A DESCRIPTIVE STUDY TO ASSESS THE KNOWEDGE OF HIGH SCHOOL STUDENTS REGARDING JUNK FOODS IN SELECTED URBAN SCHOOLS OF BANGALORE

DISTRICT WITH A VIEW TO DEVELOP AN INFORMATION PAMPHLET.

M.Sc. Nursin Diss!r"#"i$n Pr$"$c$% su&'i""!( "$

Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore. B) MR. CHANKRA PANI .P.S M.Sc NURSING *ST YEAR +,**-+,*+ Un(!r ".! Gui(#nc! $/ HOD0 D!1#r"'!n" $/ CHILD HEALTH NURSING ANURADHA COLLEGE OF NURSING0 G#n(.#(#2#3#%0 H! #n#.#%%i cr$ss0 Vis.4#n!!(#' 1$s"0 B#n #%$r! 56* 1

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES0 BANGALORE0 KARNATAKA ANNE7URE 5 II

SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

2 3

4 5

NAME OF THE CANDIDATE AND MR. CHAKRAPANI. P.S ADDRESS ANURADHA COLLEGE OF NURSING0 BANGALORE. NAME OF THE INSTITUTE ANURADHA COLLEGE OF NURSING COURSE OF STUDY 8 SUBJECT *ST YEAR M.Sc. NURSING CHILD HEALTH NURSING DATE OF ADMISSION TITLE OF THE TOPIC A DESCRIPTIVE STUDY TO ASSESS THE KNOWLEDGE OF HIGH SCHOOL STUDENTS REGARDING JUNK FOODS IN SELECTED URBAN SCHOOLS OF BANGALORE DISTRICT WITH A VIEW TO DEVELOP AN INFORMATION PAMPHLET9

:. Bri!/ R!su'! $/ ".! In"!n(!( W$r2 In"r$(uc"i$n

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Food is any substance consumed to provide nutritional support for the body. It is usually of plant or animal origin & contains essential nutrients such as carbohydrates fats proteins vitamins or minerals. !un" food is a term describing food that is perceived to be unhealthy or having poor nutritional value according to Food #tandards $gency. %he term is believed to have been coined by &ichael !acobson director of the center for science in the public interest in 1'(2. %he term has since become common usage. !un" food includes those food items that do not add any value to a person)s diet. *ere value denotes essential nutrients vitamins and minerals.1 #treet food and fast food are also ta"en in the same conte+t as !un". ,hen -e spea" of street food the fact that it)s coo"ed in unhealthy conditions ma"es it more unhealthy than the same food made at home. .oming to the latter fast food is the "ind of food item -hich can be made and served /uic"ly. %he biggest irony regarding 0un" food is the fact that it)s mostly prepared out of healthy food. .oming to Indian !un" food locally called 1.haat) these mostly include the #amosas 2achoris 3anipuris4golgappas are fried items -ith various filling -ithin an outer layer made of refined flour.2 In India even .hinese food sold in road side stalls is !un" food because they contain high amount of &onosodium 5lutamate 6&#57 -hich is a flavor enhancer and this &#5 is recogni8ed as a health ha8ard if ta"en in larger /uantities. %he evidence for this is described belo-. *erbert & 61''(7 conducted a study to determine -hether the sub0ects had a statistical difference in the incidence of their specific symptoms after ingestion of &onosodium 5lutamate 3

6&#57 compared -ith placebo. %he study selected 91 sub0ects. First 5gm &onosodium glutamate 6&#57 -as administered in random se/uence in a double-blind fashion. #ub0ects -ho reached only to a single test agent under-ent rechallenge in random se/uence in a double-blind fashion -ith placebo. %he result revealed that 1: 62'.5;7 responded to neither placebo nor &onosodium 5lutamate. 96'.:;7 to both 15 624.9;7 to placebo and 22 639.1;7 to &onosodium 5lutamate. %otal average severity of symptoms after ingestion of &onosodium 5lutamate -ere greater than after placebo ingestion. %he symptoms li"e headache muscle tightness numbers4tingling general -ea"ness and flushing occurred more fre/uently after &onosodium 5lutamate ingestion. %he study concluded that &onosodium 5lutamate reproduced symptoms in alleged sensitive persons. 3eople need to apply some common sense and decide for themselves -hat is right for them and -hat)s not. $nd it has been proven that high fat4sugar foods leads to obesity increase in cholesterol high blood pressure and cardiac problems. #o everybody must "eep certain amount of a-areness about food nutrition so that healthy choices can be made.3 Finally the investigator feel the need to mention that many children in some parts of the -orld are dying of starvation everyday and they don)t have this great choice to ma"e. $ny food -hether !un" or other-ise -ould be life for them.

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getting nutrients from a variety of food sources in to them. .hanges in our society have intensified the need for food s"ills to the e+tent that they need to become a part of child)s basic education for good health and survival. &ost people have forgotten that the primary reason for eating is nourishment. !un" food comprises of anything that is /uic" tasty convenient and fashionable. 5ood nutrition is a high priority children must "no- -hat they eat affects ho- they gro- feel and behave.4 4 J!// Ar(!r *elping our little ones develop a broad palate and accept ne- foods is a necessary part of

%raditionally it has been parents -ho have ta"en leadership in deciding -hat their "ids are going to eat. <ut &c =onald)s and other fast food companies spend billions of dollars a year on ad campaigns that target children -ith the goal of ta"ing that leadership a-ay from the parents and shifting it on to the "ids themselves. In this -ay the ads not only promote the consumption of !un" food -ith all the baneful health conse/uences -e are -itnessing today.5 !un" 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. .ommon 0un" food includes salted snac" foods li"e chips 6crsps7 candy gum most s-eet desserts fried fast food and carbonated beverages 6sodas7 as -ell as alcoholic beverages. 9 %he food habitats in India have changed due to the -estern influence and the usage of foods is also on the rise and have been a part of everyday life. In India the consumer spending rate on processed food had ncreased at an average rate of (.9; annually during the years 2>>: to 2>1> and this -as e+pected to continue as the consumer e+pense -ould rise -ith an average of around :.9; till the year 2>12. 3>; of children aged 2-1' years are considered over-eight or obese and has been estimated that 1 in 3 children born in the year 2>>> -ill develop diabetes in their lifetime over the past 3 decades the childhood obesity rate has more doubled for pre-school children aged 2-5 years and adolescents aged 12-1' years and it has more tripled for children aged 9-11 years.( $ survey -as conducted by $ssociation of chambers of commerce and industries in 25 private and public school canteens in five ma0or cities ? $hmedabad &umbai 2ol"ata .hennai including .handigarh among 5>>> high school students. %he survey disclosed that 53; of children in .handigarh spend an average of @s. (>> to 1>>> every month on 0un" food in school canteens. $nother alarming finding -as that 5'; of the food served in canteens -as 0un" food. It revealed that "ids prefer to snac" on 0un" food -hich is heavy in fats salt and sugar and -arns that if the trend continues the "ids are set to develop lifestyle diseases.: 5

$n alarming trend on the rise is that of 0un" food. It is of the utmost importance that children do not over indulge in 0un" food. Ampty calories in soft drin"s and fatty foods promote obesity responsible for many of the health problems plaguing the planet. Bbesity can have a deep effect on a child)s life increasing ris" of numerous health problems. #uch as heart disease hypertension and stro"e type 2 diabetes high level of cholesterol and sleep apnoea. Bbese children also face a higher ris" of developing liver diseases orthopedic problems and asthma.' $ study -as conducted by %racee .ornforth on young adults of age 1: to 3> years to find the effect of eating fast food for teens. %he study selected 3 >31 young blac" and -hite adults. %he participants -ere as"ed about ho- often they eat brea"fast lunch or dinner at fast food restaurants. =ata -as collected by /uestionnaire and by doing physical e+amination. %he result revealed that adverse impact on participants -eight and insulin resistance -as seen in both blac"s and -hites -ho ate fre/uently at fast food restaurants. %he study concluded that blac"s visited fast food restaurants more fre/uently than -hites.1> Coung children are not capable of understanding that the advertising is intended to manipulate their feelings and alter their behavior. %here is no better time than no- to built a supportive environment for nurturing children and endo-ing them -ith a legacy of good health.11 $s health professionals are engaged directly in the largest preventable health crisis faced by the country being an investigator -ould li"e to utilise this opportunity to impart the ill-effects of 0un" food. B-ing to the investigator she is -itnessed many children having more choice or taste to-ards the 0un" foods -hen compared to healthy food being una-are of the ill effects of those yummy items they choose. <eing an investigator -ould li"e to assess the "no-ledge of high 9

school students regarding 0un" food and update their level of "no-ledge by providing informational boo"let.

:.+ R!3i!4 $/ %i"!r#"ur!

%he purpose of revie- of literature is to obtain comprehensive "no-ledge base and in the department of information from previous studies. S$nic# Tucun(u3# P.i%i11i =+,**> conducted cross sectional study to evaluate the consumption of beverage and soft drin"s by adolescents of a public school in #ao3aulo <ra8il. %he study selected (1 adolescents aged bet-een 14 to 1( years from both genders. =ata -as collected by /uestionnaire. %he result revealed that the most fre/uent consumed beverage -as industriali8ed fruit 0uice 63:.1;7 soft drin"s 62:.9;7 and natural fruit 0uices 622.2;7 and main place -ere home 63:.2;7 school 622.1;7. %he study concluded that s-eet beverage inta"e -as fre/uent among adolescents specially soft drin"s and -ere consumed at home and at school. %he nutrition education program should aim to stimulate the inta"e of more healthy beverages by adolescents12 Si%3i# H$1! =+,*,> conducted a cross sectional study to provide locally specific evidence around the e+posure a-areness and effect of !un" food advertising and promotion to children and adolescents in Fi0i. %he study selected a total of :: primary school students and 1>3 secondary school students from high schools in #uva Fi0i. %he data -as collected by /uestionnaire. $ combination of Api data and &icrosoft e+cel -ere used in analysis. #tatistical significance -as determined using a chi s/uare test. %he result revealed that the secondary school participants -ere statistically more li"ely to -atch television on more days of the -ee" than the primary school participants. %he study concluded that children and adolescents in #uva are being e+posed to and affected by the !un" food advertisements -hich are abundant in their daily environment13 Y#n M !" #% =+,,?> conducted a e+perimental study on factors related to top 1> !un" foods consumption at : to 19 years of age in *aidian district of <ei0ing. %he purpose of the study -as to study the current situation of ten types of !un" food consumption among children and (

adolescent. %he study selected 1>1' children. $ /uestionnaire survey -as done to collect data. %he result revealed that one month prior to the study '(.5>; of children and adolescent had eaten atleast one type of !un" food and 15.::; of them had eaten all types of them. %he study concluded that eating !un" 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 o-n healthy eating behaviors14. M#n1r!!" K#ur =+,,?> conducted a study to determine the prevalence of consumption of fast food among school children and their "no-ledge regarding the food they eat. #tudy -as conducted on 1> different schools comprising of 2939 children. %he data -as obtained by /uestionnaire. %he result revealed that 5>; of the children -atched fast food being advertised on television and (>; -ere not a-are of the nutritional conte+t of this food consumed by them. %he study concluded that children in urban schools li"ed !un" food but they preferred to have these in bet-een meals and believed that food advertised -as healthy15. Di@$n H G =+,,A> conducted a cross-sectional survey to e+amine associations bet-een children)s regular %D vie-ing habits and their food related attitudes and behavior and an e+periment assessing the impact of varying combinations of %D advertisements for unhealthy and healthy foods on children)s dietary "no-ledge attitude and intentions. %he study selected '1' grade five and si+ students from different schools in &elbourne $ustralia. =ata -as collected by survey method. @esult revealed that ads for nutritious foods promote selected positive attitudes and beliefs concerning these foods. %he study concluded that changing the food advertising environment on children)s %D to on -here nutritious foods are promoted and !un" foods are relatively unrepresented -ould help to normali8e and reinforce healthy eating19. K!%%) N. A%%!n =+,,A> conducted study on effectiveness of nutrition education on fast food choices in adolescents. %he purpose of the study -as to gain insight as to ho- food choices in a simulated fast food environment might be influenced by nutrition education in a group of adolescents. %he study selected 1> adolescents. 3articipants -ere as"ed to choose food items from a fast food restaurant menu. %heir chosen meals nutrition -as calculated. Follo-ing a 3> minutes nutrition education session participants -ere again as"ed to choose a meal from the same fast :

food menu. %he result revealed that there -as a statistically significant difference of the meals chosen after nutrition education. %he study concluded that this short nutrition education intervention resulted in healthier fast food choices in this group of adolescents1(. Y#'#'$"$ JB =+,,B> conducted study to determine -hether adolescents -ill modify their ordering behavior if calorie and fat nutrition information is posted on the restaurant menu. %he study selected 1>9 adolescents aged 11 to 1: years and -ere as"ed to order a dinner of their choice from 3 different restaurant menus. %he result revealed that (5 did not change any of their orders 31 did change some orders and only ' changed their orders. %he study concluded that the provision of calorie and fat content information on the menu did not modify the food ordering behavior for the ma0ority of adolescents1:. C#nJ#n =+,,B> conducted e+perimental study on effect of nutrition education on the "no-ledge and practice of school children regarding !un" food inta"e. %he study -as conducted on 4:( students in t-o control and treatment groups. =ata -as collected by /uestionnaire. %he results revealed that nutrition education plays a crucial important role in improvement of "no-ledge and practice particularly in school1'.

Eric# G#rci#-L# $ =+,,D> conducted study to test the hypothesis that over-eight adolescents are more susceptible to adverse effects of fast food than lean adolescents. %he study selected 29 over-eight and 2: lean adolescents aged 13-1( years. %he samples -ere fed large fast food meal in food court and instructed to eat as desired in 1 hour and assessed energy inta"e under free living conditions for 2 days -hen fast food -as consumed. =ata -ere collected by direct observation and telephone. @esult revealed that mean energy inta"e from fast food meal among all participants -as e+tremely large and over-eight participants ate more than lean participants. %he study concluded that adolescents over consumed fast food regardless of their body -eight2>. S.#n".) A. B$4'#n =+,,D> conducted a study to test the hypothesis that fast food consumption adversely affects dietary factors lin"ed to obesity ris" the study selected 9212 children in adolescents of age 4 to 1' years in Enited #tates. #urvey -as done to collect the data. '

%he result revealed that 3>.3; of total sample reported consuming fast food. .hildren ate more total energy and had poorer diet /uality on days -ith compared -ith -ithout fast food. %he study concluded that consumption of fast food among children in the Enited #tates seems to have an adverse effect on dietary /uality in -ays that plausibly could increase ris" for obesity21. JA. Fu%2!rs$n =+,,*> conducted a study to e+amine demographic behavioral and dietary correlates of fre/uency of fast food restaurant use in a community based sample of adolescent students. %he study selected 4(49 adolescents from 31 schools in &innesota Enited #tates. =ata -as collected by survey. =ietary inta"e -as assessed using a semi-/uantitative food fre/uency /uestionnaire. *eight and -eight -ere directly measured. @esults revealed that fre/uency of fast food restaurant use -as positively associated -ith inta"e of total energy and availability of unhealthy foods and inversely associated -ith peer concerns about healthy eating. %he study concluded that fre/uency of fast food restaurant use is associated -ith higher energy and fat inta"e among adolescents and intervention to reduce fast food restaurants needs to perceive importance of healthy eating22.

STATEMENT OF THE PROBLEM

$ descriptive study to assess the "no-ledge of high school students regarding 0un" foods in selected urban schools of <angalore district -ith a vie- to develop an information pamphlet. :.E OBJECTIVES OF THE STUDY
1. %o assess the "no-ledge of high school students regarding !un" food studying in urban schools. 2. %o find out the association bet-een demographic variables -ith "no-ledge scores of high school students studying in urban schools regarding 0un" food. 3. %o develop and distribute information pamphlet.

1>

:.D OPERATIONAL DEFINITION

2n$4%!( !F In this study "no-ledge refers to the correct response given by high school students to the /uestionnaire regarding !un" food in urban schools. Jun2 /$$(F In this study it refers to any food item such as soft drin"s chips pi88a ice cream hamburgers coo"ies bread biscuits ca"es fried foods etc that have poor nutritional value and contains sugars fats oil & salt -hich are considered as unhealthy for children and available at school canteens colleges nearby shops restaurants and road side. Hi . sc.$$% s"u(!n"sF In this study it refers to both male and female students of : th -1>th standard -ho are studying in selected schools bet-een the age group of 13-19 years Ur&#n sc.$$%F %he high school -hich is situated in to-n or city. In/$r'#"i$n &$$2%!"F In this study informational boo"let refers to systematically prepared health pac"age -hich includes information regarding definition types effects tips to promote healthy eating. !un" food -hich can be easily understood by high school students irrespective of their "no-ledge.

:.B RESEARCH HYPOTHESIS

H*F %here -ill be significant difference in the "no-ledge regarding !un" food among high school students studying in urban schools. H+F %here is a significant association bet-een demographic variables -ith "no-ledge scores of high school students studying in selected urban schools.

:.: ASSUMPTIONS
1. Increasing the "no-ledge of high school students studying in urban schools regarding !un" food have a positive impact on preventing chronic health problems. 2. 2no-ledge on !un" food closely associated -ith some demographic characteristics such as age se+ study atmosphere family type parent occupation inade/uate "no-ledge etc. among high school students. 3. Information boo"let enhances the "no-ledge regarding !un" food among urban high school students. 11

:.A DELIMITATIONS
%he study is limited to high school students studying in urban schools. %he study is limited to a sample of :> high school students. %his study cannot be generali8ed.

:.? PILOT STUDY

%he pilot study -ill be conducted on : high school students aged 13-19 years. %he purpose of the pilot study is to find out the feasibility of conducting study and design on plan of statistical analysis. %he findings of the pilot study samples -ill not be included in the main study.

:.6 VARIABLES
@esearch variables are the concepts of various levels of abstractions that are entered manipulated and collected in a study.

D!'$ r#1.ic 3#ri#&%!sF $ge gender family type socio-economic status parent
occupation educational status income of family. D!1!n(!n" 3#ri#&%!sF 2no-ledge of high school students -ho are studying in urban schools regarding !un" food.

A., MATERIALS AND METHODS OF THE STUDY

%his study is designed to compare the "no-ledge regarding !un" food among high school students studying in schools <angalore.

A.* SOURCES OF DATA

%he data -ill be collected from high school students studying in urban schools <angalore.

A.*.* RESEARCH DESIGN

@esearch design selected for the present study is non e+perimental method.

A.*.+ RESEARCH APPROACH

$ descriptive survey approach -ill be used. 12

A.*.E RESEARCH SETTING

%he study -ill be conducted in selected urban schools <angalore.

A.*.D POPULATION
%he population of the present study includes high school students aged about 13-19 years and are studying in urban schools <angalore.

A.+ METHODS OF DATA COLLECTION

%he data collection procedure -ill be carried out for a period of 9 -ee"s. %he study -ill be initiated after obtaining prior permission from the concerned authorities. %he data -ill be collected from high school students studying in urban schools on "no-ledge regarding !un" food by using self administered /uestionnaire.

A.+.* SAMPLING TECHNIGUE

3urposive sampling techni/ue -ill be used for the present study.

A.+.+ SAMPLE SICE

%he sample consists of :> high school students from urban high schools aged 13-19 years.

A.+.E CRITERIA FOR SAMPLE COLLECTION INCLUSION CRITERIA

o *igh school students aged 13-19 years studying in urban schools <angalore. o *igh school students -ho "no- to spea" and read Anglish and 2annada. o <oth male & female students aged 13-19 years studying in urban schools <angalore.

A.+.D E7CLUSION CRITERIA

*igh school students -ho are not -illing to participate in the study. *igh school students -ho are not available during data collection.

A.+.B TOOLS FOR DATA COLLECTION

13

%he structured /uestionnaire is used to collect the data from high school students. %he structured /uestionnaire format contains /uestion of the follo-ing sections. S!c"i$n AF Guestions related to demographic variables S!c"i$n BF Guestions -hich aims to assess the "no-ledge related to !un" food.

A.+.: PLAN FOR DATA ANALYSIS

%he data collected -ill be analy8ed by means of descriptive and inferential statistics.

D!scri1"i3! s"#"is"ics
&ean standard deviations and mean percentage of sub0ects -ill be used to analy8e the level of "no-ledge regarding !un" food.

In/!r!n"i#% s"#"is"ics
%he chi s/uare test -ill be used to find out the association bet-een socio demographical variables and "no-ledge score.

A.+.A TIME AND DURATION OF THE STUDY

%he time and duration of the study -ill be limited to 9 -ee"s as per the guidelines of university.

A.E DOES THE STUDY REGUIRED ANY INVESTIGATION OR

INTERVENTION TO BE CONDUCTED ON PATIENT OR OTHER HUMAN OR ANIMALH IF SO0 PLEASE DESCRIBE BRIEFLYH
Ho since the study is descriptive study interventions are not re/uired.

A.D HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR

INSTITUTIONH
Ces the pilot study and main study -ill be conducted after the approval from the research committee. 3ermission -ill be obtained from the concerned head of the institutions. %he purpose and details of the study -ill be e+plained to the study sub0ects and an informed consent -ill be obtained from them. $ssurance -ill be given to the study sub0ects on the confidentiality and anonymity of the data collected from them. 14

?., LIST OF REFERENCES

1. $s" Ancyclopedia. $vailable from httpF44-i"i.as".com4food 2. Fran" =ia8 @aising A+cellent "ids in Insane -orldF fear of food. $vailable fromF httpF44---.north0ersey.com4community41249'3:4-@aising-A+cellent"ids-in-an-Insane--orld-fear-of -food-pait-1.html 3. Is !un" food healthyI $vailable from httpF44---.chillibree8e.com4articles-various4!un"-food.asp 4. .hildren and !un" food ? available from httpF44---.indiaparenting.com4food-and-nutrition459-11:94children-and-!un"-food.html 5. !ohn robbin. Is &c. =onald)s betraying our "ids by barrabing them -ith !un" food adsI $vaible fromF httpF44---.*uffingtonpost.com40ohnJroobins 9. !un" food.-i"ipedia. $vailable fromF httpF44en.-i"ipedia.org4-i"i40un"food (. #teep rise in fast food consumption in India ? $vaible fromF httpF44---.fnbne-s.com4article4detne-s.'.aspIarticleid-2'>1' :. @a0an -alia study on 5'; high schools serve !an" food $pril 2: 2>11 $vailable fromF httpF44articles.timesofindia.com '. *armful effects of 0un" food. $vailable fromF httpF44---.healthy0un"ie.com4article.aspIarticleidK24599andharmfuleffects-of-0un"-food 1>. %racee cornforth.Aating fast food means -eight gain Insulin resistance for teens.2>>' !uly 1'. $n fromF httpF44-omenshealth.about.com4od4girlshealth1>14a4fastfoodteen-ei.html 11. .hildren and !un" food $viable from httpF44---.Indiaparenting.com4food-and-nutrition459-11:94children-and0un"-food.html 12. .amilla chermont 3.Astima #onia %ucunduva 3hilippi Arica Lie $ra"i 5reisse Diero #.Leal &arcelle Flores &artine8 &arle dos #antos $lvarenga. <everage and #oft drin" consumption by adolescents from a public school. @evista 3aulista de 3ediatria volume 2' number 1 #ao 3aulo !anuary 2>11. $vailable from httpF444---.google.co.in. 15

13. #ilvia *ope. @eport on research underta"en in Fi0i in 2>1>. $vailable from httpF44---.pacifichealthvoices.org 14. Mhu #3 =ing C! LE NF ,ang *, Cang & ,ang 2N .hao N= Mhao M. $ study on factors related to top 1> !un" food consumption at : to 19 years of age in *aidian district of <ei0in. Mhonghua Liu Ning <ing Nue Ma Mhi 2>>: $ugustO 2'6:7F(5(-92. $vailable from httpF44---.ncbi.nlm.gov4pubmed41'1>31>(. 15. &anpreet 2aur. !aypee)s International !ournal of clinical pediatric =entistry 2>>: #eptember-=ecember 1617F 13-19. 19. =i+on *5 #cully &L ,a"efield &$ ,hite D& .ra-ford =$. %he effects of television advertisements for !un" food versus nutritious food on children)s food attitudes and preferences. !ournal of #oc #ci &ed 2>>( BctoberO 956(7F1311-23. $vailable from httpF44---.ncbi.nlm.gov4pubmed41(5:(4(4. 1(. 2elly H. $llen !ulie #mith %aylor @uth $nne 2uiper. Affectiveness of Hutrition education on fast food choices in adolescents. %he 0ournal of school nursing. =ecember 2>>( volume 23 number 9. 33(-341. 1:. Camamoto !$ Camamoto !< Camamoto <A Camamoto L5. $dolescent fast food and restaurant ordering behavior -ith and -ithout calorie and fat content menu information. !ournal of adolescent *ealth 2>>5 HovemberO 3(657F 3'(-4>2. $vailable from httpF44---.ncbi.nlm.gov4pubmed41922(125 1'. Man!an. %he scientific 0ournal of Man0an Eniversity of &edical sciences !une 2>>5 volume 13 number 51. 2>. .ara <.Abbeling 2elly <. #inclair &ar" $.3ereira Arica 5arcia-Lago *enry $.Feldman =avid #.Lud-ig. %he compensation for energy inta"e from fast food among over -eight and lean adolescents. %he 0ournal of the $merican &edical $ssociation 2>>4O 2'1 6237F 2:2:-2:3:. $vailable from httpF440ama.ama-assn.org 21. #hanthy $.<o-man #teven L. 5ortma"er .ara <.Abbeling &ar" $.3ereira =avid #.Lud-ig. Affects of fast food consumption on energy inta"e and diet /uality among children in a Hational household survey. Bfficial 0ournal of the $merican academy of pediatrics. Dolume 113 Humber 1 !anuary 1 2>>4 page number 11:-11:. $vailable from httpF44pediatrics.aappublications.org

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22. # $ French & #tory = Heumar"-#8tainer 3 *annan ! $ Ful"erson. International !ournal of Bbesity 2>>1 =ecember volume 25 Humber 12 pages 1:23-1:33. $vailable from httpF44---.nature.com.

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SIGNATURE OF THE CANDIDATE

10 REMARKS OF THE GUIDE

11 **.* NAME AND DESIGNATION OF GUIDE

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SIGNATURE

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CO-GUIDE

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SIGNATURE

**.B HEAD OF THE

DEPARTMENT

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SIGNATURE

12 *+.* REMARKS OF THE PRINCIPAL.

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