A STUDY TO ASSESS THE KNOWLEDGE AND PRACTICE OF ADOLESCENTS

REGARDING THE HEALTH HAZARDS OF JUNK FOODS, WITH A VIEW TO

PREPARE,IMPLEMENT AND EVALUATE A HEALTH TEACHING PROGRAMME IN
SELECTED URBAN AREAS AT BANGALORE.

M.SC. NURSING DISSERTATION PROTOCOL SUBMITTED TO

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA, BANGALORE.

By

MRS. SUMATHI. R
M.Sc., NURSING 1st YEAR

2010-12

Under the Guidance of

HOD, Department of Community Health Nursing,

Nightingale College of Nursing,

Guruvanna Devara Mutt Premisses,

Binnyston Garden,Magadi Road,Bangalore-560 023.

1
2
6.
BRIEF RESUME OF THE INTENDED WORK :

INTRODUCTION

Adolescence from Latin, adolescere meaning “to grow up”. The period in
Development between the onset of puberty and adulthood. It usually begins between
11 and 13 years of age with the appearance of secondary sex characteristics and spans The
teenage years, terminating at 18 to 20 years of age with the completion of the
Development of the adult form. During this period, the individual undergoes extensive
Physical, psychologic, emotional, and personality changes.1

A large number of diet and nutrition surveys have been carried out by
Different workers on the developing countries .The results have shown that a majority
Of the school children and adolescents consume inadequate diets and are
malnourished.2

Data regarding the height and weight of children in India as

Compared with American standards are given in Nutrition Atlas of India.I.C.M.R, New
Delhi .It is interest to note that the mean weight of school children and adolescents in India
are about 20-25 percent less than those of American children for the Corresponding age
group. On the other hand, the mean height of school children and Adolescents in India are
only 6-8percent less than those of American counterparts. The mean height and weight of
Indian children belonging to the higher income groups are significantly greater than those
reported for children of all income groups in India. This is evidently due to the more
nutritious diets consumed by the high income Group.3

Adolescents, as a group, are at risk for nutritional problem both from a

physiological and a psychosocial standpoint. The dramatic increase in physical growth and
development creates a high demand for nutrients and energy. Psychosocial changes, such
as the adolescent’s search for independence and identity, concern for appearance, and
active lifestyle, can have a strong impact on nutrient intake and food choices. Studies have
3
frequently found adolescents to have poor dietary habits Often, nutrition and health
educators find that developing education programs to promote healthy eating patterns and
to change dietary behaviour among this age group is challenging, but frustrating.4

The consumption of fast foods has been increased around the world over last 50
years. Foods such as French fries, hamburgers and chips, which constitutes huge amount of
fat and salt, are harmful for health. Some people believe that increasing the level of
awareness of society about deterioration of this group of foods can decrease the
consumption of them.5

A wide range of issues and concerns face adolescents in India including nutritional
deficiencies, reproductive health problems, sexually transmitted diseases, and mental and
physical stress-related problems. Stress often results in the abuse of tobacco and other
habit-forming drugs. The author discusses nutrition, reproductive health, pregnancy,
sexuality, and mental and social concerns as they are related to adolescents.6

6.1 NEED FOR THE STUDY :

Adolescence is a sensitive and important phase in an individual's life during which

a multidisciplinary approach must be taken to both understanding and solving his/her
problems. An estimated 25% of India's population of 138 million is aged 15-25 years. Girls
aged 10-19 years comprise about 22% of the female population.The single dietary change
with the biggest impact on improving your nutrition and natural health would be to stop
eating junk food. Many mature adults, over the years, have forgotten what real food is.
Rather than eat 100% home cooked meals, they eat junk that is the creation of modern food
science.7

Most health conscious individuals now mistakenly think of food in terms of

protein, fat, or carbohydrates. Thinking about protein-rich, fat-rich, or carbohydrate-rich
whole food is better. Most real foods consist of a blend of protein, fat, and carbohydrates.
Protein, fat, and carbohydrates are usually not isolated in nature.8

4
 Starting in the nineteenth century, food processing science discovered how to
isolate protein, fat, and carbohydrates from whole foods. This lead to the development of
junk food. And, today 100% artificial junk food is being sold as real food. However, not all
processed food is junk food. Indeed, avoiding all processed food would be very difficult to
do in the modern world. Junk food, thus, should be viewed as food that has been processed
to the extreme.9

The easiest way to improve our nutrition is by buying produce from your local
grocery store. All food sold in plastic bags, boxes, or in cans is processed food. To improve
your nutrition simply starts reading food labels. You may be surprised to learn that the so
called healthy juice that you have been drinking is more a creation of food science than
Mother Nature. Most junk foods contain less than 5% of the recommended daily
allowances (RDA) of any one of eight basic nutrients. Remember, that all processed foods
are designed to enrich the profits of food companies, rather than to enrich your nutrition.10

To improve our nutrition and natural health simply stop eating Junk Food! Avoid
eating processed food that is more artificial than real. Avoid eating processed foods that
contain too much junk, like high-fructose corn syrup, saturated fat, or salt.9

In India 25% of population are adolescent so it is important to maintain their health

status by avoiding junk food and start to take healthy foods and to become better adult and
citizen .It will be helpful in prevention of health issues and problem in adolescents. A study
like this very much essential to take adequate measures to have healthy life style in
adolescents by health education about effects of junk food. Each individual is important to
make well to do community and will reflect on world.9

5
6.2 REVIEW OF THE LITERATURE

Review of literature is a key step in research process. It refers to an extensive,

exhaustive and systematic examination of publications relevant to the research project.
Nursing research may be considered a continuing process in which knowledge gained from
earlier studies is an integral part of research in general. One of the most satisfying aspects
of the literature review is the contribution it makes to the new knowledge before delivering
into a new area of study while conducting a study, when interpreting the results of the
study and when making judgments about the applications of a new knowledge in nursing
practice. The major goal of review of literature is to develop a strong knowledge base to
carry out research activity.
In this present study, review of literature can be discussed in these
following headlines.
1) KNOWLEDGE REGARDING JUNK FOOD IN ADOLESCENTS

A survey was conducted on secondary school students in December 2004 to

identify their perceived knowledge and attitudes toward fast foods. The population in this
study consisted of 1,050 middle and high school students aged 14~19 from five school
districts in Bussan, Korea. The survey data were collected after trained school teachers
administered the survey in their classrooms. The student survey was completed by 968
students (response rate:92%) which included 541 middle school and 435 high school
students. The findings of the current study cannot be generalized for all adolescents'
perception and attitudes about fast foods throughout the world, not even Korea; however,
these findings are in agreement with the limited numbers of studies published on the
similar topics in other countries, though food habits often differ from countries.
Intervention to reduce frequency of fast food consumption or to improve the food choices
at fast food restaurants may need to address not only the perceived convenience but also
the importance of nutritious and healthy eating habits among adolescents. 11

Parents are the primary influence of preschool children’s diets. The purpose of this
study was to describe diet-related attitudes and knowledge of parents, family fast food
dollars spent, fruit and vegetable intake of children, and their relation to their children’s

6
body mass index-for-age status. We found that 95.5% of preschool children do not eat at
least three vegetable servings a day and that consumption patterns for fruit varies between
Black and White children. Parents’ knowledge and attitudes were not associated with
children’s fruit and vegetable intake nor with BMI status of their children. Findings
indicated a negative correlation between family fast food dollars spent and children’s
vegetable intake and positive correlation to children’s fruit intake
Study participants included 3,031 young black and white adults who were between
the ages of 18 and 30 in 1985-1986.12

The participants, who were part of the Coronary Artery Risk Development in
Young Adults (CARDIA) study, received dietary assessments over a 15-year period.
CARDIA centres are located in Birmingham, AL, Chicago, IL, Minneapolis, MN, and
Oakland, CA. According to the study, men visited fast-food restaurants more frequently
than women and blacks more frequently than whites. Black men reported an average
frequency of 2.3 visits per week in 2000-01. White women had the lowest frequency, at an
average of 1.3 visits per week in 2000-01.13

A cross-sectional and institutional study, adopting a multistage stratified cluster

sampling procedure, was carried out during 2003 on adolescents 12 to 17 years of age of
both sexes from Hyderabad, India.The overall prevalence of overweight was 6.1% [ 95%
confidence interval (CI): 4.2, 8.0] among boys and 8.2% among girls (CI: 6.0, 10.4); 1.6%
and 1.0% were obese, respectively. The prevalence was significantly higher (p <0.05)
among adolescents who watched television 3 h/d (10.4% ) or belonged to a high
socioeconomic background (14.9% , P<0.001), whereas it was significantly lower among
those participating regularly in outdoor games 6 h/wk (3.1% ,P<0.004) and household
activities 3 h/d (4.7% ,P 0.0>01). The logistic regression analysis revealed that the
prevalence of overweight was 4 times higher among the adolescents of high
socioeconomic status [ odds ratio (OR): 4.1; CI: 2.25, 7.52] , 3 times higher in those not
participating in outdoor games (OR: 2.75; CI: 1.56, 4.72), and 1.92 times higher in those
watching television 3 h/d (OR: 1.92; CI: 1.16, 3.18).14

7
2) PRACTICES REGARDING JUNK FOOD IN ADOLESCENTS
.
A cross-sectional and institutional study, adopting a multistage stratified
cluster sampling procedure, was carried out during 2003 on adolescents 12 to 17 years
of age of both sexes from Hyderabad, India. The results shows that the overall prevalence
of overweight was 6.1% [ 95% confidence interval (CI): 4.2, 8.0] among boys and 8.2%
among girls (CI: 6.0, 10.4); 1.6% and 1.0% were obese, respectively. The prevalence was
significantly higher (P<0.05) among adolescents who watched television 3 h/d (10.4%)
or belonged to a high socioeconomic background (14.9% ,P< 0.001), whereas it was
significantly lower among those participating regularly in outdoor games 6 h/wk (3.1% ,
P<0.004) and household activities 3 h/d (4.7% , P<0.001). The logistic regression analysis
revealed that the prevalence of overweight was 4 times higher among the adolescents of
high socioeconomic status [ odds ratio (OR): 4.1; CI: 2.25, 7.52] , 3 times higher in those
not participating in outdoor games (OR: 2.75; CI: 1.56, 4.72), and 1.92 times higher in
those watching television 3 h/d (OR: 1.92; CI: 1.16, 3.18).15

An assessment of the current diet and nutritional status of 12,124 adolescents was
carried out in villages of 10 states of India in 1996 by the National Nutrition Monitoring
Bureau (NNMB), India, and compared with the data of an earlier survey conducted in
1975-79 in the same villages. The average daily food and nutrient intake of different
groups were studied and compared with the recommended dietary intake for Indians
(RDA1981), whereas the average intake of nutrients was compared with the
Recommended Dietary Allowances (RDA) for Indians (1990).The results revealed that
intake of most foods, except cereals, millets, roots and tubers, were below the RDI in all
ages of adolescence. Consumption of green leafy vegetables, fruits, pulses and milk was
grossly inadequate. The mean nutrient intakes were below the RDA in all adolescent age
groups irrespective of sex. In both the sexes, the proportion of adolescents consuming
inadequate amounts was higher in case of micronutrients i.e., iron and vitamin A than that
of protein, energy and total fat. Almost half of the adolescents of both sexes were not
getting even 70% of their daily requirements of energy and a quarter of them were getting
less than 70% of RDA of proteins. However, the extent of severe deficit with respect to
energy intake (<50%) decreased from 21% to 9% in boys and 14% to 5% in girls during
1996-97 as compared to 1975-79.Similarly, the deficit in protein intake also decreased.

8
Low energy and protein intake by adolescents in India can explain to some extent the high
proportion of undernourished and stunted adolescents and adults.16

30 schools were selected from the list by proportional stratified random sampling
which was procured from the District Education Officer, Ahmedabad.18 schools were
selected from the urban areas and 12 schools from rural areas.Estimated sample of 900
students (rural-540, urban-360) was taken from 30 school by systemic random sampling
technique. Sampling Technique: 30 schools were selected from the list by proportional
stratified random sampling which was procured from the District Education Officer,
Ahmadabad. 18 schools were selected from the urban areas and 12 schools from rural
areas. Estimated sample of 900 students (rural-540, urban-360)
was taken from 30 schools by systemic random sampling technique. students were
classified as physically inactive if physical activity was<1 hr/day12. Daily diets of the
students were analysed for fruits and vegetable intake. Students were given stress code by
Glazer’s stress coding system and classifiedaccordingly13. Fried food, fast food, bakery
items and cold drinks were considered as high energy food. Students were classified as per
their consumption of high energy food per week. The findings shows the mean ages of the
urban and rural boys were found as 14.65±1.03 years and 14.96±1.13 years respectively.
Mean ages of urban and rural girls were 14.97±1.14 years and 15.02±0.96 years
respectively. Students belonging to the socio-economic classes II and III were
comparatively more in rural areas (80%) while students belonging to the socioeconomic
class I were comparatively more in urban areas (32.2%). In rural areas, around 50 per cent
of the family members were illiterates or had taken education up to primary level. Family
members with post-graduate education were more in urban areas. Family members who
were unskilled labourers were more in number in rural areas than in urban areas. Rate of
unemployment was also higher in rural areas. As per the findings, physical inactivity and
use of extra Salt in diet was significantly higher amongst the urban adolescents. Tobacco
chewing Practices amongst the rural adolescents (3.05%) were significantly higher than
the Urban adolescents (P < 0.05). Weekly intake of high energy food was found to be
More among the urban habitats. The number of urban students taking vegetables and
Fruits was more in comparison to their rural counterparts which was also statistically

9
 Significant. Prevalence rate of stress was higher in urban areas but it was statistically
Not significant (P > 0.05).14

STATEMENT OF PROBLEM :-

A STUDY TO ASSESS THE KNOWLEDGE AND PRACTICE OF

ADOLESCENTS REGARDING THE HEALTH HAZARDS OF JUNK FOODS,
WITH A VIEW TO PREPARE,IMPLEMENT AND EVALUATE A HEALTH
TEACHING PROGRAMME IN SELECTED URBAN AREAS AT BANGALORE.

OBJECTIVES OF THE STUDY :-

6.3. 1) To assess the existing knowledge of adolescents regarding the health hazards of
Junk foods in a selected urban areas at Bangalore.
2) To assess the existing practice of adolescents regarding the health hazards of Junk
foods in a selected urban areas at Bangalore.

3) To evaluate the health education programme regarding health hazards of Junk foods

4) To find out association between knowledge and practices on health hazards of Junk
foods with selected democratic variables such as age, sex, education, socio
economic status of the family, dietary pattern.

HYPOTHESIS :-

6.4. 1. The mean post test knowledge score will be significantly higher than the mean
pre test knowledge score on health hazards of Junk foods among Adolescents in
selected Urban areas at Bangalore.
2. There will be significant association between knowledge score and selected
demographic variables.

10
 OPERATIONAL DEFINITIONS :-

6.5. KNOWLEDGE:
Refers to the correct responses of the adolescents to the items listed in self
administered knowledge questionnaire on health hazards of Junk foods.

PRACTICES:
Refers to the correct responses of the adolescents to the items listed in self
administered practices questionnaire on health hazards of Junk foods.

HEALTH HAZARDS:
A danger to health resulting from exposure to life style choices.

JUNK FOODS:
It is an informal term applied to some foods that are perceived to have little or no
nutritional valves.

ADOLESCENTS:
The period between child hood and adult hood, begins after secondary sexual
characteristics appear and continues until sexual maturity is complete.

ASSUMPTIONS :-
The study assumes that adolescents will have inadequate knowledge, and
6.6. practices on health hazards of Junk foods.

DELIMITATIONS :-

6.7. The study is delimited to:

 Adolescents between age group of 16-18 years.

 Adolescents, who can read, write or understand either Kannada or English.

 Adolescents in selected urban areas.

11
 PROJECTED OUTCOME :-

The present study will help the adolescents to understand about the health
6.8. hazards on Junk foods, hence it will help to improve the health status of
adolescents.

MATERIALS AND METHODS :-

7. 7.1. SOURCE OF DATA

The data will be collected from adolescent’s age group between 16-18 years in
selected urban areas.

7.1.1. RESEACH DESIGN :-

 The research design adopted for this study is one group pretest posttest design
quasi experimental study.

RESEARCH APPROACH:-
 The research approach is evaluative approach

7.1.2. SETTING :-
 The study will be conducted in selected urban areas at Bangalore.

7.1.3. POPULATION :-
 The population selected are adolescents from 16-18 year age on selected urban
areas at Bangalore..

7.2.1. SAMPLING PROCEUDRE

7.2.  Sampling technique adopted for this study is simple randomization.

12
 7.2.2. SAMPLE SIZE
 The Sampling size will be 60.

7.2.3 INCLUSION CRITERIA:

The criteria for sample selection are

 Adolescents aged between 16-18 year old.

 Willing to participate in the study.

 Who can read, write or understand either Kannada or English.

7.2.4 EXCLUSION CRITERIA

 Adolescents who are not willing to participate in the study.
 Adolescents above 18 years old.
 Adolescents who were not available at the time of data collection.

7.2.5. INSTRUMENTS INTENDED TO BE USED

Part 1: The tool consists of demographic Performa.
Part 2: Questionnaire will be used to assess the knowledge

Part 3: Questionnaire will be used to assess the practices.

SCORING PROCEDURE

For answers. If answer is right 1

If answer is wrong 0

SCORING INTERPRETATION

Good :- 75-100%

Average :- 51-74%

Poor :- Below 50%

13
 7.2.6. DATA COLLECTION METHOD

Adolescents in the selected urban area will be selected for the study using simple
randomization sampling. Formal administrative permission will be obtained from the
concerned panchayat president. The data will be collected from 60 adolecents after
obtaining their consent. The procedure will be explained to them and confidentiality
will be assured. Data will be collected from 5-7 samples per day. The duration will be 4
weeks.

7.2.7. DATA ANALYSIS PLAN:

The plan of data analysis are

 The data obtained will be analyzed in view of the objectives of the study.
 Mean, median, mode, and standard deviation is used for assessing knowledge
scores
 Chi-square test to find out the association between the knowledge attitude and
practices . On growth monitoring with selected demogratic variables. The
significant findings will be expressed in tables, figures and graphs.

HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR INSTITUTION?

YES, ethical clearance will be obtained from the research committee of nightingale
college of nursing.

BIBLIOGRAPHY
7.4
1) http://medical dictionary.the free dictionary.com.adolescence.

2) http://en.wikipedia.org/wiki/adolescence.

3) http://www.milk.mb.ca/Teachers/Images_Docs/Adolescents'%20Views%20on%20
8.
Food%20and%20Nutrition.pdf.

4) http://www.english-test.net/forum/ftopic71607.html

5) http://www.ncbi.nlm.nih.gov/pubmed/12346858

6) Hand book of food and nutrition ,Dr.M.Swaminathan , Bangalore printing and

14
 Publishing Co.Ltd.fifth edition .p.no.180.

7) http://naturalhealthperspective.com/food/processedfood.html.

8) Paediatric Nursing ,Mrs.M.Tanbulwadkar,second edition ,vora medical

publication,p.no. 20.

9) Appledorf H, Kelly LS. Proximate and mineral content of fast food. J Am

Diet Assoc. 1979;74:35–40. [PubMed].

10) Brown K, McIlveen H, Strugnell C. Nutritional awareness and food

preferences of young consumers. Nutrition & Food Science. 2000;30:230–

235.

11) Cho J, Han Y. Dietary behavior and fast-foods use of middle school students in

Seoul. Korean Journal of the Home Economics Education Association. 996;8:105–

119.

12) Emerson RL. The New Economics of Fast Food. New York. USA: Van Nostrand

Reinhold; 1990.

13) French SA, Story M, Jeffery RW. Environmental influences on eating and

physical activity. Annu Rev Public Health. 2001a;22:309–335. [PubMed.

14) http://www.nature.com/oby/journal/v15/n6/full/oby2007165a.html

15) http://www.nihfw.org/Publications/material/J649.pdf

16) http://www.searo.who.int/LinkFiles/Nutrition_for_Health_and_Development_6-

Nutritional_Issues_Among_Adolescents.pdf

15
Signature of the candidate

Remarks of the Guide

Name and Designation of (In block

letters)

Guide

Signature

Co-Guide

Signature

Head of the Department

Signature

Remarks of the chairman and

Principal
Signature

16