present sceneries shows that many of adult diseases have their origin during

childhood and adolescent period. Studies reveal that as early as the age of 30% arteries

could beginning clogging and lay the ground work for further heart diseases. What

children eat from puberty affects their risk of prostrate and breast cancer. Osteoporosis

and hypertension are other diseases related to unhealthy or poor eating habits. Hence,

health eating habits in childhood and adolescent period is important for proper growth

and development and to prevent the health problems such as obesity, dental caries and

iron deficiency anemia 14

An descriptive study carried out in Sydney by Mcfarlad on Oct 20, 2009, strongly suggest

that the many types of junk foods are very low in magnesium and that resulting

magnesium deficiency can causes diabetes, arteriosclerosis and high blood pressure,

hyper triglyceridemia and hyperlipedemia. Recent research has shown that magnesium

deficiency associated with insulin resistant in obese children. Also proved that adults

with hyperlipedemia has got strong root of childhood obesity and junky food

consumption.

Lot of studies in adolescents pertaining to fast food consumption and their various

correlates or association with home, school environment have been conducted in

developed countries but in developing countries this field is not studied to grate extent.

Moreover out of these only few account to interventional studies.

An evaluative studies carried out on rats to determine the links between processed food

and addiction found that a high fat diet appears to alter the brain biochemistry in similar

way to drugs such as Morphine. The report said that this is due to release of opioids –

chemicals in the brain that reduces the feeling of beingful. From the finding the

researches assumed that it is possible that human being become addicted to high sugar

and fatty food. That is responsible for the behavioural change to occur among

adolescents.

Seminar held on “problems in adolescents”, organized by the Cipla manufacturing

Limited Sri Durga Malleswara Siddartha Mahila Kalasala. Dr. Madhavi said that

polycystic ovary syndrome was a common problem among many teenaged girls and

young women. “Obesity is contributing to problems like irregular periods, which will

ultimately lead to growth of unwanted hair and acne”. She said that most of the problems

could be addressed by making a little change to the diet schedule on adolescents. It is a

common practice among teenagers to take pizza, burgers, French fries and chips between

the meal and to avoid this junk food completely 15

An evaluative study was conducted by Koh, Vivienme to investigate the meaning of

health and unhealthy eating habits and the importance of healthy eating habits among

adolescents. Findings suggest that interventions are needed that assists adolescence with

the translation of their knowledge into healthy eating behaviour. Planned teaching

programme should help in making the healthy eating habits, aimed at reducing the health

problems of adolescent by reducing children’s consumption of unhealthy food and soda

drinks 16

Hence, the investigator felt the need to conducted the study planned teaching

programmes regarding health hazards of junk foods and to evaluate the effectiveness of

planned teaching programme among adolescents.

6.2 REVIEW OF LITERATUREA literature review is the background for understanding correct knowledge on the topic

and illuminates the significance of new study.

Review of literature is explained in 3 headings

Students related to

1. Changing trends in adolescents eating pattern

2. Promoting factors of junk food

3. Health hazards of junk food

(i) Students related to changing trends in adolescents eating pattern:-

A national health and nutrition examination surveys was conducted in USA to determine

the adolescent’s beverage consumption trends and causes. The sample consisted of 73

(345) individuals aged 12-16 years. The results of the study showed that for this age

group sweetened beverage consumption increased and milk consumption decreased.

Overall energy intake from sweetened beverages increased by 85% and was reduced by

38% from milk. With a 278 total calorie increased. This trend was associated with

increased proportion of adolescents consuming sweetened beverages and disease in milk

consumption. This study recommended the beneficial impacts of decreased soft drink

and fruit drink intake.

A cross sectional study was conducted in USA to describe foods and beverages

consumed at schools in terms of number of serves the data have been collected from 1001

children aged 4-12 years. Food and beverages in take was assessed using a school food

check list. The result of the study showed that 30% of children had fruit bars. 59% had

packed snacks and 26% had chocolates, during their lunch and coffee breaks. 10% of

children reported using the canteen and fast foods were the most frequently purchased

items.

A study was conducted to assess meals versus snacks in terms of their contribution to

total daily energy intake. Meals and snacks were assessed from 13-14 years old

adolescents (n=220). The result of the study showed that boys and girls consumed about

the same percentage of their total daily energy intake as snacks (29%). Chocolates, crips

and fizzy drinks were popular snack foods in the adolescent group. This study

recommended giving more concern related to snacks with dental cares.

2. Studies related to factors promoting junk foods:-A study was conducted in chile on increased consumption of junk food and snacks in

recent years its association with marketing strategies. The study was conducted on 400

adolescents in the age group of 13-18 years by using questionnaire. The study showed

that the availability of junk foods and snacks at low prices and marketing had triggered

increased consumption of junk foods. The contribution of snacks to daily energy intake

among children was increased by 30% in 1996. This study indicated that education about

junk food consumption and health eating habits in the family should be strengthened.

A study to determine the relationship between the presence of television during meals

and children food consumption pattern was conducted in 91% parents child pairs.

Children were in 10-14 years of age group. Non-consecutive 24 hours dietary recall was

conducted with each child. The result showed that there was significant association

between television and children consumption of caffine. Children from families with

high TV viewing Derived 5% more of their energy intake from pizza, salty snacks and

soda.

3. Literature related to health hazards of junk foods:A study was conducted in USA to describe association between dental caries and intake

of beverages in children subjects (n-642) were in the age group of 4 to 7 years. Caries

were identified during dental examination by 2 trained and calibrated dentist. The result

of the study showed that subjects with caries were identified during dental examination

by 2 trained and calibrated dentist. The result of the study showed that subjects with

caries had higher means intake. Eg: regular soda pop and regular beverage consumption.

An explorative study was conducted on the biological effects of fast food suggest that

bingening on foods that are excessively high in fat and sugar can cause changes in the

brain and body that make it hard to say no. A few even believe that the foods can trigger

changes that are similar to full blown addiction.

6.3 OBJECTIVES OF STUDY:-1. To assess the knowledge of adolescents regarding the health hazards of junk foods

before and after planned teaching programme.

2. To assess the attitude of adolescents regarding the health hazards of junk foods before

and after planned teaching programme.

3. To find out the effectiveness of planned teaching programme.

Operational Definitions:-1. Knowledge: It refers to the correct response of the students to the questions related to

the health hazards of junk foods.

2. Attitude: If refers to the expressed feeling of high school students regarding junk food

consumption which is measured by using attitude scale.

3. Adolescents: Adolescents are those between the age group of 13-19 years. In this

study it refers to individual in the age group of 13 to 15 years.

4. Junk Foods: It refers to the food item that has low nutritive value, which are easy to

make and easy to consume (eg. Fast foods, fried items, candies, potato waffer, carbonated

beverages). These have only fats using in it causing all ill effects on the health.

Assumptions:-

1. Adolescents are the vulnerable group exposed to the hazardous aspects of junk foods.

2. Adolescents have some knowledge regarding health hazards of junk foods.

3. Adolescents have favourable attitude towards junk foods.

4. Planned teaching programme improves knowledge and attitude regarding healthy food

habits among adolescents.

Hypothesis:

To achieve the stated objective the following hypothesis was formulated.

All the hypothesis will be tested at the 0.05 level of significance.

H1: The mean post-test knowledge scores of adolescents attending planned teaching

programme on health hazards of junk foods will be significantly higher than their mean

pre-test knowledge scores.

H2: The mean post-test attitude scores of adolescents attending planned teaching

programme of health hazards of junk foods will be higher than their mean pre-test

attitude scores.

7. Material and Method:

7.1 Source of data:

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

Research Design:

Pre=experimental, one group pre test-post test design was adopted for the study.

Setting:

The study will be conducted in selected urban high school, Bangalore, Karnataka.

Population:-

The population under study consist of adolescents studying in high school classes.

7.2 Method of data collection:-

The data will be collected from high school children by administering structured

knowledge questionnaire and attitude rating scale.

Sampling Technique:-

In this study stratified random sampling technique to be used.

Sample Size:

In this study sample size consists of children between 13 to 15 years of age studying in

urban high schools.

Inclusive Criteria:

- Adolescents between the age group of 13 to 15 years.

- Adolescents who are willing to participate in study

- Adolescents studying 8th, 9th and 10th Standard.

- Adolescents who are studying in English medium.

Exclusive Criteria:

- Adolescents who have been exposed to similar teaching previously.

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

- Adolescents who are not available during the time of the study.

Instrument intended be used:

- Structured knowledge questionnaire on health hazards of junk food.

- Attitude rating scale will be used for assessing the attitude regarding junk foods.

Data Analysis:-

The collected data will be analysed by using descriptive and inferential statistics.

7.3 Does the study require any investigation or interventions to be conducted on patients

or other humans or animals?

Yes, the investigation is done on the group of adolescents.

7.4 Has ethical clearance been obtained from the institutions in case of 7.3

Yes, the return permission order has been obtained from the authorities of selected school

prior to conduct the study.

8.0 List of References:

1. Krause’s food, nutrition and diet therapy, 11th edition, saunders publications Page No.

284-294

2. Koh, Vivienne, “The Battle between junk food and health food” Aug 2007.

3. www.Ergonomics.org.uk/20 October 2009.

4. www.copperwiki.org/index/junk food 12 October 2009

5. www.india.parenting.com / food and nutrition / 11/2009

6. Impact of a diet and nutrition, related educational package on Awareness and practices

of school children of Chandigarh, the internet journal of Epidemiology, 2008, Volume-6,

No. 1

7. Statistics on Indian population 4th of April 2009.

8. Children and junk food – http://www.indiaparenting.com/food and nutrition/56, 2009.

9. Junk food availability in School raises anemia http://www.nber.org/digest - Sep, 2009.

10. Junk foods makes kids fatter, but happier – http://www.sciencedaily.com 2009/04

11. Food and Nutrition research, Vol 49 No. 4, 2005.

12. The Hindu:magazine/health:beware of junk foods –

http://www.hindu.com/mag/2009/11

13. Junk food summary and analysis summary http://www.bookrags.com/junk food?

14. The Hindu:Andra Pradesh/Vijayawada News; http://www.the hindu.com/2009/10/14

15. Journal of Nutrition education, volume 333, issue 4, July-August 2001.

16. Swaminathan ‘food and nutrition, fifth edition, The Bangalore printing and

publication Page No. 185.

17. Programme for adolescent health and development WHO 1999

18. The Health of young people, a challenge and a promise, Geneve, WHO.

19. Rajarathnam J. Ashokan J.S. et al “Prevalance of anemia among adolescence girls of

Urgan cities 2000 : 37:532-6

20. Chaturvedi S. Kapil U et al : Nutrient update amongst adolescent girls belonging to

Rajasthan.

21. Indian journal of paedistrics 1996:33:198-201