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The relationship of nutrition knowledge, attitudes and practices of grade 8 secondary school students… Thompson, Jean Kathleen 1975

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THE RELATIONSHIP OF NUTRITION KNOWLEDGE, ATTITUDES AND PRACTICES OF GRADE 8 SECONDARY SCHOOL STUDENTS IN VANCOUVER, TO SELECTED ENVIRONMENTAL VARIATES by JEAN KATHLEEN THOMPSON B.Sc. ( N u t r i t i o n ) , Queen E l i z a b e t h Col lege , U n i v e r s i t y of London, 1967 A THESIS SUBMITTED IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF SCIENCE in the D i v i s i o n of HUMAN NUTRITION SCHOOL OF HOME ECONOMICS We accept t h i s thes i s as conforming to the required standard. THE UNIVERSITY OF BRITISH COLUMBIA A p r i l , 1975 In present ing th is thes is in p a r t i a l fu l f i lment o f the requirements for an advanced degree at the Un ivers i ty of B r i t i s h Columbia, I agree that the L ibrary sha l l make it f r ee ly ava i l ab le for reference and study. I fur ther agree that permission for extensive copying of th is thes is for s c h o l a r l y purposes may be granted by the Head of my Department or by h is representa t ives . It is understood that copying or p u b l i c a t i o n of th is thes is fo r f i n a n c i a l gain sha l l not be allowed without my wr i t ten permission. The Un ivers i ty of B r i t i s h Columbia 2075 Wesbrook Place Vancouver, Canada V6T 1W5 Date i3t>*- Aforf, \<\1< i i ABSTRACT Adolescence, a per iod of rap id growth and development accompanied by increased nutr ient requirements, i s frequently a stage i n the l i f e cycle when d ie tary prac t ices are poor (Nutr i t ion Canada 1973 and 1974) . The n u t r i t i o n knowledge of teenagers has been considered inadequate, while a review of the l i t e r a t u r e reveals that few studies of the at t i tudes of adolescents toward n u t r i t i o n have been conducted. The r e l a t i o n s h i p among n u t r i t i o n knowledge, a t t i tudes and prac t ices i s a lso not c l e a r l y def ined. An a s s o c i a t i o n a l , non-experimental study was designed, using survey research techniques, to invest igate the n u t r i t i o n knowledge, a t t i tudes and pract ices of grade 8 secondary school students in the C i t y of Vancouver, B r i t i s h Columbia. The nature of the r e l a t i o n s h i p among the c r i t e r i o n v a r i a b l e s , n u t r i t i o n knowledge, at t i tudes and p r a c t i c e s , was assessed and the inf luence of se lec-ted , environmental var ia tes upon the c r i t e r i o n var iab les deter-mined. The var ia tes studied included family var ia tes (family s ize and socio-economic s t a tu s ) ; school var ia tes (school a t h l e t i c and non-a th le t i c a c t i v i t i e s and l o c a t i o n ) ; and i n d i v i d u a l var iates (sex, age, l e i su re a c t i v i t i e s and employment s ta tus ) . In October 1974, quest ionnaires were completed by 366 e ighth grade students from 6 Vancouver schools . The responses were s t a t i s t i c a l l y analysed by computer, a l l tests being conducted at the 5% l e v e l of s i g n i f i c a n c e . Mean percentage scores in tests of n u t r i t i o n knowledge, at t i tudes and pract ices were 66%, 66% and 81% r e s p e c t i v e l y . Students were found to have poor knowledge in the areas of d ietary supplementation and food composit ion. The a t t i tude assoc iat ing good n u t r i t i o n a l value and " d i s l i k e d " foods was common. Dietary adequacy was achieved by 73% of the students. Intake of foods from the f r u i t and vegetable, meat and cerea l food groups was r e l a t i v e l y h i g h , while low intake of foods from the milk group and vitamin D-containing foods was recorded. Vitamin-mineral supplementation was reported by 32% of respondents. Frequency of food intake was h i g h , with 85% consuming food 4 to 6 times per day. Analys i s of variance showed that n u t r i t i o n knowledge test scores were s i g n i f i c a n t l y re l a ted to both family v a r i a t e s , family s ize and socio-economic s ta tus ; the school v a r i a t e , l o c a t i o n ; and the i n d i v i d u a l v a r i a t e , sex. A s i g n i f i c a n t r e l a t i o n s h i p was found between scores in the n u t r i t i o n at t i tudes test and the ^var ia te s , family s i z e , socio-economic s ta tus , school l o c a t i o n , sex and age. V a r i a t e s , school l o c a t i o n and age, were s i g n i f i c a n t l y re la ted to n u t r i t i o n prac t ices test scores . P a r t i a l c o r r e l a t i o n analys i s of test scores for the three c r i t e r i o n var iab les revealed s i g n i f i c a n t c o r r e l a t i o n c o e f f i c i e n t s for n u t r i t i o n knowledge and a t t i tudes (0.500) and for n u t r i t i o n at t i tudes and prac t ices (0.208). The c o r r e l a t i o n between n u t r i t i o n knowledge and pract ices was very low and n o n - s i g n i f i c a n t . Implications for n u t r i t i o n educators from the f indings of the study were discussed. TABLE OF CONTENTS ABSTRACT i i LIST OF TABLES v i LIST OF FIGURES ix ACKNOWLEDGEMENTS x Chapter I. INTRODUCTION 1 Background and Need for the Study 1 Statement of the Problem 5 Hypotheses 7 D e f i n i t i o n s of Terms 8 Assumptions 9 Organisat ion of the Study 10 I I . REVIEW OF THE LITERATURE 11 Dietary Pract ices of Adolescents 11 Dietary Pract ices and Environmental Variates 15 Survey Methodology for Assessment of Dietary Pract ices 19 N u t r i t i o n Knowledge of Adolescents 22 N u t r i t i o n Knowledge and Dietary Pract ices . . . . 23 N u t r i t i o n At t i tudes of Adolescents 23 N u t r i t i o n At t i tudes and Dietary Pract ices . . . . 25 N u t r i t i o n Knowledge and At t i tudes 28 Knowledge, At t i tudes and Pract ices 28 Summary „ 52 I I I . DESIGN OF THE STUDY . . 36 Target Population and Sampling 36 Research Design 37 Data C o l l e c t i o n 38 Data C o l l e c t i o n Instruments 38 Procedure 41 Data Analys i s 44 IV. FINDINGS AND INTERPRETATIONS 46 Descr ip t ion of the Sample Population 46 Family Variates 46 i v School Variates 47 Indiv idual Var ia tes 49 N u t r i t i o n Knowledge, At t i tudes and Pract ices Tests 51 Method of Scoring 51 Results for Tests of N u t r i t i o n Knowledge, At t i tudes and Prac t i ces 53 N u t r i t i o n Pract ices in Terms of Food Groups 58 In te r -cor re l a t ions of Mean Scores for the Food Groups and Tota l Prac t ices Mean Score 63 Vitamin-Mineral Supplementation 65 Frequency of Food Intake 66 The Relat ionship of Selected Var iates to N u t r i t i o n Knowledge, At t i tudes and Pract ices . . 69 Comparison of Family Var ia tes and N u t r i t i o n Knowledge, At t i tudes and Pract ices (Hypothesis 2) 69 Comparison of School Var ia tes and N u t r i t i o n Knowledge, At t i tudes and Pract ices (Hypothesis 3) 71 Comparison of Indiv idua l Var ia tes and N u t r i t i o n Knowledge, At t i tudes and Pract ices (Hypothesis 4) 74 Stepwise Regression Results 76 Discuss ion of the Relat ionship among Selected Var ia tes and N u t r i t i o n Knowledge, At t i tudes and Pract ices 81 In te r -cor re l a t ions of N u t r i t i o n Knowledge, At t i tudes and Pract ices 84 L imita t ions of the Study 85 V. S U M M A R Y AND IMPLICATIONS 8 7 Summary 8 7 Implications 93 > LITERATURE CITED 99 APPENDICES A. Data C o l l e c t i o n Instruments 108 B. Scoring Systems for N u t r i t i o n Knowledge, At t i tudes and Pract ices Tests 115 C. Pretest Questionnaire 121 D. Instruct ions to Students for Completion of the Questionnaire 123 v LIST OF TABLES 1. Percentage of adolescents with "marginal" and "inadequate" intakes of nutr ient s 12 2. Number and percentage of students, by sex, in each school 37 3. Number and percentage of respondents i n d i c a t i n g various family s izes 46 4. Number and percentage of respondents i n d i c a t i n g various l eve l s of socio-economic status 47 5. Number and percentage of respondents i n d i c a t i n g various l eve l s of involvement i n school a t h l e t i c a c t i v i t i e s 48 6. Number and percentage of respondents i n d i c a t i n g various l eve l s of involvement in school non-a t h l e t i c a c t i v i t i e s 48 7. Number and percentage of respondents i n d i c a t i n g various ages , 49 8. Number and percentage of respondents i n d i c a t i n g various l eve l s of involvement in l e i su re a c t i v i t i e s 50 9. Number and percentage of respondents i n d i c a t i n g various l eve l s of employment status . . . , 50 10. Number and percentage of respondents i n d i c a t i n g " t y p i c a l " versus " a t y p i c a l " d ie tary prac t ices 52 11. Two-sample Kolmogorov-Smirnov test 52 12. Mean percentage scores for n u t r i t i o n knowledge, a t t i tudes and prac t ices tests 55 13. Statements measuring n u t r i t i o n knowledge for which respondents achieved lowest mean scores 54 14. Statements measuring n u t r i t i o n a t t i tudes for which respondents achieved lowest mean scores 56 15. Number and percentage of respondents achieving various n u t r i t i o n prac t ices scores 57 v i 16. Number and percentage of respondents achieving various scores for intake of milk group foods 58 17. Number and percentage of respondents achieving various scores for intake of f r u i t s and vegetables . 59 18. Number and percentage of respondents achieving various scores for intake of meat group foods 60 19. Number and percentage of respondents achieving various scores for intake of cerea l group foods . . . . 61 20. Number and percentage of respondents achieving various scores for intake of vi tamin D 62 21. Mean scores for intakes from the four food groups, vitamin D intake and t o t a l p rac t i ce s 62 22. Corre l a t ion matrix for mean scores achieved for food groups and t o t a l prac t ices 63 23. Mean scores of boys and g i r l s for each of the food groups and t o t a l p rac t i ce s 64 24. Corre l a t ion matrix for mean scores achieved by boys for food groups and t o t a l p rac t i ce s 65 25. Corre l a t ion matrix for mean scores achieved by g i r l s for food groups and t o t a l prac t i ce s 65 26. Number and percentage of respondents using a vi tamin-mineral supplement 66 27. Number and percentage of respondents i n d i c a t i n g various frequencies of food intake 67 28. Number and percentage of respondents i n d i c a t i n g frequencies of food intake at various times of the day 68 29. Mean percentage scores of respondents for n u t r i t i o n knowledge, a t t i tudes and prac t i ce s tests in terms of family s ize 70 30. Mean percentage scores of respondents for n u t r i t i o n knowledge, a t t i tudes and prac t i ce s tests in terms of socio-economic status 71 31. Mean percentage scores of respondents for n u t r i t i o n knowledge, a t t i tudes and prac t i ce s tests in terms of school a t h l e t i c a c t i v i t i e s 72 v i i 32. Mean percentage scores of respondents for n u t r i t i o n knowledge, a t t i tudes and prac t ices tests in terms of school non-a th le t i c a c t i v i t i e s 72 33. Mean percentage scores of respondents for n u t r i t i o n knowledge, a t t i tudes and prac t ices tests in terms of school loca t ion 73 34. Mean percentage scores of respondents for n u t r i t i o n knowledge, a t t i tudes and prac t ices tests in terms of sex 74 35. Mean percentage scores of respondents for n u t r i t i o n knowledge, a t t i tudes and prac t ices tests in terms of age 7 5 36. Mean percentage scores of respondents for n u t r i t i o n knowledge, a t t i tudes and prac t i ce s tests in terms of l e i sure a c t i v i t i e s 76 37. Mean percentage scores of respondents for n u t r i t i o n knowledge, a t t i tudes and prac t i ce s tests in terms of employment status 77 38. Stepwise regress ion re su l t s for var ia tes s i g n i f i c a n t -ly r e l a ted to mean percentage scores for the n u t r i t i o n knowledge test 78 39. Stepwise regress ion re su l t s for var ia tes s i g n i f i -cant ly re l a ted to mean percentage scores for the n u t r i t i o n a t t i tudes test 79 40. Stepwise regress ion re su l t s for var ia tes s i g n i f i -cant ly r e l a t ed to mean percentage scores for the n u t r i t i o n prac t i ce s test 81 41. P a r t i a l c o r r e l a t i o n of mean percentage scores for n u t r i t i o n knowledge, a t t i tudes and prac t i ce s tests . . 84 v i i i LIST OF FIGURES 1. Model expla ining the frame of reference of observed food behaviour 29 2. Four poss ib le models of the i n t e r - r e l a t i o n s h i p of n u t r i t i o n knowledge, a t t i tudes and pract ices (K-A-P) . 33 3. Model of the suggested r e l a t i o n s h i p among n u t r i t i o n knowledge, a t t i tudes and prac t i ce s 84 ix ACKNOWLEDGEMENTS The author wishes to express her s incere appreciat ion to her major advi sor , Dr. Nancy Schwartz, for her continuous guidance, support and encouragement throughout the per iod of graduate study. Members of the committee, Dr . Eleanor Vaines and Dr. G a r f i e l d Pennington, are acknowledged for t h e i r in tere s t i n the study and for t h e i r p r a c t i c a l suggestions for the improvement of the report . Apprec ia t ion i s extended to Mr. Alan Moodie, Co-ordinator , Research Studies and Tes t ing , Vancouver School Board Education Department, and to the secondary school personnel , whose co-operation made th i s study pos s ib l e . Sincere thanks are also extended to the secondary school students who so w i l l i n g l y par-t i c i p a t e d in the survey. Gratitude is expressed to Mrs. Inger Nissen for her help with key-punching; to Mr, Christopher Webber for h i s ass istance with computer programming and s t a t i s t i c a l analys i s of the data; to Mr. Bruce Hodgson for h i s c r i t i c a l reading of the report and invaluable suggestions for improvement; to Debbie Welbourn, my t y p i s t ; and to a l l graduate students in the D i v i s i o n of Human N u t r i t i o n and other fr iends for t h e i r continuous encouragement during the pro jec t . A spec ia l thank-you goes to my parents , G i l b e r t and Dorothy Thompson., whose support and encouragement during my e a r l i e r years of education made poss ib le these l a t e r years of study. x - 1 -CHAPTER I INTRODUCTION Background and Need for the Study The importance of adequate n u t r i t i o n to the p h y s i c a l , mental and s o c i a l wel l-being of ind iv idua l s has long been recognised. The phys ica l changes that occur during puberty, s p e c i f i c a l l y the greater growth rate and rate of maturation, a l t e r the n u t r i t i o n a l requirements of the adolescent popula t ion . The emotional stress that frequently accompanies adolescence may lead to i n e f f i c i e n t use of ce r t a in important n u t r i e n t s , increas ing requirements further (Everson 1960) . Many s o c i a l factors may also inf luence the eating habits of adolescents . As teenagers struggle to e s t a b l i s h t h e i r i d e n t i t y , d ie tary prac t i ce s may change, to conform to those accepted by others who are at. th i s same stage of s o c i a l development. The extent of s o c i a l involvement during th i s per iod of l i f e often determines the time spent in eating and' the adolescent may f ind himself too busy to eat proper ly . Using the interview technique to study adolescent a t t i tudes and food h a b i t s , Spindler and Acker (1963) recorded the fol lowing statements made by subjects , 15 to 17 years of age: "We are in such a hurry we do not have time to eat" and "Our a c t i v i t i e s in te r fe re with our e a t i n g " . S o c i a l i s a t i o n with his peers may lead to frequent snacking of non-nutr i t ious food items (Spindler and Acker 1963; Hinton e_t a_l. 1962; Armstrong e_t aj_. 1964; Marlay 1971; Mongeau 1971; and Wolfish 1975); the type of snack consumed i s often - 2 -inf luenced by the at t i tudes of the peer-group toward that food (Spindler and Acker 1963) . The increas ing self-awareness of the young adolescent may lead him to change his food habits in order to a t ta in a des ired phys i ca l appearance (Huenemann et_ a^. 1966) . Thus, the eating pract ices of the teenager are inf luenced by a large number of f ac tor s , the least of which may be the n u t r i t i v e value of the food consumed. Adolescents may, with good reason, be considered a vulnerable group with respect to n u t r i t i o n . Phys ica l and emotional factors may increase the n u t r i t i o n a l requirements, whi l e , s imultaneously, s o c i a l inf luences may decrease the intake of n u t r i e n t s . The recent release of N u t r i t i o n Canada data concerning the n u t r i t i o n a l status of B r i t i s h Columbians (1974) , re-emphasises the problems frequently c i t e d concerning adolescent n u t r i t i o n . Low intakes of the n u t r i e n t s , i r o n , calc ium, p r o t e i n , and vitamins A and D were recorded. Dietary intakes of adolescent g i r l s were less adequate than those of adolescent boys (Nut r i t ion Canada 197 3). Iron intake i s a p a r t i c u l a r l y important problem; 78% of g i r l s and 46% of boys had a less-than-adequate or inadequate intake . The i ron shortage in the d iet at these ages makes i t d i f f i c u l t for body stores to be b u i l t up to normal l eve l s l a t e r in l i f e (p. 60). Other far-reaching consequences of-poor n u t r i t i o n during adolescence include obesity and i t s associated problems; approxi-mately 10% of a l l Canadian schoolchi ldren are obese (Mongeau 1971; Wolfish 1975). At the opposite end of the continuum, up to 25% of North American schoolchi ldren have no breakfast while many others - 3 -have no lunch. Such ch i ld ren are often hungry, and hunger may influence learning and behaviour, p r i m a r i l y in terms of a b i l i t y to concentrate. These ch i ld ren are frequently described by teachers as l i s t l e s s , nervous or d i s rupt ive (Read 1973). N u t r i t i o n prac t ices of the adolescent have been re la ted to a number of environmental or demographic va r i a t e s , inc lud ing fami ly , school (or i n s t i t u t i o n a l ) and i n d i v i d u a l v a r i a t e s . The r e l a t i v e importance of these groups of var iates has not been c l e a r l y es tabl i shed in the l i t e r a t u r e . A l l e n e_t a_l. (1970) in a s o c i o l o g i c a l study, came to the conclusion that : Food and n u t r i t i o n a l factors exert s i g n i f i c a n t inf luence on school performance, s o c i a l maturation and vocat iona l preparat ion of High School youth . . . The process of prepar ing , serving and sharing family meals in the home plays a foca l part in the development and maturation of the High School student (p. 337) . Desirable d ie tary prac t i ce s are e s sent i a l for good h e a l t h . Sound knowledge of the p r i n c i p l e s of n u t r i t i o n does not mean that d ie tary pract ices w i l l be adequate and provide a n u t r i t i o u s , hea l th fu l d i e t . A t t i t u d e s , acquired through s o c i a l i s a t i o n and hab i tua t ion , pattern an i n d i v i d u a l ' s response to a ce r t a in s i tua-t i o n - - that i s , they help determine behaviour or p r a c t i c e s . The pattern of acceptable behaviour in a given s o c i a l group i s often c a l l e d i t s culture (Kilander 1968). Hence, cul ture may determine p r a c t i c e s , inc lud ing d ie tary p r a c t i c e s . A review of the l i t e r a t u r e suggests adolescents value good heal th (Litman 1964; McElroy and Taylor 1966). In one survey, 691 s a i d , " i t mattered a l o t to them to be hea l thy" (Brunswick 1969) , but the re l a t ionsh ip between the at t i tude and the means of achieving th i s goal through good n u t r i t i o n prac t i ce s has not been - 4 -c l e a r l y documented. N u t r i t i o n knowledge of ado lescents , in most s tudies , has been considered inadequate (Mirenda 1966; Morris 1969; Dwyer et a l . 1970; Garton and Bass 1974). Few studies have been reported on the n u t r i t i o n at t i tudes of adolescents , and these are usua l ly part of larger studies of general health a t t i tudes . The n u t r i t i o n prac t i ce s of teenagers have been studied quite ex tens ive ly , but u sua l ly in r e l a t i o n to the environ-mental factors which inf luence these p r a c t i c e s . The f indings of these studies are c o n f l i c t i n g . There i s a lack of information concerning n u t r i t i o n knowledge and at t i tudes of adolescents , the r e l a t i o n s h i p between the two, and the further r e l a t i o n s h i p s between these var iab les and n u t r i t i o n p r a c t i c e s . At t i tudes are e s s en t i a l i n condi t ion ing an i n d i v i d u a l to des i rab le behaviour; and knowledge gives r a t i o n a l ins ight into behaviour, and there fore , inf luences an i n d i v i d u a l ' s a t t i t u d e s , strengthening them and tend-ing to make them la s t longer (Ki lander 1968, p. 32). Thus, i t would seem, in order to e s t ab l i sh des i rab le d ie tary p r a c t i c e s , that p o s i t i v e n u t r i t i o n a t t i tudes must be created and that these at t i tudes must be supported by sound knowledge of n u t r i t i o n . This study attempted to determine the extent of the n u t r i t i o n knowledge possessed by young adolescents , the n u t r i t i o n a t t i tudes they h o l d , t h e i r customary d ie tary pract ices and the re l a t ionsh ip s between these three v a r i a b l e s . The r e l a t i o n s h i p of se lected environmental var ia tes to n u t r i t i o n knowledge, a t t i tudes and prac t i ce s was also inves t iga ted . The f indings of the study w i l l provide data which w i l l be part of the basis from which e f fec t ive n u t r i t i o n education programmes in B r i t i s h Columbia may be planned and implemented. - 5 -Statement of the Problem A survey was conducted to invest igate the nature of the r e l a t i o n s h i p among n u t r i t i o n knowledge, a t t i tudes and prac t i ce s of f i r s t year secondary school students in the C i t y of Vancouver, B r i t i s h Columbia. The r e l a t i o n s h i p of se lected environmental factors to n u t r i t i o n knowledge, a t t i tudes and pract ices was also assessed. The environmental var ia tes studied were: 1. Family var ia tes a) Family s ize b) Socio-economic status 2. School var ia tes a) A c t i v i t i e s (1) A t h l e t i c (2) Non-athle t ic b) Location 3. Indiv idual var ia tes a) Sex b) Age c) Leisure a c t i v i t i e s d) Employment status The study was conducted with the co-operation and approval of the Vancouver School Board. Complete anonymity of pa r t i c ipant s was maintained. School Board regu la t ions , designed to ensure the pr ivacy of students, made impossible the inves t i ga t ion of ce r t a in environmental var iates concerning the students ' f a m i l i e s . These included the educational and occupational l e v e l of the mother and fa ther , family income and ethnic background. - 6 -The fol lowing object ives were es tabl i shed for inves t i ga t ing the problem: 1. To ascerta in the n u t r i t i o n knowledge, a t t i tudes and pract ices of grade 8 secondary school students in Vancouver 2. To determine among grade 8 students , the r e l a t i o n s h i p between n u t r i t i o n : a) Knowledge and at t i tudes b) Att i tudes and prac t ices c) Knowledge and pract ices and the i n t e r - r e l a t i o n s h i p of n u t r i t i o n knowledge and a t t i -tudes with prac t i ce s 3. To determine among grade 8 students, the r e l a t i o n s h i p between n u t r i t i o n knowledge, a t t i tudes and p r a c t i c e s , and the fol low-ing environmental v a r i a t e s : a) Family var ia tes (1) Family s ize (2) Socio-economic status b) School var ia tes (1) A c t i v i t i e s a) A t h l e t i c b) Non-athle t ic (2) Location c) Indiv idua l var ia tes (1) Sex (2) Age (3) Leisure a c t i v i t i e s (4) Employment status The study was designed to meet these o b j e c t i v e s , to develop d a t a - c o l l e c t i o n instruments f o r t h i s type of survey, and to c o n t r i b u t e to the p r e s e n t l y a v a i l a b l e i n f o r m a t i o n on n u t r i t i o n knowledge, a t t i t u d e s and p r a c t i c e s of young a d o l e s c e n t s . Hypotheses The f o l l o w i n g r e s e a r c h hypotheses were t e s t e d : 1. There w i l l be a p o s i t i v e c o r r e l a t i o n between the scores of t e s t s i n n u t r i t i o n : a) Knowledge and a t t i t u d e s b) Knowledge and p r a c t i c e s c) A t t i t u d e s and p r a c t i c e s of grade 8 secondary s c h o o l students 2. There w i l l be a s i g n i f i c a n t r e l a t i o n s h i p between the v a l u e s f o r each of the " f a m i l y v a r i a t e s " ( f a m i l y s i z e and s o c i o -economic s t a t u s ) and scores i n t e s t s of n u t r i t i o n knowledge, a t t i t u d e s and p r a c t i c e s of grade 8 students 3. There w i l l be a s i g n i f i c a n t r e l a t i o n s h i p between the v a l u e s f o r each of the " s c h o o l v a r i a t e s " ( s c h o o l a c t i v i t i e s and l o c a t i o n ) and the scores i n t e s t s of n u t r i t i o n knowledge, a t t i t u d e s and p r a c t i c e s of grade 8 students 4. There w i l l be a s i g n i f i c a n t r e l a t i o n s h i p between the values f o r each of the " i n d i v i d u a l v a r i a t e s " (sex, age, l e i s u r e a c t i v i t i e s and employment s t a t u s ) and the scores i n t e s t s of n u t r i t i o n knowledge, a t t i t u d e s and p r a c t i c e s of grade 8 students - 8 -D e f i n i t i o n of Terms The fo l lowing terms were defined for the purpose of th i s study: N u t r i t i o n knowledge - Comprehension of the basic p r i n c i p l e s and concepts of n u t r i t i o n , as measured and numerical ly scored by the use of a se l f -adminis tered quest ionnaire . N u t r i t i o n at t i tudes - Opinions toward n u t r i t i o n and eating h a b i t s , as measured and numerical ly scored by the use of a se l f -adminis tered quest ionnaire . An a t t i tude i s "an acquired p red i spos i t i on to react in a c h a r a c t e r i s t i c way, usua l ly favourably or unfavourably, toward a given type of person, s i t u a t i o n , object or i d e a l " (Kilander 1968, p . 33). N u t r i t i o n prac t i ce s - The d a i l y habits of the adolescent with respect to s e l ec t ion of food, in terms of food group intake , as measured and numerical ly scored by the use of a se l f -administered quest ionnaire . Family var ia tes - Factors r e l a t i n g to the student 's fami ly : 1. Family s ize - the number of c h i l d r e n in the family 2. Socio-economic status School var iates - Factors r e l a t i n g to the student 's school : 1. A c t i v i t i e s taking place at school or in the name of the school , inc lud ing both a t h l e t i c and non-a th le t i c a c t i v i t i e s 2. Location of the school wi th in the Ci ty of Vancouver Indiv idual var iates - Factors r e l a t i n g to the i n d i v i d u a l student: 1. Sex 2. Age - 9 -3. L e i s u r e a c t i v i t i e s - number of hours per week spent i n community s p o r t s a c t i v i t i e s 4. Employment s t a t u s - whether or not the student i s employed Meal - The amount of food and d r i n k taken at one time, i n response to a p p e t i t e . B r e a k f a s t - The f i r s t meal of the day. Assumptions The f o l l o w i n g assumptions have been made f o r the purpose of t h i s study: 1. The students s e l e c t e d f o r the study were r e p r e s e n t a t i v e of grade 8 students i n the C i t y of Vancouver 2. The secondary s c h o o l students i n c l u d e d i n the sample of t h i s survey c o u l d s a t i s f a c t o r i l y respond to the s e l f - a d m i n i s t e r e d q u e s t i o n n a i r e , f o r the purposes of the study 3. The students had r e c e i v e d no formal n u t r i t i o n e d u c a t i o n p r i o r to the study. In B r i t i s h Columbia, n u t r i t i o n i s taught l a r g e l y w i t h i n home economics courses. Students do not begin to study home economics u n t i l the e i g h t h grade, when n u t r i t i o n c o n s t i t u t e s o n l y a minor p a r t (10%) of the course 4. Each q u e s t i o n n a i r e was completed by a student i n the study without the a s s i s t a n c e of other i n d i v i d u a l s 5. The s u b j e c t s each had an e s t a b l i s h e d d i e t a r y behaviour and thus e x h i b i t e d c o n s i s t e n t food h a b i t s 6. The p r e v i o u s day's d i e t c o u l d be r e c a l l e d a c c u r a t e l y and recorded by the grade 8 students 10 -7. Conducting the survey at d i f f e r e n t times of day, and on d i f f e r e n t days of the week, d i d not i n f l u e n c e the a b i l i t y of the students to complete the q u e s t i o n n a i r e O r g a n i z a t i o n of the Study The study begins with a review of r e l a t e d l i t e r a t u r e i n Chapter I I , s t r e s s i n g the need f o r o b j e c t i v e examination of the n u t r i t i o n knowledge, a t t i t u d e s and p r a c t i c e s of young a d o l e s c e n t s . T h i s i s f o l l o w e d by a chapter e x p l a i n i n g the design o f the study; the t a r g e t p o p u l a t i o n and s e l e c t i o n ; data c o l l e c t i o n and a n a l y s e s . Chapter IV i n c l u d e s a d i s c u s s i o n o f the f i n d i n g s of the study and a summary of the f a c t o r s t h a t were found to be r e l a t e d to n u t r i -t i o n knowledge, a t t i t u d e s and p r a c t i c e s among the s u b j e c t s o f the survey. The l a s t c h a p t e r , Chapter V, c o n t a i n s a summary of the study, and i m p l i c a t i o n s based on i n t e r p r e t a t i o n of the f i n d i n g s . Appendices c o n t a i n m a t e r i a l s p e r t i n e n t to the i n v e s t i g a t i o n and are i d e n t i f i e d i n the s e c t i o n s of the r e p o r t to which they apply. - 11 -CHAPTER II REVIEW OF THE LITERATURE One of the f i r s t n u t r i t i o n surveys in Canada was that of Pett and Hanley (1947) , who studied the n u t r i t i o n a l status of schoolchi ldren in B r i t i s h Columbia and Saskatchewan. The study included 1700 c h i l d r e n ; d ie tary inadequacies were found in 251 of the populat ion. Results of th i s survey were as fo l lows : 1. Low milk intake was shown in 16% of the c h i l d r e n 2. Thinness was evident i n 14%, i n d i c a t i v e of a low c a l o r i c intake 5. Inadequate intakes of the n u t r i e n t s , r i b o f l a v i n and vitamin A, were also recorded 4. Anemia was found in 1 out of 12 ch i ld ren 5. Low serum ascorbic ac id l e v e l s , associated with an observed . lack of f r u i t in the d i e t , were found in 40% of the c h i l d r e n Since that date, many s tudies , in both Canada and the United States of America, have d i sc lo sed the inadequacy of adoles-cents ' d i e t s ; in f a c t , low intakes of the same nutr ient s are s t i l l reported. Some of these studies are examined in the next s e c t i o n . Research f indings concerning the n u t r i t i o n knowledge and at t i tudes of adolescents are then reviewed. The f i n a l sect ion of th i s chapter contains a review of the l i t e r a t u r e concerning the r e l a t i o n s h i p among knowledge, a t t i tudes and p r a c t i c e s . Dietary Pract ices of Adolescents In terms of food groups, there i s frequently a low intake - 12 of f r u i t , vegetables , milk and milk products and cereals among adolescents (Hinton et a_l. 1963; Trenholme and Milne 1963 ; Edwards et a l . 1964 ; Myers e_t a l . 1968 ; Robson 1971; AuCoin et a l . 1972). TABLE 1 PERCENTAGE OF ADOLESCENTS WITH "MARGINAL" AND "INADEQUATE INTAKES" OF NUTRIENTS Percentage with "marginal " and "inadequate" intakes of nutr ient s Nutrient Recommended Dai ly Intake Adolescent boys (10-19 y r . ) Adolescent g i r l s (10-19 y r . ) B .C . Survey Nat ional Survey B.C. Survey National Survey Protein >1.0 g/kg 5.5 7.4 19.6 20.5 Calcium >1200 mg 62 .1 52.5 84.1 66 .2 I r o n a > 15 mg 33 .8 43.4 78.9 72 .4 Vitamin A >750 r e t i n o l equiv. /kg 28.8 29.2 41.6 47.7 Vitamin D >400 i . u . 76. 8 73.1 87.7 86 .8 Vitamin C b >30 mg 7.2 6.5 9.9 11.6 Vitamin C c > 30 mg 18.6 21.1 36.8 27.0 Thiamine >0.8 mg 26.3 26.1 32 . 7 29.8 R ibof l av in >1.10 mg 6.9 11.7 15.5 13.3 Niac in >13.2 n i a c i n equiv. 0.8 0.8 0.5 3.8 SOURCE: Canada, Department of Nat ional Health and Welfare, N u t r i t i o n Canada National Survey (Ottawa: Information Canada, 1973), pp. 72 and 75 and The B .C . Survey Report (Ottawa: Infor-mation Canada, 1974), Appendix Tables fo l lowing p. 152. a Percentage with intake less than 14 mg per day Percentage with intake less than 20 mg per day c 1 Percentage with intake less than 40 mg per day 13 -Nutrient intake data from the N u t r i t i o n Canada Nat ional  Survey (1973) and the more d e t a i l e d report for B r i t i s h Columbia, re ferred to as the B r i t i s h Columbia Survey Report (1974) , are recorded in Table 1. Nat ional and p r o v i n c i a l f indings were very s i m i l a r . Prote in intakes were considered more than adequate for teenage boys and g i r l s . Median d ie tary intakes of vitamin A, ascorbic a c i d , thiamine, r i b o f l a v i n and n i a c i n were also reported as s a t i s f ac tory for a l l adolescents . Teenage g i r l s had marginal intakes of vitamin D and calcium while boys had marginal vi tamin D intakes only . Adolescent g i r l s were also not meeting t h e i r requirements for i ron though the iron, status of boys was found adequate. Other studies show low intakes of the n u t r i e n t s , i r o n , calc ium, ascorbic a c i d , vitamin A and vitamin D (Trenholme and Milne 1963; Caron-Lahaie and Mongeau 1968; Bree l ing 1970; Paterson 1971; Schorr et a l . 1972; and Ruck 1974). In most cases, nutr ient intakes of adolescent g i r l s are less than those of adolescent boys (see Table 1; Milne et_ al_. 1963; Trenholme and Milne 1963; Schorr et a l . 1972). Adolescent meal patterns are t y p i f i e d by numerous small snacks. Sometimes the snacks are n u t r i t i o u s (Huenemann et a l . 1968; Paterson 1971), but more often the snacks are of the "empty-ca lor ie" type (Hinton e_t al_. 1962 ; Armstrong e_t a_l. 1964; Litman et al_. 1964; Hodges and Krehl 1965 ; Marlay 1970 ; Mongeau 1971; Wolfish 1975). Thomas and Cal l ,however , in a recent review (1973), suggested the problem of "empty-ca lor ie " snacks is exaggerated. Using data from the U.S . Department of Hea l th , Education and Welfare 's 10-State survey, i t v/as ca lcula ted that 14 -approximately 23% of c a l o r i c intake came from snacks. Nutrient intake from snacks exceeded the Recommended Dietary Allowance (RDA) per 100 k i l o c a l o r i e s (1973) for p r o t e i n , r i b o f l a v i n and ascorbic a c i d . For vitamin A , calcium and i r o n , nut r i ent intake from snacks was below the RDA/100 k c a l . , but these nutr ient s were also low in the o v e r a l l assessment of t o t a l d a i l y intake . A s i m i l a r conclusion was reached by Eppright e_t a l . (1972) , in a study of infants and preschool c h i l d r e n . When the number of meals per day was greater than 5 or 6, calcium and prote in intakes were favourable in f luenced ; when the number of meals consumed was less than 4, ca lc ium, p r o t e i n , i ron and ascorbic ac id intakes were unfavourably a f fected . Teenagers who considered themselves "obese" ate less than those who considered themselves " l e a n " or "average"; those who ate less than 3 times per day consumed a poor diet (Hampton et_ a l . 1967). In contras t , Hinton et a l . (1962) found no r e l a t i o n s h i p between the number of snacks con-sumed and the adequacy of the d i e t . An adolescent 's breakfast i s f requently small or omitted (Armstrong ejt a l . 1964; Hodges and Krehl 1965; Robson 1971; Read 1973; Wolfish 1975), and lunch i s often not consumed (Breel ing 1970; Robson 1971). Teachers describe ch i ld ren who are hungry because they have not eaten breakfast as l i s t l e s s , nervous and d i s r u p t i v e ; they have an i n a b i l i t y to concentrate in the classroom (Read 1973) . A Swedish report (Arvedson e_t a l . 1969) concluded that "breakfast intakes of less than 400 c a l o r i e s adversely influenced performance", and in the United States , " . . . bet ter a t t i tudes and scho la s t i c achievement during the - 15 -period when breakfast was eaten" were observed (Tutt le e_t a l . 1954). It should be noted that l i t t l e or no well-designed research on hunger and school performance has been conducted, p r i m a r i l y because of the d i f f i c u l t y of quant i fying hunger (Read 1973). Some studies have shown the use of vitamin supplements by adolescents , regardless of the necess i ty (Wolfish 1975). In Deisher and M i l l s ' study group (1965), 40% took a supplement d a i l y ; more u s u a l l y , consumption among 12 to 15% was recorded (Trenholme and Milne 1965; Dibble e_t al_. 1965 ; Huenemann e_t a l • 1968) . A recent study conducted in Montreal (Gascon-Barre et_ a l . 1973) among s c h o o l c h i l d r e n , 7 to 8 and 11 to 12-years-old , repor-ted a high incidence of d ie tary supplementation with vitamins A and D (40.6% and 38.0% r e s p e c t i v e l y ) . Mineral supplementation was much less popular and only 10.1% took an i ron supplement and 9.8% a calcium supplement. The conclus ion reached was that : Vitamin supplements were widely used by . . . Montreal schoolchi ldren . . . but t h e i r use was ind i scr iminate and could not be j u s t i f i e d . . . on the basis of i n -adequacy of a 7-day food record . Iron and calcium supplementation, although often ind ica ted on the same b a s i s , was seldom prac t i ced (p . '546) . Dietary Pract ices and Environmental Var ia tes Quality of adolescents ' d ie t s has been re la ted to a number of environmental v a r i a t e s , but reports of the r e l a t i o n s h i p between dietary pract ices and environmental var ia tes are c o n f l i c t -ing . A review of the l i t e r a t u r e fo l lows . Family var ia te s Family c h a r a c t e r i s t i c s , such as socio-economic s tatus , - 16 -ethnic background and family s i z e , have been re la ted in varying ways with adolescent n u t r i t i o n p r a c t i c e s . Hinton e_t a_l. (1963), Hampton e_t a l . (1967) , Huenemann et a l . (1968) , Bree l ing (1970) and Morris and Sims (1974) showed q u a l i t y of the d ie t and/or n u t r i t i o n a l status improved with the socio-economic l e v e l of the family . However, Robson (1971) and Cook et_ al_. (1973) suggested socio-economic status was not s i g n i f i c a n t in producing good d ie tary habits and, hence, adequate nutr ient intakes . The s ize of the family had no inf luence on s c h o o l c h i l d r e n ' s eat ing prac t ices (Sanjur 1971; AuCoin e_t al_. 1972), or d ie tary complexity, a measure of d ie tary intake over three consecutive school-days (Schorr et_ a l . 19.72). In comparison, Cook e_t al_. (1973) and Sims and Morris (1974) did f i n d that food intake depended on the number of s i b l i n g s in the f ami ly , and Hendel e_t al_. (1965) concluded d ie tary intakes of vitamins A and C were inver se ly re l a ted to family s i z e . In the United States of America, c u l t u r a l minor i ty groups such as the Negroes, Spanish-Americans and Asians have been shown to have poor d ie tary prac t i ce s (Dibble e_t a l . 1965; Hampton et_ a l . 1967 ; Huenemann ejt a l . 1968 ; Myers et a l . 1968 ; Bree l ing 1970). . L i t t l e work has been reported on the inf luence of e t h n i c i t y on n u t r i t i o n prac t i ce s in Canada. N u t r i t i o n Canada Nat ional Survey f indings (1973) repeatedly ind ica ted that the nut r i ent intakes of two of Canada's minori ty groups, Indians and Eskimos, were lower than those of the general populat ion . Dietary intakes of other ethnic groups are not separated from those of the general popula t ion , and thus, i t i s impossible to draw conclusions from 17 -t h i s survey regarding the inf luence of e t h n i c i t y on dietary p r a c t i c e s . Research f indings concerning the r e l a t i o n s h i p between dietary prac t i ce s and parental educat ion, parental occupation or family income are also c o n f l i c t i n g . The l e v e l of education of the mother has been shown to be s trongly and p o s i t i v e l y re l a ted to the d ie tary intake of her c h i l d r e n (Young et_ al_. 1956; Hendel et a l . 1965; F u t r e l l e_t al_. 1971; AuCoin e_t al_. 1972 ; Schorr et a l . 1972; Morr is and Sims 1974). Sanjur (1971), however, showed that there was n e g l i g i b l e a s soc ia t ion between the mother's l e v e l of education and the d ie tary intake of her c h i l d r e n . A negative a s soc ia t ion between a c h i l d ' s d ie tary intake and the employment status of the mother was reported by the same researcher . Robson (1971) and AuCoin et_ al_. (1972) found that the employment status of the mother had no s i g n i f i c a n t inf luence on adolescent d ie tary p r a c t i c e s . However, Schorr and co-workers (1972), stated the complexity of the adolescent ' s d ie tary pattern increased s i g n i f i c a n t l y with improvement in the occupational l e v e l of the mother. Father ' s occupational l e v e l has also been p o s i t i v e l y re l a ted to d ie tary q u a l i t y (Hinton e_t al_. 1963; Schorr et a l . 1972; Morr is and Sims 1974). The educat ional achievement of the fa ther , again, has been re la ted p o s i t i v e l y to the d ie tary prac-t i c e s of the adolescent (Hinton et_ al_. 1963; AuCoin et a l . 1972). Family income has been p o s i t i v e l y cor re l a ted with d ie tary intake of vitamins A and C (Hendel e_t a_l. 1965) and of calcium and vitamin C (Morris and Sims 1974). Conversely, Hodges and Krehl (1965) , found that "students have i n d i v i d u a l d ie tary habits 18 -which do not r e f l e c t the economic status or recommendations of t h e i r parents" . F u t r e l l e_t a l . (1971) found a less s i g n i f i c a n t , po s i t i ve r e l a t ionsh ip between income and n u t r i t i o n a l status of preschool ch i ld ren than between parenta l educational achievement and dietary q u a l i t y . The importance of good family re l a t ionsh ips to adequate n u t r i t i o n prac t ices i s s tressed by Hinton and co-workers (1962 and 1963). A l l e n e_t a l . (1970) concluded that : Food and n u t r i t i o n a l factors exert s i g n i f i c a n t inf luence on school performance, s o c i a l maturation and vocat iona l preparat ion of High School youth. Of the four n u t r i t i o n f a c t o r s , family commensality emerged as the one most f u l l y corre la ted to in t ra fami ly and [school] performance f ac tor s . It i s concluded that the process of prepar ing , serving and sharing family meals i n the home plays a foca l part in the development and maturation of the High School student (p. 337). Indiv idua l var ia tes C h a r a c t e r i s t i c s of the i n d i v i d u a l adolescent are important when consider ing teenage d ie tary p r a c t i c e s . It i s g e n e r a l l y , agreed that adolescent g i r l s have poorer d ie t s than adolescent boys (Kunkel and H a l l 1958 ; Milne e_t a l . 1963; Huenemann et a l . 1968; A l l e n ert a l . 1970; Schorr et al. 1972 ; N u t r i t i o n Canada  Nat ional Survey 1973) . AuCoin e_t a l . (1972), however, stated that there was no s i g n i f i c a n t d i f ference between food intakes of boys and g i r l s . Myers and co-workers (1968) determined that boys from 9 to 13 years of age had poorer d iets than g i r l s of the same age, though as age increased, a more pronounced decl ine in adequacy was seen with g i r l s than boys. Thus, age also appears to be an important var iab le in the d ie tary habits of adolescents . AuCoin et a l . (1972) found the percentage of students v/ith 19 -adequate food scores ( in terms of "Canada's Food Guide") decreased with age. A sample of 14-year-olds ate more adequately than a group of 16-year-olds (Ohlson and Hart 1965). In contras t , no s i g n i f i c a n t c o r r e l a t i o n was found between d ie tary complexity and age by Schorr et_ al_. (1972) . The l a t t e r researchers reported the complexity of the diet increased s i g n i f i c a n t l y with the extent of s o c i a l p a r t i c i p a t i o n of the adolescent and with his employment status. However, the inf luence on d ie tary p r a c t i c e s , of adolescent a c t i v i t i e s at home, at school and in the community, i s not w e l l -documented. Another important cons iderat ion i s the self-image of the adolescent and i t s e f fect upon d ie tary p r a c t i c e s . Marlay (1971) showed that 451 of a group of 15-year-old g i r l s , considered them-selves too fat and had a l tered t h e i r d ie tary prac t ices accord ing ly . Those adolescents who considered themselves "average" or " l e a n " consumed more c a l o r i e s than those who considered themselves "obese" (Hampton e_t a_l_. 1967). Huenemann e_t a_l. (1966) stated: S ixty-three percent of a l l g i r l s in the n in th grade wanted to lose weight, . . . . These f igures far exceed the numbers who c a l l e d themselves fat . . . [and] contrast sharply with the 15 percent and 10 percent . . . c l a s s i f i e d as somewhat obese and obese, r e s p e c t i v e l y . . . . F i f t y - t h r e e percent of boys in the n in th grade . . . sa id they wanted to gain weight and were concerned about underweight, many more than described themselves as th in . . . . . . . in the n in th grade 50 percent of the boys and 65 percent of the g i r l s said they were t r y i n g to do something about t h e i r weight . . . changes in the diet outranked changes in phys i ca l a c t i v i t y (p. 534). Survey Methodology for Assessment of Dietary Pract ices Studies of d ietary adequacy, as compared to surveys of n u t r i t i o n a l s tatus , involve only an evaluat ion of d ietary intake : 20 -dietary prac t ices are assessed (1) in a quant i ta t ive manner, where intake i s re la ted to a standard such as the Canadian Recommended Dai ly Nutrient Intakes (1964) , or (2) in a more q u a l i t a t i v e manner, where intake i s re la ted to a standard such as "Canada's Food Guide" (1968). For groups of i n d i v i d u a l s , there i s general agreement that 1 day's d ie t (a 24-hour r e c a l l ) can provide v a l i d information on usual d ietary intake (Young e_t a l . 1952 ; Thomas et a l . 1954; Pekkarinen 1970; Samuelson 1970; Linusson et a l . 1974). When used with large samples to evaluate the mean intake of groups, t h i s technique i s as r e l i a b l e as 7-day food records in measuring food intake (Young et a l . 1952) Linusson et a l . (1974) concluded: . . . i f the purpose i s to gather trends in d ie tary patterns from s izeable groups poss ib ly to serve as basel ine data i n Appl ied N u t r i t i o n and Publ i c Health programmes then the choice of the 24-hour r e c a l l i s a v a l i d one (p. 291). In a study of the food habits of 11-, 13- and 15-year-old schoolchi ldren throughout the province of Nova S c o t i a , AuCoin et a l . (1972) used a technique of scoring d ie tary intakes r e l a -t ive to a q u a l i t a t i v e standard, "Canada's Food Guide" . A two-day food record was completed and the "average d a i l y intake" c a l c u l a t e d . Foods were scored numer ica l ly , with each of the f ive food groups (milk , f r u i t , vegetables , bread and cereals and meat) assigned a maximum poss ible score of 20. This method of data c o l l e c t i o n was considered h ighly successful by the research-ers for the purposes of t h e i r study. An a l t e rna t ive to "Canada's Food Guide" was developed by Milne et a l . (197.1) , to represent a pattern of food usage that - 21 -r e f l e c t e d , more c l o s e l y , actual food intakes , and supplied nutr ients in recommended amounts. From die tary intake data for 4,529 i n d i v i d u a l s , aged 7 to 60 p l u s , 1,418 were considered to have adequate nutr ient intakes when these were compared with Canadian Recommended Da i ly Intakes. However, only 1 of the 1,418 ind iv idua l s consumed the recommended intake of foods from a l l food groups in "Canada's Food Guide" . When the a l t e rna t ive food guide was applied a much higher percentage (34%) of those with s a t i s f ac tory nutr ient intakes had proposed intakes in a l l four food groups. The remaining por t ion of those with s a t i s f a c t o r y nutr ient intakes did not have a consistent pattern of food con-sumption. There was,however, a tendency to compensate in other food groups when one food group was less than the proposed intake . It i s the a l ternate food guide developed by Milne et a l . (1971) upon which the B r i t i s h Columbia Mi lk Foundation's scoring system for d ietary intake i s based. The accuracy of a 24-hour r e c a l l of c h i l d r e n may be ques-t ioned , but Emmons and Hayes (1973), in t h e i r study of young c h i l d r e n , 6 to 12 years of age, came to the fo l lowing conclus ions : 1. Young ch i ldren can provide information on t h e i r diet as accurate ly , or more accurate ly , than t h e i r mothers There were more s i g n i f i c a n t cor re l a t ions between the n u t r i t i v e l eve l s from the c h i l d ' s r e c a l l of lunch and the lunch ac tua l ly eaten than between the n u t r i t i v e l eve l s ca lcu la ted from the mother's and c h i l d ' s r e c a l l s of the c h i l d ' s diet (p. 415). 2. The a b i l i t y to r e c a l l c o r r e c t l y the foods eaten improved with age 22 -Eppright et_ a l . (1952) , in t h e i r study of the problems associated with c o l l e c t i n g d ie tary information among groups of c h i l d r e n , determined that weekend dietary prac t ices d i f f e red from school-day hab i t s . Thus a 24-hour r e c a l l should be conducted between Tuesday and Fr iday , to e l iminate th i s problem. N u t r i t i o n Knowledge of Adolescents N u t r i t i o n knowledge of ch i ld ren in grades 4 to 6 has been described as "confused" . Chi ldren could se lect foods belonging to the bas ic four food groups when shown a l i s t of foods, but could not define a "good d i e t " (Paterson 1971) . Studying 12 to 15-year-olds , Mirenda (1966) also described a lack of f a m i l i a r i t y with bas ic n u t r i t i o n knowledge and with the i n t e r - r e l a t i o n s h i p s of n u t r i t i o n and hea l th . This was evidenced by low n u t r i t i o n knowledge test scores and a high degree of acceptance of food f a l l a c i e s . The mean score atta ined on a n u t r i t i o n knowledge test by students from grades 9 to 12 was 55.9%, with g i r l s scor ing s l i g h t l y higher than boys (Dwyer e_t a l . 1970) . A l l past studies of n u t r i t i o n knowledge among high school students in the United States as reviewed by the l a t t e r researchers (1970) , reported s i m i l a r f indings of poor n u t r i t i o n knowledge. Morris (1969) came to the same conclus ion in her study of Canadian students. More o p t i m i s t i c a l l y , " i n genera l , . . . teenagers [in a l o n g i t u d i n a l study from grades 9 to 12] had a reasonably good knowledge of d ietary needs and causes of obes i ty , although some had misconcep-t i o n s " (Huenemann et a l . 1966). - 23 -N u t r i t i o n Knowledge and Dietary Pract ices Poolton (1972) has expressed concern about the lack of app l i ca t ion of n u t r i t i o n knowledge in d a i l y food hab i t s , though the re l a t ionsh ip of n u t r i t i o n knowledge to d ie tary prac t ices of adolescents i s not c l e a r . Hinton e_t al_. (1963), in t h e i r study of 12 to 14-year-old g i r l s , found: Knowledge of n u t r i t i o n , as measured by a test of a b i l i t y to apply n u t r i t i o n a l p r i n c i p l e s in se l ec t ing an adequate d i e t , was p o s i t i v e l y re l a ted to good food pract ices (p. 225). This observation i s supported by Mirenda (1966) , who studied both g i r l s and boys at the jun ior high l e v e l , and by Kunkel and H a l l (1958) in t h e i r study of Los Angeles ' seniors . Hampton et_ a l . (1967) suggested n u t r i t i o n knowledge may improve food prac t i ce s of boys but not g i r l s . Adminis t ra t ion of a n u t r i t i o n education programme caused no s i g n i f i c a n t changes in the d ietary prac t i ce s of grade 4 and 5 boys and g i r l s (Baker 1972) or grade 6 and 7 schoolchi ldren (Morris 1969), even though scores on a test of n u t r i t i o n knowledge increased. In contras t , Head (1974) reported a s i g n i f i c a n t improvement in both n u t r i t i o n knowledge and d ie tary prac t ices in f i f t h and seventh grade c la s ses , fo l lowing a n u t r i t i o n education programme. The changes in n u t r i t i o n prac t ices decreased progres s ive ly at higher grade l e v e l s . However, Whitehead (1960) found a marked improvement in d ie tary p r a c t i c e s , even at higher grade l e v e l s , and the degree of improvement was dependent on the length of the n u t r i t i o n education programme. N u t r i t i o n At t i tudes of Adolescents Adolescent a t t i tudes have been found to be grea t ly influenced by parental a t t i tudes (Spindler and Acker 1965; 24 Huenemann e_t a l . 1966; Ebel 1969; V/alker e_t al_. 1973), p a r t i c u -l a r l y by the a t t i tudes of the mother (Litman et a l . 1964; Marlay 1971) . "Permiss ive" parents produce " fussy-eaters " (Walker et_ a l . 1973) . Peer group values are thought by some to be a greater inf luence than parenta l values on the formation of adolescent a t t i tudes (Spindler and Acker 1963; Mums 1972). Even though they thought parents were responsible for t h e i r eating h a b i t s , these adolescents recognised that being part of the teen group was important. "We se lect what everyone else eats" (Spindler and Acker 1963, p . 230). Rachman (1970) concluded tha t , u n t i l c h i l d r e n are approxi-mately 12 years of age, parents are those most i n f l u e n t i a l in determining c h i l d r e n ' s a t t i t u d e s ; beyond t h i s age, the peer group becomes the main in f luence . Spindler and Acker (1963) demonstrated that the a c t i v i t i e s of the adolescent in te r f e red with ea t ing : If the teenager had a date, an opportunity to dr ive the family car , a school or club a c t i v i t y , or a chance to be with the "gang", meals appeared to be secondary even when they were ava i l ab le (p. 229). Adolescents are very concerned about t h e i r h e a l t h ; 69% sa id " i t mattered a l o t to them to be hea l thy" (Brunswick 1969). They also f ee l i t i s important to eat we l l to keep healthy (Spindler and Acker 1963; McElroy and Taylor 1966). Those hea l th concerns most frequently expressed by a group of adolescents , 12 to 17-years-old , in Brunswick's study- (1969) were: 1. I am not get t ing enough exercise (35%) 2. I am not eating the r ight kind of food (28%) 3. I am not eating the r ight amount of food (12%) 4. I am eating too many sweets (16%) 25 -Many adolescents , however, be l ieved that t h e i r "apparent" weight or appearance was the major factor in f luenc ing t h e i r eat ing habits (Deisher and M i l l s 1965; Spindler and Acker 1965; Huenemann et a l . 1966; Brunswick 1969; Marlay 1971). The state of t h e i r complexion, as a problem re la ted to d i e t , was of much concern to 17% of adolescent males and 24% of adolescent females (Deisher and M i l l s 1965). Paradox ica l ly , most adolescents be l ieved they knew what to eat (Spindler and Acker 1965) and rated t h e i r d iets f a i r to good (Huenemann et_ a l . 1966), yet were c r i t i c a l of o ther ' s eat ing habits and admitted t h e i r own diets could be bet ter (Spindler and Acker 1963). N u t r i t i o n At t i tudes and Dietary Pract ices Childhood background and ear ly food experiences are possib-l y the most important factors determining an i n d i v i d u a l ' s l a t e r n u t r i t i o n behaviour or d ie tary prac t i ce s (Emerson 1967; Beyer and Morris 1974). "An adolescent 's food patterns are frequently those of h i s parents" (Emerson 1967, p . 53). Beyer and Morris (1974) noted: . . . a great degree of s i m i l a r i t y between food habits of c h i l d r e n during preschool years and in elementary school . This implies that the preschool years may be the t r a i n i n g ground for the q u a l i t y of d iet in l a t e r l i f e (p. 13). It has been we l l -e s t ab l i shed that the a c c e p t a b i l i t y of a cer ta in food to a fami ly , p a r t i c u l a r l y the mother, determines the household consumption of that food (Litman e_t a_l, 1964 ; Huenemann et a l . 1966; Marlay 1971; Walker et a l . 1973; Cosper and Wake-f i e l d 1975) . Parental knowledge and at t i tudes tov/ard f r u i t s and 26 -vegetables inf luenced the number of these foods served (Walker et a l . 1973) . Husbands were found to exert the strongest influence on whether or not t h e i r wife would attempt to prepare a "new" food. Other major in f luences , in order , were profess ion-a l s , parents , ch i ld ren and close fr iends (Cosper and Wakefield 1975). As the wife or mother usua l ly prepares the family food, i t might be expected that her preferences or a t t i tudes toward a food would determine the f ami ly ' s consumption of that p a r t i c u l a r food. A l l e n e_t al_. (1970) found a s i g n i f i c a n t po s i t i ve c o r r e l a -t i o n between family commensality and d ie tary adequacy of high school youth. More recent ly , Sims and Morris (1974) developed a typology of family c h a r a c t e r i s t i c s and maternal a t t r ibute s which was d i r e c t l y re l a ted to the d ie tary intake and phys ica l status of preschoolers . Chi ldren of mothers who exhibi ted more " e g a l i t a r i a n " a t t i tudes toward c h i l d - r e a r i n g tended to have higher intakes of calcium and ascorbic a c i d . The second type of mother displayed more au thor i t a r i an at t i tudes toward c h i l d - r e a r i n g . Her ch i ld ren ate food with more c a l o r i e s , carbohydrate, i ron and thiamine, had somewhat higher hemoglobin and hematocrit va lues , and weighed s l i g h t l y more for t h e i r height than those ch i ld ren from the other group. Food preferences alone accounted for 25 to 50% of an i n d i v i d -u a l ' s consumption (P i lgr im 1961; Cosper and Wakefield 1975). Minnesota s c h o o l c h i l d r e n , 10 to 22-years-old, chose food for two reasons: (1) they were "hea l thy" and " n u t r i t i o n a l " , though th i s s e lec t ion was based on mis- informat ion, and community-family r a t i o n a l i s a t i o n , and (2) they re f l ec ted personal preferences - 27 -and tastes (Litman et al_. 1964). Teenage subjects l i k e d a wide va r i e ty of foods and usua l ly l i s t e d several times the number of foods in the " l ike-mos t " category than in the " l i k e least of a l l " and "never tas ted" c l a s s i f i c a t i o n s (Schorr et_ al_. 1972) . They came to the conclusion that i t i s p o s s i b l e , with wise p lanning , to consume a nut r i t iona l ly -adequate d iet by se l ec t ing only "popular" foods. Food " l i k e s " were shown to corre la te s i g n i f i c a n t -l y with d ietary adequacy (Al len et al_. 1970). In Breckenridge 1 s study (1959) , c h i l d r e n of 5 to 12 years of age had far more " l i k e s " than " d i s l i k e s " ; from a l i s t of foods, l i k e d foods averaged 19.9 while d i s l i k e d foods averaged 3. One d i s l i k e of great n u t r i t i o n a l importance was that of vegetables , which may be r e f l ec ted in the low consumption of th i s food group by c h i l d -ren (Breel ing 1971) ; 731 mentioned they d i s l i k e d eat ing cooked vegetables ; 24% also d i s l i k e d raw vegetables (Breckenridge 1959) . The frequent d i s l i k e of vegetables by ch i ld ren was also noted by Litman e_t al_. (1964) , Schorr e_t a_l. (1972) and Beyer and Morris (1975). Many a t t i tudes af fect d i e t a ry p r a c t i c e s , but one of impor-tance during adolescence i s the i n d i v i d u a l ' s percept ion of weight or appearance. As mentioned p r e v i o u s l y , many adolescents , par-t i c u l a r l y g i r l s , consider themselves overweight, and though an a l t e r a t i o n of d ie tary prac t i ce s i s not indicated for hea l th reasons, many do so for the sake of appearance (Huenemann e_t a l . 1966; Dwyer et a l . 1967). L i t t l e work has been reported on the actual c o r r e l a t i o n between n u t r i t i o n at t i tudes and p r a c t i c e s , p a r t i c u l a r l y among - 28 adolescents. Ja l so et a l . (1965) did f ind a high p o s i t i v e c o r r e l a t i o n between n u t r i t i o n opinion scores and n u t r i t i o n prac t i ce scores among a group of adult members of various com-munity organizations in New York State . N u t r i t i o n Knowledge and At t i tudes Just as the re l a t ionsh ips of n u t r i t i o n knowledge to d ie tary pract ices and n u t r i t i o n at t i tudes to prac t i ce s are not c l e a r , the r e l a t i o n s h i p of n u t r i t i o n knowledge to a t t i tudes i s even less apparent. The n u t r i t i o n knowledge of mothers has been p o s i t i v e l y l inked with t h e i r n u t r i t i o n at t i tudes toward meal-planning and food preparat ion (Eppright e_t a l . 1972). I f t h i s i s so, since adolescents are s trongly inf luenced by parental a t t i t u d e s , one might expect that the n u t r i t i o n knowledge and at t i tudes of adolescents would r e f l e c t those of t h e i r parents . However, i t appears there may i n fact be no r e l a t i o n s h i p between the n u t r i t i o n knowledge and at t i tudes of mothers (Emmons and Hayes 1973) , and hence no r e l a t i o n s h i p between the n u t r i t i o n knowledge and at t i tudes of adolescents. Knowledge, At t i tudes and Pract ices "Values ( inc luding a t t i tudes) d i r e c t behaviour by provid ing a basis for making choices " (McElroy and Taylor 1966). Most studies of communication and a t t i tude change rest on the premise that a t t i tudes play an i n f l u e n t i a l ro le in determining behaviour. At t i tudes and b e l i e f s do affect overt behaviour, but caution must be used in i n f e r r i n g at t i tudes from behaviour or in predic-t i n g behaviour from a t t i tude s . Many factors other than at t i tudes - 29 -influence behaviour (Di l lehay 1965) . Sher i f and Sher i f (1969) developed a model to explain the mutual inf luences of environ-mental, personal and b i o l o g i c a l factors on behaviour. This was applied to food behaviour by Schafer and Yet ley (1975) , as shown in Figure 1. Family Friends Advertisements T e l e v i s i o n programmes Educat ional programmes e t c . EXTERNAL FACTORS E l E 2 E 5 *FOOD BEHAVIOUR J3 ' ' * ~n INTERNAL FACTORS At t i tudes Self-concept Personal values Be l i e f s Sociogenic needs Biogenic needs e t c . Figure 1. Model expla ining the frame of reference of observed food behaviour. Hea l th , or n u t r i t i o n knowledge does not guarantee sat is fac-tory behaviour for i t does not always furnish adequate motive to ef fect the desired ac t ion . But there i s no act ion without moti-vat ion and motivation i s based upon previous experience of some kind (Kilander 1968) . - 30 -Individuals with greater knowledge and understanding are more l i k e l y to have favourable a t t i tudes and there fore , are more l i k e l y to prac t i ce des i rab le behaviour (Kilander 1968 , p . 32). The influence of ear ly childhood experiences on subsequent behaviour has been well-documented (Gi f f t et_ a l . 1972) . The importance of parental knowledge and at t i tudes on the knowledge and a t t i t u d e s , and consequently, the behaviour or prac t i ce s of t h e i r c h i l d r e n may be e a s i l y recognised. Knowledge w i l l inf luence a t t i tudes and hence p r a c t i c e s , only i f the knowledge means enough to the learner to motivate ac t ion . A c q u i s i t i o n of knowledge does not have a l i n e a r r e l a t i o n -ship to change in p r a c t i c e s . Yet research, observation and experience a l l t e l l us knowledge i s p o s i t i v e l y re la ted to b e n e f i c i a l change (Gi f f t et 'a l . 1972 / p . 269). A person's a t t i tudes are acquired , not i n h e r i t e d , in the fo l lowing way: 1. A gradual accumulation of r e l a ted experiences over a per iod of time 2. The re su l t of one sudden, dramatic, intense experience 3. Taken from other people in the form that was already held or developed (Kilander 1968, p . 34) Our c u l t u r a l group determines our a t t i tudes . D i l l e h a y (1965) suggests there are three components to a t t i tudes : 1. Cogni t ion ; from information or a person's evaluat ion of t h i s information 2. A f f e c t ; an emotional or f e e l i n g component 3. Act ion (or behavioural) tendencies ; usua l ly p o s i t i v e or negative tendencies toward act ion - 31 -These three components are interdependent and the complexity of each affects the p o t e n t i a l for change. There is also strong evidence that behaviour (or pract ices ) moulds a t t i tudes . Fe s t inger ' s theory of cogni t ive dissonance (1957) suggests tha t , i f an i n d i v i d u a l behaves in some way that i s discrepant with his b e l i e f s , the b e l i e f s may change to be more consistent with h i s ac t ions . The perceived discrepancy between previous b e l i e f s and present actions i s sa id to be uncomfortable for the i n d i v i d u a l and therefore becomes motivat ing to a change in a t t i tude . The l i k e l i h o o d of inducing a change in a t t i tude is i n f l u -enced by the major mot ivat ional supports for the a t t i t u d e . These supports may be: 1. Knowledge; f ac tua l or from experience 2. Soc i a l adjustment; der ived from the norms of reference groups 3. Ego-defense; based upon per sona l i ty c o n f l i c t wi th in the i n d i v i d u a l (Di l lehay 1965) . Evoking a change i n a t t i tudes through a change in knowledge w i l l only be e f f ec t ive i f the a t t i tude i s based p r i m a r i l y upon knowledge. At t i tudes formed through s o c i a l adjustment may be suscept ible to change by working through opinion leaders . Those at t i tudes based on defense of the ego are very d i f f i c u l t to change and are almost c e r t a i n l y not susceptible" to change so l e ly through information or knowledge about the object of the a t t i t u d e . Despite the question of the v a l i d i t y of a t t i tude change as a means of desired changes in behaviour, i t i s one that should receive a t t e n t i o n . Di l l ehay (1965) suggests a t t i tudes and b e l i e f s - 32 play a prominent ro le in experience and behaviour. A paper by Rachman (1970) discusses current knowledge on the modi f ica t ion of a t t i tudes and behaviour. It suggests that the most successful persuasive influence i s a communicator of high c r e d i b i l i t y . The communication should present both sides of the message. Accep-tance of an idea i s more l i k e l y i f i t promises increased s o c i a l appeal. In a d d i t i o n , acceptance i s further enhanced i f a group a c t i v e l y pa r t i c ipa te s in d i scuss ion and makes a pub l i c commitment to some form of change in a t t i tude or behaviour. Rachman also comments on the importance of i m i t a t i o n and modell ing procedures, p a r t i c u l a r l y of prest ige f i gure s , that i s , f a m i l i a r or favoured f i gure s , as an avenue for changing behaviour. One can read i ly see the importance of the d i rec t app l i ca t ion of these f indings to n u t r i t i o n educat ion, where changes in a t t i tudes are frequently des i red . Why we eat what we eat i s a matter that involves many c u l t u r a l and s o c i a l factors as wel l as p sycholog ica l factors (Knutson 1965, p . 139). Summary From t h i s b r i e f review of the l i t e r a t u r e , the importance of a t t i tudes in behaviour and the poss ib le i n t e r - r e l a t i o n s h i p s among knowledge, a t t i tudes and prac t i ce s may be seen. The three var iab les may re la te to one another in a number of ways. Four poss ib le models of the i n t e r - r e l a t i o n s h i p s of n u t r i t i o n knowledge, a t t i tudes and pract ices were conceived by Schwartz (1973) (Figure 2). Model 4 i s poss ib ly that which i t i s most des i rable to follow in any n u t r i t i o n education programme designed to change dietary p r a c t i c e s . - 33 -K-A-P MODEL 1 K < > A < > P Att i tudes mediate knowledge and prac t ices K-A-P MODEL 2 > P A Knowledge and at t i tudes in terac t to inf luence prac t ices K-A-P MODEL 3 K A Knowledge and at t i tudes independently inf luence prac t ices K-A-P MODEL 4 A K 4 y P Knowledge influences prac t ices both d i r e c t l y and i n d i r e c t l y as mediated by a t t i t u d e s , concurrently Figure 2. Four poss ib le models of the i n t e r - r e l a t i o n s h i p of n u t r i t i o n knowledge, a t t i tudes and pract ices (K-A-P) . ; - 34 -Research in the area of adolescent n u t r i t i o n has been mainly d i rec ted at d ietary prac t ices and environmental factors in f luenc ing those p r a c t i c e s . The f indings are often i n disagree-ment with one another. Many studies have assessed the n u t r i t i o n a l status of adolescents and have shown the inadequacy of adolescent d i e t s . Few studies have been conducted on the n u t r i t i o n knowledge and a t t i tudes of teenagers, and very few have attempted to f i n d a r e l a t i o n s h i p between these var iab les and d ie tary p r a c t i c e s . The f indings of the few studies reviewed here are at variance with one another, suggesting that further study i s necessary to f a c i l i -tate a f u l l e r understanding of a l l the var iab les in f luenc ing adolescent d ie tary p r a c t i c e s . The recent report by the B r i t i s h Columbia School Trustees Assoc ia t ion (1974) recommended that : The Government of B r i t i s h Columbia, through i t s C h i l d r e n ' s Committee, develop a comprehensive p r o v i n c i a l p o l i c y with regard to n u t r i t i o n education for c i t i z e n s of a l l ages . . . (p. 10) . The Government of Canada, through i t s Department of Health and Welfare, fund a research project in B r i t i s h Columbian schools to : a) determine the food items which are popular with pub l i c school students, and the n u t r i t i v e value of each . . . (p. 19) . and that : The Government of B r i t i s h Columbia, through i t s Department of Education and i t s Department of Health Services and Hospi ta l Insurance, i n s t i t u t e a p i l o t project in some selected schools , to develop and f i e l d test a comprehen-sive programme of n u t r i t i o n education, integrated with other parts of the curriculum . . . (p. 20), Before e f fec t ive n u t r i t i o n education programmes may be planned and implemented, the extent of n u t r i t i o n knowledge and current a t t i tudes toward food and n u t r i t i o n must be determined. A review - 35 -of the l i t e r a t u r e reveals the need for further de ta i l ed study of the n u t r i t i o n knowledge and at t i tudes of young adolescents . Educational programmes are i d e a l l y aimed at p o s i t i v e changes in knowledge, a t t i tudes and p r a c t i c e s ; n u t r i t i o n educa-t i o n programmes may be designed to change knowledge, a t t i tudes and prac t ices as re la ted to foods and n u t r i t i o n . The American D i e t e t i c A s s o c i a t i o n , in t h e i r P o s i t i o n Paper on n u t r i t i o n educa-t i o n , for the publ ic (1975), defined n u t r i t i o n education as: . . . the process by which b e l i e f s , a t t i t u d e s , environ-mental in f luences , and understanding about food lead to pract ices that are s c i e n t i f i c a l l y sound, p r a c t i c a l , and consistent with i n d i v i d u a l needs and ava i l ab le food resources (p. 429). The tenuous l i n k s between knowledge and p r a c t i c e s , knowledge and at t i tudes and at t i tudes and prac t i ce s have been discussed in t h i s chapter. Common assumptions are that changes in knowledge w i l l inf luence a t t i t u d e s , and a t t i tude changes w i l l af fect p r a c t i c e s . The American D i e t e t i c A s s o c i a t i o n , in the P o s i t i o n Paper mentioned above, s ta tes : Values , a t t i tudes , and b e l i e f s contro l man's behaviour; therefore , planned change is a de l ibera te e f for t to improve n u t r i t i o n through i n t e r v e n t i o n , and i t occurs by design (p. 429). Objective evidence of the i n t e r - r e l a t i o n s h i p s of these three v a r i a b l e s , knowledge, a t t i tudes and p r a c t i c e s , i s l a c k i n g . E l u c i d a t i o n of such re l a t ionsh ip s is v i t a l , to a id in the develop-ment of e f fec t ive n u t r i t i o n education programmes. It i s hoped that Poolton (1972) i s correct when she s ta tes : With expanded i n t e r e s t , r e s u l t i n g from deeper under-standing of n u t r i t i o n , there w i l l be a change in f e e l i n g , a t t i tudes or va lues , and a corresponding change in behaviour (p. 115). - 36 -CHAPTER III DESIGN OF THE STUDY This study was designed to invest igate the n u t r i t i o n knowledge, a t t i tudes and prac t i ce s of f i r s t year secondary school students in the C i ty of Vancouver, B r i t i s h Columbia. The nature of the r e l a t i o n s h i p among the dependent v a r i a b l e s , ( n u t r i t i o n knowledge, a t t i tudes and p r a c t i c e s ) , was assessed and the ef fect of s e lec ted , independent var ia tes upon the dependent var iab les was determined. The study was conducted with the co-operation of the Vancouver School Board. The intent was to determine present n u t r i t i o n knowledge, a t t i tudes and prac t ices among eighth grade students in the hope that th i s information could be used in the development and implementation of n u t r i t i o n education programmes in the pub l i c school system. Target Populat ion and Sampling The target populat ion i n t h i s study was the eighth grade secondary school students in the C i ty of Vancouver, B r i t i s h Columbia. Students were se lected with the help of Mr. A. Moodie, Co-ordinator , Research Studies and T e s t i n g , Vancouver School Board Education Department, to maximise co-operation from the schools . Six schools in the Vancouver School D i s t r i c t considered representat ive of d i f f e rent socio-economic areas were chosen. Magee (Arbutus), E r i c Hamber (Oakridge), S i r Charles Tupper - 57 -(Cedar Cottage) , K i l l a r n e y (Southern Slope) , John O l i v e r (South-ern Slope) and Templeton (Burrard) were the schools se lec ted . P r i n c i p a l s from the s ix schools were asked to provide two classes of grade 8 students, containing approximately equal numbers of boys and g i r l s , for p a r t i c i p a t i o n in the study. The sample consisted of a l l students in the 12 eighth grade c la s ses , who were present on the days that the quest ionnaire was administered. The f i n a l sample t o t a l was 366 students . TABLE 2 NUMBER AND PERCENTAGE OF STUDENTS, BY SEX, IN EACH SCHOOL SCHOOL TOTAL 1 2 5 4 5 6 Num-ber % Num-ber % Num-ber % Num-ber % Num-ber % Num-ber % Num-ber % Girls 29 7.9 24 6.6 55 9.6 31 8.5 50 8.2 51 8.5 180 49.2 Boys 38 10.4 33 9.0 28 7.7 28 7.7 28 7.7 27 7.4 182 49.7 Total 67 18.3 * 59 16.1 * 64 L7.5 59 16.1 59 16.1 58 15.8 * 366 100 * Missing data. Research Design An a s s o c i a t i o n a l , non-experimental study (Baker and Shutz 1972) \vas conducted u t i l i s i n g survey research techniques, to invest igate the r e l a t i o n s h i p of cer ta in c r i t e r i a to selected environmental var iates among eighth grade secondary school students. - 38 -The dependent var iables or c r i t e r i o n var iables (Baker and Schutz 1972) in t h i s study were: 1. N u t r i t i o n knowledge 2. At t i tudes toward n u t r i t i o n 3. N u t r i t i o n pract ices The independent var iab les or non-manipulable var ia tes (Baker and Schutz 1972) were categorised as: 1. Family var ia tes 2. School var ia tes 3. Indiv idual var ia tes The nature of the r e l a t i o n s h i p between the c r i t e r i o n var iab les and the var ia tes was assessed. In a d d i t i o n , the nature of the re l a t ionsh ip among the c r i t e r i o n var iab les themselves was deter-mined. The study was o r i g i n a l l y designed to include i n v e s t i g a t i o n of the r e l a t i o n s h i p among such var ia tes as the educational and occupational l eve l s of the mother and fa ther , family income and ethnic background, and the dependent v a r i a b l e s , n u t r i t i o n know-ledge, a t t i tudes and p r a c t i c e s . However, School Board regula-t i o n s , designed to ensure the pr ivacy of students, d id not allow questions to be asked which re la ted to such family v a r i a t e s . Data C o l l e c t i o n Data C o l l e c t i o n Instruments Data c o l l e c t i o n instruments (see Appendix A, p. 108) were developed for measurement of the three c r i t e r i o n v a r i a b l e s . N u t r i t i o n knowledge A test cons i s t ing of 20 true or false statements re la ted to 39 -general knowledge of basic n u t r i t i o n p r i n c i p l e s , was developed and pretested for use in th i s study. A pretest was conducted to va l ida te the items on the t e s t . The quest ionnaire was com-pleted by a group of grade 8 students and a group of adult n u t r i -t i o n experts . V a l i d i t y was demonstrated by the higher mean scores obtained on the test by the adult group than by the group of eighth grade students (Edwards 1957) . The test-instrument provided for two responses to each item. The f i r s t was an i n d i c a t i o n of true or f a l s e , and the second was a designation of one of four degrees of ce r t a in ty for the response, ranging from very cer ta in to very doubtful . This method of information r e t r i e v a l was va l ida ted by Schwartz (1973). Each of the statements was scored between 0 and 7 (see Appendix B, p. 115), with a poss ib le n u t r i t i o n knowledge score between 0 and 140 for the ent i re t e s t . At t i tudes toward n u t r i t i o n Adolescent a t t i tudes toward n u t r i t i o n were measured using a test developed and pretested in a s i m i l a r manner to the n u t r i -t i o n knowledge test described above. The test contained 15 statements r e f l e c t i n g a t t i tudes toward food se l ec t ion and diet adequacy, and the importance of n u t r i t i o n with regard to h e a l t h . As with the n u t r i t i o n knowledge t e s t , the a t t i tude test provided for two responses to each statement, agree or disagree and the degree of cer ta in ty of the response. Each statement was scored between 0 and 7 (Appendix B) , with a poss ib le score between 0 and 105 for the ent i re t e s t . - 40 -N u t r i t i o n pract ices N u t r i t i o n pract ices were assessed by obtaining a 24-hour r e c a l l of a l l food consumed by the adolescent during the day p r i o r to the survey. The r e c a l l was part of the se l f -adminis tered questionnaire (Appendix A ) . No interviews with students were conducted. Students were asked to l i s t the amount of food and drink consumed, in terms of household measurements only , through-out the 24-hour per iod . From t h i s l i s t , the quantity of food consumed in each of the four food groups (milk and milk products ; f r u i t and vegetables ; meat and a l t e rna te s ; and cerea l s , bread and pastas ) , as wel l as an estimate of vitamin D intake , were ca l cu l a t ed . Dietary adequacy was thus estimated. Using the B r i t i s h Columbia Mi lk Foundation's "Guide to Good Eat ing Everyday" (Appendix B) , a score for n u t r i t i o n prac t ices was assigned. The maximum score poss ib le for the n u t r i t i o n prac t ices test was 25. In addi t ion to the type and amount of food consumed, the questionnaire determined the frequency with which food was eaten, with whom the food was consumed and the place of ea t ing . Seeking th i s information i s thought to a s s i s t i n d i v i d u a l s in r e c a l l i n g more accurately the foods consumed the previous day. These data were not included in the n u t r i t i o n pract ices score. Instead, they were presented in terms of frequencies , to demonstrate the number of times per day that students of th i s age consume food. Demographic Information Demographic information (non-manipulable var iates ) necessary for data analys i s and i n t e r p r e t a t i o n , was obtained in a sect ion e n t i t l e d "Information about You" (Appendix A ) . Data concerning - 41 -three sets of v a r i a b l e s , f ami ly , school and i n d i v i d u a l v a r i a t e s , were c o l l e c t e d . Family var ia tes included family s ize only . An assessment of socio-economic status was made from the abbreviated address requested of the students. Using a map of the socio-economic areas of Vancouver, constructed by Patterson (1974), an i n d i c a t i o n of socio-economic status was obtained. Information concerning school loca t ion and school a c t i v i t i e s was c l a s s i f i e d as school v a r i a t e s . Indiv idual var ia tes included sex, age, l e i -sure a c t i v i t i e s and employment s tatus . Procedure The data c o l l e c t i o n instruments were pretested in Ju ly 1974, by graduate students in Human N u t r i t i o n at the U n i v e r s i t y of B r i t i s h Columbia, and by a group of grade 8 students , repre-sentative of subjects in th i s study. Ten graduate students and 10 eighth grade students completed the quest ionnaire f u l l y . As expected, the graduate students scored higher on both the n u t r i -t i o n knowledge and at t i tudes t e s t s , (mean scores of 133.2 and 106.6 r e s p e c t i v e l y ) , than did the grade 8 students , (mean scores of 92.0 and 91.6 r e s p e c t i v e l y ) . This i s an i n d i c a t i o n of the v a l i -d i t y of the te s t . The statements on the tests were se lected from previous ly-adminis tered t e s t s , and the r e l i a b i l i t y of these items was assumed. However, an add i t iona l s t a t i s t i c was ca l cu la ted from the pretest responses. The percentage of subjects responding c o r r e c t l y to each item provided an i n d i c a t i o n of the l e v e l of d i f f i c u l t y of that item. Those items found to be very d i f f i c u l t or .very easy were discarded. - 42 -A pretest quest ionnaire (Appendix C) was designed and used to c o l l e c t information on the c l a r i t y , p r e c i s i o n and context of the data c o l l e c t i o n instruments. From the information gathered during the pre te s t ing a dec i s ion was made to e l iminate 5 of the 20 opinion items, as these had been found inappropriate for the pur-pose of the study. Other minor rev i s ions were made to the ques-t i o n n a i r e , to e l iminate ambiguities and to incorporate the sug-gestions of the pretest subjects . It had been hoped that permission would be granted to enter the schools during the month of September 1974. This i s the f i r s t month of secondary school l i f e for the subjects being s tudied , and p r i o r to any formal n u t r i t i o n education. Entry at t h i s time proved to be impossible due to adminis trat ive d i f f i c u l t i e s a r i s i n g during the f i r s t month of an academic year. Admission to the schools was gained, beginning the second week in October 1974, and the survey was completed during the next two weeks. Economic condit ions in the home may change over a per iod of a month, and influence d ie tary p r a c t i c e s . Conducting the study during the second and t h i r d weeks of the month minimised any such poss ib le e f f ec t s . The study was conducted from Tuesday to Fr iday on ly , to ensure that the day for d ie tary r e c a l l d id not f a l l on a weekend. Food intake on such days may not be considered representat ive of a subject ' s usual d ietary behaviour (Eppright et_ a_l. 1952). Each of the s ix schools was asked to provide two classes of grade 8 s tudents, containing approximately equal numbers of boys and g i r l s . Fo l lowing ,a b r i e f explanation by the researcher, of the object ives of the study (Appendix D) ,' the students com-pleted the quest ionnaire during regular c la s s t ime, under the - 43 -supervis ion of the i n v e s t i g a t o r . Af te r completion of the n u t r i -t i o n knowledge and at t i tudes t e s t s , the 24-hour r e c a l l was con-ducted. As a learning experience, the students were asked to score t h e i r own n u t r i t i o n prac t ices using the B r i t i s h Columbia Mi lk Foundation's score guide (Appendix B) . From th i s assessment, the subjects could c l e a r l y see the de f i c i enc i e s ( in terms of food groups) in the previous day's d i e t . The t o t a l number of quest ion-naires c o l l e c t e d was 366. The responses were coded and the questionnaires submitted to the Key-punching Service of the Computing Centre at the Univer s i ty of B r i t i s h Columbia, for key-punching. Scoring of the n u t r i t i o n knowledge, a t t i tudes and prac t ices t e s t s , frequency d i s t r i b u t i o n s and s t a t i s t i c a l analyses were performed by an IBM 370/168 computer, using programmes designed or furnished for t h i s study, by personnel in the Computing Centre. Scoring of the tests was performed using programmes designed s p e c i f i c a l l y for th i s study. The programmes se lected for s t a t i s t i c a l analyses included SPSS, TRIP and the K-S t e s t . In order to f a c i l i t a t e the completion of the study by March 1975, a time schedule was designed. This schedule fo l lows: Schedule Stage 1 - Planning and preparat ion Dates 1. Design study May 19 74 2 . Develop questionnaire June 3. Request approval from Vancouver School June 4. Pretest and revise quest ionnaire Ju ly - 44 -Stage 1 (Continued) 5. P r i n t questionnaire 6. Develop coding scheme Dates August September Stage 2 - Data c o l l e c t i o n 1. Contact schools selected for permission to enter September 2. C o l l e c t data Stage 3 - Data analys i s 1. Code questionnaire responses 2 . Check coding 3. Key-punch from coded quest ionnaires 4. Analyse data by computer 5. Prepare f i n a l report October 1-7 November -December December -January February February -March February -March 19 75 Data Analys i s Data c o l l e c t e d were coded, key-punched on cards and treated s t a t i s t i c a l l y by computer a n a l y s i s , to test the hypotheses: 1. The r e l a t i o n s h i p of n u t r i t i o n knowledge to a t t i tudes and p r a c t i c e s , and n u t r i t i o n at t i tudes to prac t i ce s (hypothesis 1) and the i n t e r - r e l a t i o n s h i p of the three c r i t e r i o n var iab les (objective 2) were determined by p a r t i a l c o r r e l a t i o n a n a l y s i s , and the c o r r e l a t i o n c o e f f i c i e n t s recorded 2. Stepwise regression analyses were c a r r i e d out on the three c r i t e r i o n v a r i a b l e s , n u t r i t i o n knowledge, a t t i tudes and prac-t i c e s , to determine whether the non-manipulable var ia tes were - 45 -factors which re la ted to the dependent var iables (objective 5) 5. The r e l a t i o n s h i p of family var ia tes (family s ize and socio-economic status) to n u t r i t i o n knowledge, a t t i tudes and pract ices (hypothesis 2) was determined by analys i s of variance for s i g n i f i c a n t di f ferences in group means for each of the three c r i t e r i o n var iab les 4. The r e l a t i o n s h i p of school var ia tes (school a c t i v i t i e s and locat ion) to n u t r i t i o n knowledge, a t t i tudes and prac t i ce s (hypothesis 5) was tested by a n a l y s i s . o f variance for s i g n i f i -cant di f ferences in group means for each of the three c r i t e r i o n var iables 5. The r e l a t i o n s h i p of i n d i v i d u a l var ia tes (sex, age, l e i sure a c t i v i t i e s and employment status) to n u t r i t i o n knowledge, a t t i tudes and prac t ices (hypothesis 4) was inves t igated by analys i s of variance for s i g n i f i c a n t di f ferences in group means for each of the three c r i t e r i o n var iab les In a d d i t i o n , a Kolmogorov-Smirnov Goodness of F i t test (Zar 1974) was conducted on n u t r i t i o n pract ices scores , for " t y p i c a l " versus " a t y p i c a l " days. This was used to determine i f there was a s i g n i f i c a n t di f ference between the 2 groups, in the frequency of d i s t r i b u t i o n of prac t i ce s test scores . I f no d i f -ference was found, a l l n u t r i t i o n prac t ices scores could be combined to give a larger sample. 46 -CHAPTER IV FINDINGS AND INTERPRETATIONS In th i s survey of eighth grade secondary school students in Vancouver, B r i t i s h Columbia, the nature of the re l a t ionsh ip s between n u t r i t i o n knowledge, a t t i tudes and prac t i ce s and selected environmental var ia tes was explored. The i n t e r - r e l a t i o n s h i p s among-the three c r i t e r i o n var iables themselves ( n u t r i t i o n knowledge, a t t i tudes and pract ices ) were a lso inves t i ga ted . Descr ip t ion of the Sample Population Univar ia te frequency tables were designed to describe how the surveyed student populat ion was d i s t r i b u t e d in terms of the var iates te s ted . Family Var ia tes Family s ize Most students came from fami l ies with two or more ch i ldren (85.7%), while only 4.31 were from s i n g l e - c h i l d fami l ies (Table 3) . TABLE 3 NUMBER AND PERCENTAGE OF RESPONDENTS INDICATING VARIOUS FAMILY SIZES Number of ch i ld ren in the family Number % 1 15 4.3 2 72 20.6 3 94 26.8 4 72 20.6 5 or more 97 27.7 Tota l 350 100 .0 47 -Socio-economic status D i s t r i b u t i o n of respondents among the various socio-economic l eve l s was very uneven (Table 4) . Only 5% came from the lowest socio-economic l e v e l . The lower socio-economic l e v e l s , 2 and 3, contained the largest port ions of the study group (31.5% and 24.5% respect ive ly) whereas 15.7% were members of the highest socio-economic l e v e l . The remainder of the sample was almost evenly d i s t r i b u t e d among socio-economic l eve l s 4, 5 and 6 (10.5%, 5.6% and 9.1% r e s p e c t i v e l y ) . TABLE 4 NUMBER AND PERCENTAGE OF RESPONDENTS INDICATING VARIOUS LEVELS OF SOCIO-ECONOMIC STATUS Socio-economic Status Number % 1 (low) 9 3.1 2 90 31.5 3 70 24.5 4 30 10 .5 5 16 5.6 6 26 9.1 7 (high) 45 15 .7 Tota l 286 100 .0 School Var ia tes School a t h l e t i c a c t i v i t i e s A very large percentage of the students (42.1%) d id not p a r t i c i p a t e in the school a t h l e t i c a c t i v i t i e s at the time of the survey (Table 5). The majority of those who d id p a r t i c i p a t e , did so for 1 to 5 hours or 5 to 6 hours per week (22.5% and 15.4% r e s p e c t i v e l y ) . Smaller numbers were a c t i v e l y involved for more than 6 hours per week. - 48 -TABLE 5 NUMBER AND PERCENTAGE OF RESPONDENTS INDICATING VARIOUS LEVELS OF INVOLVEMENT IN SCHOOL ATHLETIC ACTIVITIES Number of hours per week spent in school a t h l e t i c a c t i v i t i e s Number % 0 150 42 .1 <1 18 5 .1 1-3 79 22 .5 3-6 55 15 .4 6-10 33 9 .3 • >10 20 5 .6 Tota l 355 100 .0 School non-a th le t i c a c t i v i t i e s Table 6 shows that again, the majority of students (68%) were not act ive in n o n - a t h l e t i c , e x t r a - c u r r i c u l a r school programmes. Of those who were invo lved , most p a r t i c i p a t e d for a short per iod of time on ly , 7.3% for less than 1 hour, 13.4% for 1 to 3 hours and 9.8% for 3 to 6 hours per week. Very few (1.5%) were act ive more than 6 hours a week. TABLE 6 NUMBER AND PERCENTAGE OF RESPONDENTS INDICATING VARIOUS LEVELS OF INVOLVEMENT IN SCHOOL NON-ATHLETIC ACTIVITIES Number of hours per week spent i n school non-a th le t i c a c t i v i t i e s Number % 0 231 68.0 <1 25 7.3 1-3 46 13.4 3-6 34 9.8 6-10 2 0.5 >10 4 1.0 Tota l 342 100.0 - 49 -School l oca t ion The sample was se lected to ensure that approximately equal numbers of students were provided by each of the schools (see Table 2 , p. 37) . Ind iv idua l Var iates Sex The study was designed to provide approximately equal numbers of boys and g i r l s (see Table 2, p .37) . Age The majority of students (70.91) were 13-years-old , while o n l y . 1.9% were 15.years of age (Table 7). The remaining students were equal ly d i s t r i b u t e d between the 12- and 14-year-old groups (12.5% and 14.7% r e s p e c t i v e l y ) . TABLE 7 NUMBER AND PERCENTAGE OF RESPONDENTS INDICATING VARIOUS AGES Age (years) Number % 12 39 12 .5 13 222 70 .9 14 46 14 .7 15 6 1 .9 T o t a l 313 100 .0 Leisure a c t i v i t i e s For the purposes of t h i s study, the amount of time spent per week in community sport a c t i v i t i e s was taken as an i n d i c a t o r of out-of-school l e i sure a c t i v i t i e s . Table 8 shows that the majority of students (50.0%) did not p a r t i c i p a t e in community - 50 -sport a c t i v i t i e s . The next largest categories were those students who were act ive for 1 to 3 hours (18.71) and 3 to 6 hours (14.6%) per week. Smaller percentages spent 6 to 10 or more than 10 hours per week in such a c t i v i t i e s (5.5% and 9.7% r e s p e c t i v e l y ) . TABLE 8 NUMBER AND PERCENTAGE OF RESPONDENTS INDICATING VARIOUS LEVELS OF INVOLVEMENT IN LEISURE ACTIVITIES Number of hours per week spent i n l e i s u r e a c t i v i t i e s Numb e r % 0 164 50 .0 <1 5 1.5 1-3 62 18.7 3-6 48 14.6 6-10 18 5.5 >10 32 9.7 To ta l 329 100 .0 Employment status F i f t y percent of the students were not employed at the time of t h i s study. Of those who were employed, approximately equal numbers f i l l e d the categories studied (Table 9). TABLE 9 NUMBER AND PERCENTAGE OF RESPONDENTS INDICATING VARIOUS LEVELS OF EMPLOYMENT STATUS Number of hours per week spent in employment Number % 0 194 56.3 <1 10 3.0 1-3 33 9.6 3-6 30 9.0 6-10 44 12 .7 >10 32 9.4 T o t a l 343 100 .0 51 -N u t r i t i o n Knowledge, At t i tudes and Pract ices Tests Method of Scoring The test of n u t r i t i o n knowledge (Appendix A) consis ted of 20 statements, each answered by 'True ' or ' F a l s e ' and by the degree of cer ta inty for the response. Each statement was scored between 0 and 7 (Appendix B) . The mean t o t a l score for the knowledge test was ca l cu la ted by adding respondent knov/ledge scores and d i v i d i n g by 554. This l a t t e r f igure i s the t o t a l number of students who completed at least 19 of the 20 knowledge statements on the t e s t . Questionnaires with more than one response missing were e l iminated from the a n a l y s i s . Mean scores for each statement on the test were obtained by t o t a l l i n g i n d i v i d -ual statement scores and d i v i d i n g by the t o t a l number of answered statements. Those quest ionnaires with an unanswered statement were assigned the mean score for that p a r t i c u l a r statement. A s i m i l a r scoring procedure was appl ied to the at t i tudes or opinions test (Appendix A) with students i n d i c a t i n g agreement or disagreement, and again, the degree of ce r t a in ty for the response. The maximum score poss ib le for each statement was 7 (Appendix B) . A t o t a l of 351 respondents completed at least 14 of the 15 a t t i tude statements. The test was marked in a manner analogous to that of the n u t r i t i o n knowledge te s t . The n u t r i t i o n prac t ices t e s t , a se l f -adminis tered 24-hour r e c a l l of the previous day's d i e t , was scored as shown in Appen-dix B. The scoring system was based on the B r i t i s h Columbia Milk Foundation's "Guide to Good Eat ing Every Day". Only complete - 52 -responses to the n u t r i t i o n prac t i ce s test were included in the c a l c u l a t i o n of the mean n u t r i t i o n pract ices scores . Complete questionnaires t o t a l l e d 347. Respondents were asked to indica te i f they considered t h e i r d ie tary r e c a l l to be " t y p i c a l " or " a t y p i c a l " of t h e i r usual d ietary habits or prac t ices (Table 10). The Kolmogorov-Smirnov test was conducted to determine i f there was a s i g n i f i c a n t di f ference in the frequency d i s t r i b u t i o n of the n u t r i t i o n prac t ices scores of the 2 groups, " t y p i c a l " and " a t y p i c a l " . TABLE 10 NUMBER AND PERCENTAGE OF RESPONDENTS INDICATING "TYPICAL" VERSUS "ATYPICAL" DIETARY PRACTICES Sex " T y p i c a l it " A t y p i c a l II Numb e r % Number % G i r l s Boys 124 110 72.1 67 .5 48 53 27.9 32 .5 T o t a l 234 69.9 101 30.1 No s i g n i f i c a n t di f ference was found between the two groups of prac t ices scores at the 1% l e v e l of s i gn i f i cance (Table 11). Therefore, in further analyses , the scores of the two groups were combined to provide a l a rger sample. TABLE 11 TWO-SAMPLE KOLMOGOROV-SMIRNOV TEST K-S value S ign i f i cance C r i t i c a l value (p = 0 .01) 0 .1994 Calculated di f ference (D) 0 .1683 N.S. 53 -Descr ipt ive aspects of n u t r i t i o n p r a c t i c e s , such as frequency of food intake and supplementation of the diet with vitamins or minerals , were reported but were not included in the t o t a l prac t i ce score, and, there fore , were not considered when te s t ing the research hypotheses. Results for Tests of N u t r i t i o n Knowledge, At t i tudes and Pract ices Scores of n u t r i t i o n knowledge, a t t i tudes and pract ices tests were converted to percentages so that the three var iab les could be analysed from a common base. The mean scores are shown i n Table 12. TABLE 12 MEAN PERCENTAGE SCORES FOR NUTRITION KNOWLEDGE, ATTITUDES AND PRACTICES TESTS Test Mean Score (%) Standard Deviat ion Knowledge 66.67 8 .91 Att i tudes 66 .94 10 .53 Pract ices 81.32 16 .00 Mean scores on the n u t r i t i o n knowledge and at t i tudes tests were very s i m i l a r (66.67% and 66.94% r e s p e c t i v e l y ) . The mean score for the n u t r i t i o n prac t i ce test was much higher at 81.32%. N u t r i t i o n knowledge The mean score for the n u t r i t i o n knowledge test was some-what higher than that found by Dwyer e_t a l . (1970) , where the mean score at ta ined among 1,358 high school students from grades 9, 10 and 12 was 55.9%. .Junior high school g i r l s (grades 7 and 8) 54 -scored 50.0% on the same te s t . The f indings of the present study are in c loser agreement with Huenemann et_ al_. (1966) who concluded that teenagers had a "reasonably good knowledge of dietary needs", with "some misconceptions" . Students appeared to score highest on items r e l a t i n g n u t r i t i o n to hea l th , and on statements concerning a more s p e c i a l -ized area of knowledge of nut r i ent s and t h e i r funct ion i n the body. Lowest scores were achieved on knowledge statements 3, 4, 5, 6, 7, 10, 13, and 19 (Table 13). Many students held misconceptions concerning the need for supplementation of the d ie t with vitamins or minerals or the need of athletes for high pro te in supplements. The majority of students considered anyone consuming three meals a day to have good eating hab i t s . This i s in contrast to t h e i r actual d ietary p r a c t i c e s , where 861 ate between 4 and 6 times a day (see Table 27, p . 6 7 ) . TABLE 13 STATEMENTS MEASURING NUTRITION KNOWLEDGE, FOR WHICH RESPONDENTS ACHIEVED LOWEST MEAN SCORES Statement Poss i b l e Score Mean Score 3. Athletes should eat high pro te in supple-7.0 2.2 4. Teenagers need mult ip le vitamin p i l l s 7.0 3.6 5. Most fat people have glandular problems . . 7.0 3.2 6 . A slimming diet should not contain any 7.0 3.3 7. I f a person eats three meals a day, he should be considered to have good eating 7.0 2.7 - 55 -TABLE 13 (Continued) Statement Poss ib le Score Mean Score 10. Milk contains a l l the e s s en t i a l elements of a good diet 7.0 2 .9 13. Equal amounts of f i s h or beef have the same amounts of prote in 7.0 3.6 14. Dry beans, peas, and nuts can replace part of the daily need for meat, f i s h , or poul try 7.0 3.2 Knowledge of food composition appeared poor. The majority of students shared the b e l i e f that milk contains a l l the elements of a good d i e t . Another important n u t r i t i o n fact of which the students were not aware concerned pro te in subs t i tu tes : they did not r e a l i z e that meat and f i s h contain approximately equal amounts of p r o t e i n , and that part of the da i lyneed for e i t h e r can be replaced by dry beans, peas or nuts . N u t r i t i o n a t t i tudes Students scored poorly on a number of a t t i tude statements, as shown in Table 14. Scores of these re f l ec ted knowledge mis-conceptions ( s p e c i f i c a l l y , numbers 8 and 10). One at t i tude that may be i n f l u e n t i a l in determining n u t r i t i o n prac t ices i s that contained in statement 14 "Foods that are good for me are not usual ly those that I l i k e the most". The Food and Drug Adminis-t r a t i o n (FDA) Consumer Survey ( F u s s i l l o 1974) made a s i m i l a r f i n d i n g : only 12% of consumers studied agreed that "Most people can get enough of the nourishment they need i f they just eat the things they l i k e " . This f ind ing may be important to n u t r i t i o n 56 -educators. It i s poss ib le that a greater e f for t should be made to increase the a c c e p t a b i l i t y of ce r t a in h ighly n u t r i t i o u s , yet frequently d i s l i k e d foods. TABLE 14 STATEMENTS MEASURING NUTRITION ATTITUDES, FOR WHICH RESPONDENTS ACHIEVED LOWEST MEAN SCORES Statement As long as I am not s i c k , I must be eat ing the r ight foods A person has a tendency to l i k e the foods his fr iends and family l i k e If I eat a balanced d i e t , I eat three meals a day An athlete does not have to eat h igh-prote in supplements A very act ive person needs some concen-trated sweets every day Foods that are good for me are not usua l ly those that I l i k e the most Poss ible Score Me an Score 2 . 3. 8. 10 . 12. 14. 3.8 3.4 2.2 2.8 3.3 1.7 N u t r i t i o n prac t ices From Table 15, i t may be seen that for the n u t r i t i o n pract ices test the majority of the students scored 20 out of 25, or bet ter than 80%. AuCoin e_t al_. (1972) assessed d ie tary intake by assigning a score based on food group intake . They s tated: In recogni t ion of the fact that i t i s quite poss ib le to obtain a s a t i s f ac tory nutr ient intake in terms of Canadian Dietary Standards yet not meet a l l of the recortmendat ions of Canada's Food Guide (McClinton e_t a l . 1971; Milne e_t a l . 1963) for the purpose of th i s study~7 a score of 70 or more out of a poss ible 100 was considered to be adequate (p. 147). - 57 -TABLE 15 NUMBER AND PERCENTAGE OF RESPONDENTS ACHIEVING VARIOUS NUTRITION PRACTICES SCORES N u t r i t i o n Prac t ice Score Number % 8 3 0.9 9 2 0.6 10 5 1.4 11 4 1.2 12 3 0.9 13 11 3.2 14 6 1.7 15 16 4.6 16 10 2.9 17 10 2.9 18 22 6.3 * 19 33 9.5 20 36 10.4 21 - 26 7.5 22 42 12.1 23 43 12 .4 24 11 3.2 2 5 " 64 18,4 Tota l 347 100.0 l eve l of d ie tary adequacy - 58 -If a s i m i l a r assumption i s made in th i s study, d ietary adequacy is indicated by a score of 18.5 or greater . This score was achieved by 73% of the students surveyed. In contras t , AuCoin et a l . reported adequate scores for only 49% of a group of 13-year-olds in Nova Sco t i a . N u t r i t i o n Pract ices in Terms of Food Groups Responses to the n u t r i t i o n pract ices test were summarised as the percentage of respondents achieving various scores for intake of foods in each of the 4 food groups. Vitamin D intake was s i m i l a r l y presented. Milk and milk products TABLE 16 NUMBER AND PERCENTAGE OF RESPONDENTS ACHIEVING VARIOUS SCORES FOR INTAKE OF MILK GROUP FOODS Mi lk Group Score 0 1 2 3 4 Number % Number % Number % Number % Number % G i r l s 11 6.3 21 12. 1 36 20 .7 34 19 .5 72 41 .4 Boys 12 7.4 23 13. 5 29 17 . 1 30 17 .6 76 44 .7 To ta l 23 6.7 44 12 . 8 65 19 .9 64 18 .6 148 43 .0 Forty-three percent of the respondents consumed at least the recommended d a i l y intake for milk or milk products (4 servings per day) (Table 16). Since the aim of the study was a q u a l i t a t i v e evaluat ion of students ' food intakes , rather than a quant i ta t ive - 59 -assessment of nutr ient intakes , no attempt was made to record intakes in excess of the recommended l e v e l s . However, many students were noted to consume more than 4 servings of foods from the milk group per day. A further 19% recorded an intake of 3 servings . Dietary adequacy may be demonstrated by intakes of 3 or more servings ; on th i s b a s i s , 62% had an adequate intake of mi lk . Only 7% said the consumed no milk or milk products . No s i g n i f i c a n t di f ferences were found between boys and g i r l s for any of the milk group scores. F r u i t and vegetables In contrast to frequent reports of low f r u i t and vegetable intake , a large percentage (58%) achieved the maximum score of 7 for intake of foods in th i s group (Table 17). TABLE 17 NUMBER AND PERCENTAGE OF RESPONDENTS ACHIEVING VARIOUS SCORES FOR INTAKE OF FRUITS AND VEGETABLES Fru i t s and Vegetables Score 0 2 3 4 5 6 7 Num-ber % Num-ber % Num-ber % Num-ber % Num-ber % Num-ber % Num-ber % G i r l s Boys Tota l 14 4 8.2 2.3 10 14 5.8 8.0 8 3 4.7 1.7 15 9 8.8 5.2 23 23 13.5 13 . 2 12 9 7.0 5 . 2 89 112 52 .0 64.4 18 5.2 24 7.0 11 3.2 24 7.0 46 13.5 21 6.1 201 58.3 - 60 -A further 6% and 14% scored 5 and 6 points r e s p e c t i v e l y . If 5 plus is taken to indica te d ietary adequacy, 78% of the surveyed populat ion had an adequate intake of f r u i t s and vegetables . S i gn i f i c an t di f ferences were found, at the 5% l e v e l , between intakes of boys and g i r l s , with boys consuming more foods from th i s group than g i r l s . Meat or a l ternates The maximum score of 6 for intake of foods in t h i s group was achieved by 74% of respondents (Table 18) . TABLE 18 NUMBER AND PERCENTAGE OF RESPONDENTS ACHIEVING VARIOUS SCORES FOR INTAKE OF MEAT GROUP FOODS Meat Group Score 0 3 6 Number % Number % Number % G i r l s 5 2.9 44 25 .0 125 71.8 Boys 4 2.3 36 20.8 133 76.9 Tota l 9 2.6 80 23.1 258 . 74.4 Twenty-three percent of respondents consumed 1 serving of meat or a l t e rna t ives and scored 5 po in t s . Only 3% reported no intake of food from the meat group. Intakes of boys and g i r l s did not d i f f e r s i g n i f i c a n t l y . Cerea l s , bread or pasta Three servings from th i s food group were consumed by 83% - 61 -of the students, who achieved the maximum score of 6 points (Table 19). TABLE 19 NUMBER AND PERCENTAGE OF RESPONDENTS ACHIEVING VARIOUS SCORES FOR INTAKE OF CEREAL GROUP FOODS • Cereals Grc >up Score 0 2 4 6 Number % Number % Number % Number % G i r l s Boys Tota l 1 3 0.6 1.7 10 3 5.7 1.7 26 15 14.9 8.7 137 152 78.7 87.9 4 1.2 13 3.7 41 11.8 289 83.3 A t o t a l of 95% had an adequate intake of foods from the cerea l group (adequate being taken as a score of 4 p l u s ) . Very few (1%) ate no foods from th i s group. S i g n i f i c a n t di f ferences were shown between the intakes of boys and g i r l s , with g i r l s scoring higher than boys. Vitamin D intake Only 38% achieved a maximum score of 2 for vitamin D intake (Table 20). A score of 1 was a t ta ined by 44% of respondents. A high percentage (18%) were reported as having no sources of vitamin D in t h e i r d i e t . Note should be made,however, that the resul t s for vitamin D intake may be less than accurate. It was d i f f i c u l t to evaluate the intake of the vitamin from the 24-hour r e c a l l provided by the students. Hence the estimated intake may be lower than the actual intakes . - 62 -TABLE 20 NUMBER AND PERCENTAGE OF RESPONDENTS ACHIEVING VARIOUS SCORES FOR INTAKE OF VITAMIN D Vitamin D Score 0 1 2 Number a. 0 Number % Number 0, '0 G i r l s Boys To ta l 31 32 17.8 18.8 85 67 48.9 39.9 58 71 33.3 41.8 63 18.3 152 44.2 129 37 .5 Table 21 summarises the mean scores achieved for intake from each of the four food groups, and for vitamin D intake . TABLE 21 MEAN SCORES FOR INTAKES FROM THE FOUR FOOD GROUPS, VITAMIN D INTAKE AND TOTAL PRACTICES Food Group Tota l Poss ible Score Mean Score Standard Deviat ion Mi lk F ru i t and Vegetables Meat Cereals Vitamin D 4.0 7.0 6.0 6.0 2.0 2.8 5.6 5.2 5.5 1.2 1.3 2.1 1.5 1.1 0.7 Tota l Pract ices 25.0 20.5 4.0 These scores r e f l e c t the f indings discussed above. The mean scores for the food groups, f r u i t and vegetables (5.6 out of 7 .0) , meat (5.2 out of 6.0) and cereals (5.5 out of 6 .0 ) , were - 63 -r e l a t i v e l y h igh . The milk group mean score was a l i t t l e lower (2.8 out of 4 .0 ) , and vitamin D intake (1.2 out of 2.0) was below the l e v e l of d ie tary adequacy. The t o t a l prac t ices mean score i n d i c a t e d , once again, that the majority of students in t h i s survey were obtaining an adequate d i e t . These f indings confirm the re su l t s of others who reported low intakes of milk and milk products among adolescents (Hinton et a l . 1963; Trenholme and Milne 1963; Edwards' et a l . 1964; Myers et a l . 1968; Robson 1971; AuCoin et a l . 1972). However, the same researchers also reported low intakes of f r u i t and vegetables , and cerea l foods. The present study found high intakes of foods from these groups. In te r -cor re l a t ions of Mean Scores for the Food Groups and Tota l Prac t ices Mean Score In te r -cor re l a t ions of mean scores in the four food groups showed a strong p o s i t i v e c o r r e l a t i o n (p<0.01) between scores for milk and f r u i t and vegetables groups, and between scores for meat and cereal groups (Table 22) . TABLE 2 2 CORRELATION MATRIX FOR MEAN SCORES ACHIEVED FOR FOOD GROUPS AND TOTAL PRACTICES Mi lk F r u i t and Vegetables Meat Cereals Pract ices Mi lk F r u i t and Vegetables Meat Cereals Pract ices 1.000 0.175** 0.091 0 .144 0 .642** 1.000 0.104 0.099 0.669** 1.000 0.157** 0.527** 1.000 0 .470** 1.000 *p<0.05 *p<0.01 - 64 A weaker po s i t i ve r e l a t i o n s h i p (p<0.05) was found between milk and cerea l group scores . As expected, each of the four food group mean scores was s trongly and p o s i t i v e l y corre la ted with the t o t a l n u t r i t i o n prac t ices mean score. The H o t e l l i n g t^-test ind ica ted an o v e r a l l s i g n i f i c a n t di f ference (p<0.05) between food group mean scores of boys and g i r l s . Examination of the confidence i n t e r v a l l i m i t s for each p a i r of means showed that , taken separate ly , the di f ference between any p a i r was n o n - s i g n i f i c a n t . A l l of the confidence in terva l s included zero (Table 23) . TABLE 23 MEAN SCORES OF BOYS AND GIRLS FOR EACH OF THE FOOD GROUPS AND TOTAL PRACTICES Mean Score Confidence Intervals S igni f icance G i r l s Boys Left l i m i t Right l i m i t Milk 2.79 2 .78 -0.45 0.50 N.S . F r u i t and Vegetables 5.35 5.90 -1.28 0.18 N.S. Meat 5 .24 5.07 -0.38 0.72 N.S. Cereals 5.65 5.44 -0.19 0.63 N.S . Tota l pract ices 20.26 20. 50 -1.48 1.41 N.S. Mi lk and f r u i t and vegetables , and milk and cerea l group mean scores were found to cor re l a t e s t rongly (p<0.01) in boys' d iets (Table 24). Meat and f r u i t and vegetables or cerea l group mean scores re la ted less s trongly (p<0.05). In comparison, the only c o r r e l a t i o n found among the g i r l s studied was between milk and f r u i t and vegetables group scores (p<0.05) (Table 25). - 0 5 -TABLE 24 CORRELATION MATRIX FOR MEAN SCORES ACHIEVED BY BOYS FOR FOOD GROUPS AND TOTAL PRACTICES Milk F r u i t and Vegetables Meat Cereals Pract ices Mi lk F r u i t and Vegetables Meat Cereals Pract ices 1.000 * * 0. 209 0.120 0. 259 0 .675** 1.000 0.179 * * 0.141 0.717** 1.000 0.188* 0 .545** 1.000 0.490** 1.000 * p<0.05 * * p<0.01 TABLE 2 5 CORRELATION MATRIX FOR MEAN SCORES ACHIEVED BY GIRLS FOR FOOD GROUPS AND TOTAL PRACTICES Mi lk F r u i t and Vegetables Meat Cereals Pract ices Milk F r u i t and Vegetables Meat Cereals Pract ices 1.000 0.168* 0.068 0.053__ 0.618** 1.000 0.045 0.097.. 0.624 1.000 ° - 1 2 6 * * 0.520 * * 1.000 0 .465** 1.000 * p<0.05 * * p<0.01 Vitamin-Minera l Supplementation Students were asked to indicate if- they had taken a vitamin or mineral supplement the day p r i o r to the study. Of the 557 respondents, 51.5% said they had taken a supplement (Table 26). A s l i g h t l y higher percentage of g i r l s (34.1%) than boys (28.7%) recorded supplementation of the diet with vitamins and - 66 -TABLE 2 6 NUMBER AND PERCENTAGE OF RESPONDENTS USING A VITAMIN-MINERAL SUPPLEMENT Using a Supplement Not Using a Supplement Number % Number % G i r l s Boys To ta l 59 47 34.1 28.7 114 117 65.9 71.3 106 31. 5 231 68 .5 minerals . This f ind ing i s s i m i l a r to the r e l a t i v e l y high incidence of vitamin A and D supplementation (40.61 and 38.0% respect ive ly ) reported by Gascon-Barre et al. (1973) among Montreal school-c h i l d r e n , and much higher than the 12 to 13% incidence of sup-plementation shown by Trenholme and Milne (1963) for Toronto students. The higher percentage may r e f l e c t the increas ing trend for supplementation of the d iet over the past ten years . Another reason for the di f ference may be that the present study was conducted in the F a l l , when the incidence of supplementation may be h igher . Findings of the Food and Drug Adminis t ra t ion survey of heal th prac t i ce s and opinions (Pearson 1972) , indicated that more than h a l f of a sample of 2,839 adults "thought that extra vitamins and minerals were of value in preventing c o l d s " . Frequency of Food Intake Most students (41.4%) consumed food 5 times a day (Table 27). A further 21.0% and 23.7% reported eat ing 4 or 6 times a day r e s p e c t i v e l y . Very few ate less than 4 or more than 6 times a day. Thus, i f there i s a poss ible r e l a t i o n s h i p between d ie tary - 67 -adequacy and frequency of food intake (as suggested by Hampton et a l . 1967 and Eppright et a l . 1972), the high mean n u t r i t i o n pract ices score reported in t h i s study may be d i r e c t l y re l a ted to the f inding that the great majori ty of students ate 4 to 6 times during the day. TABLE 2 7 NUMBER AND PERCENTAGE OF RESPONDENTS INDICATING VARIOUS FREQUENCIES OF FOOD INTAKE Number of Times per Day Food Consumed Number % 2 3 1.0 3 26 7.4 4 74 21.1 5 145 41.4 6 83 23.7 7 14 4.0 8 5 1.4 Tota l 350 100.0 In comparison to statements frequently made in the l i t e r a -ture of "missed" breakfasts , only 13% ate nothing before school (Table 28). In evaluat ing the d ie tary r e c a l l , breakfast was considered a meal only i f i t contained both food and beverage (see d e f i n i t i o n s p . 8) . Therefore , 87% of the students consumed a meal before school . In comparison, 25% of Robson's study group of adolescents (1971) ate breakfast less than 3 times a week. The vast majority (71%) ate nothing before the noon break. Ninety-eight percent ate at noon, in contrast to the " sk ipped" lunches mentioned by Breel ing (1970) and Robson (1971). - 68 -TABLE 2 8 NUMBER AND PERCENTAGE OF RESPONDENTS INDICATING FREQUENCIES OF FOOD INTAKE AT VARIOUS TIMES OF THE DAY Time of Frequency G i r l s Boys To ta l Day Number % Number % Number 0, 0 Before 0 26 14 .8 19 11.0 45 12.9 School 1 146 83.0 154 89.0 500 86.0 2 4 2 . 3 0 0.0 4 1.1 At School , 0 129 73 .3 118 68.2 247 70.8 before 1 45 25.6 52 50 .1 97 27.8 noon 2 2 1.1 3 1.7 5 1.4 Noon 0 2 1.1 2 1.1 4 1.1 1 175 98.9 170 97.7 345 98.3 2 0 0.0 2 1.1 2 0.6 Between 0 26 14.8 34 19.5 60 17.1 noon and 1 137 77.8 134 77.0 271 77.4 Evening 2 11 6.3 6 5.4 17 4.9 meal 3 2 1.1 0 0.0 2 0.6 Evening 0 2 1.1 3 1.7 5 1.4 Meal 1 173 98.9 171 98 .5 544 98.6 After 0 26 14.9 35 20.2 61 17.6 Evening 1 128 73.6 128 74 .0 256 73.8 meal, be- 2 19 10.9 9 5.2 28 8.1 fore bed- 3 1 0.6 1 0.3 2 0.6 time Nearly three-quarters of the ch i ld ren br ing t h e i r lunch to school . Less than h a l f of them eat i t a l l , and 9% . . . sa id they usua l ly throw i t out (Robson 1971, p. 17). Suggested reasons for the discrepancies between the f indings are (1) age - - both Bree l ing and Robson studied adolescents whose average age was greater than that of the present study, or (2) economic status - - those who threw away t h e i r lunches were poss ib ly more a f f luent . - 69 -Seventy-seven percent indicated eating once and 5% twice between noon and the evening meal. This i s s imi l a r to the f i n d -ing of Marlay (1971) who reported that among a group of 13-year-old g i r l s , less than 3% "never" snacked and 83% " u s u a l l y " snacked at th i s time. A very small percentage (1.4%) did not consume an evening meal, and most students (74%) ate at least once more during the evening, before bedtime. Frequency of food intake did not d i f f e r s i g n i f i c a n t l y between boys and g i r l s . The Relat ionship of Selected Var iates to N u t r i t i o n  Knowledge, At t i tudes and Pract ices The re l a t ionsh ip s of the non-manipulable var ia tes to the c r i t e r i o n v a r i a b l e s , n u t r i t i o n knowledge, a t t i tudes and p r a c t i c e s , were invest igated in two ways: by analys is of variance using Scheffe 's t e s t , and analys i s of variance using stepwise mul t ip le regres s ion . Scheffe 's test allows mul t ip le comparisons of a number of means taken two at a t ime, even when the means are from groups of unequal s i z e . Stepwise regress ion analys is determines which of the var ia tes studies has a s i g n i f i c a n t ef fect on the c r i t e r i o n v a r i a b l e s . This ef fect i s independent of the ef fect of a l l other v a r i a t e s . Comparison of Family Var ia tes and N u t r i t i o n Know-ledge, At t i tudes and Pract ices (Hypothesis 2) Family s ize Family s ize was not s i g n i f i c a n t l y re la ted to n u t r i t i o n know-ledge or pract ices of eighth grade students (Table 29) . The n u t r i t i o n at t i tudes mean score of students whose famil ies numbered 70 -5 or more was s i g n i f i c a n t l y lower (p< 0.05) than that of students who came from 2-chi ldren f a m i l i e s . Neither groups' scores were s i g n i f i c a n t l y d i f f e rent from the scores of those who came from fami l ies of 1, 5 or 4 c h i l d r e n . TABLE 29 MEAN PERCENTAGE SCORES OF RESPONDENTS FOR NUTRITION KNOWLEDGE, ATTITUDES AND PRACTICES TESTS, IN TERMS OF FAMILY SIZE Number of ch i ld ren in the family Test 1 2 3 4 5 S ign i f i cance Knowledge 65 .66 69.06 66 .85 65.86 65.62 N.S. At t i tudes 65.59. 69 .58 67.01 67.87 65.46 S. Pract ices 70.40 80.33 79 .49 82 .06 77 .69 N.S. S igni f icance l e v e l = 0.05 Results of Scheffe 's test for di f ferences between n u t r i t i o n a t t i tudes mean test scores of students , in terms of family s ize _5 1 4 5_ 1 4 5 2 For family s izes underl ined by the same l i n e , d i f ferences in mean scores for the N u t r i t i o n a t t i tudes test were not s i g n i f i -cant . Hypothesis 2, regarding the r e l a t i o n s h i p of family s ize to the three c r i t e r i o n v a r i a b l e s , was p a r t i a l l y supported by these f i n d -ings in that n u t r i t i o n a t t i tudes were s i g n i f i c a n t l y re l a ted to f a m i l y s i z e . Socio-economic status Hypothesis 2, with respect to socio-economic s tatus , was re jected as n u t r i t i o n knowledge, a t t i tudes and prac t i ce s were 71 -found not to be s i g n i f i c a n t l y re l a ted to the socio-economic status of the student (Table 30). TABLE 30 MEAN PERCENTAGE SCORES OF RESPONDENTS FOR NUTRITION KNOWLEDGE, ATTITUDES AND PRACTICES TESTS, IN TERMS OF SOCIO-ECONOMIC STATUS Test Socio-Economic Status S i g n i -f icance 1 2 3 4 5 6 7 Knowledge 62 .56 65. 68 64.26 66.17 68 .64 69 . 85 69 .64 N.S . At t i tudes 65 .10 64. 15 66.22 66. 80 63.43 68 . 15 73 . 33 N.S. Pract ices 72 .89 77. 78 81.14 78 . 53 88.50 80 . 31 84 .44 N.S . S igni f i cance l e v e l = 0.05 Comparison of School Variates and N u t r i t i o n Knowledge, Att i tudes and Pract ices (Hypothesis 3) School a c t i v i t i e s No s i g n i f i c a n t r e l a t i o n s h i p was found between n u t r i t i o n knowledge, a t t i tudes and prac t i ce s and the time spent per week in school a t h l e t i c a c t i v i t i e s (Table 31). Thus, the aspect of hypothesis 3 regarding school a t h l e t i c a c t i v i t i e s was not suppor-ted . Those students who p a r t i c i p a t e d in non-a th le t i c a c t i v i t i e s at school for more than 10 hours per week achieved lower n u t r i t i o n knowledge and a t t i tude scores. However, these were not s i g n i f i -cant at the 5% l e v e l of s i g n i f i c a n c e . Neither n u t r i t i o n know-ledge, a t t i tudes nor pract ices of the students were s i g n i f i c a n t l y re la ted to the degree of p a r t i c i p a t i o n in non-a th le t i c school a c t i v i t i e s (Table 32). These f indings did not support that aspect of hypothesis 3 re la ted to non-a th le t i c school a c t i v i t i e s . - 72 -TABLE 31 MEAN PERCENTAGE SCORES OF RESPONDENTS FOR NUTRITION KNOWLEDGE, ATTITUDES AND PRACTICES, IN TERMS OF SCHOOL ATHLETIC ACTIVITIES Number of school hours per week spent a t h l e t i c a c t i v i t i e s in S igni f i cance Test 0 <1 1-5 5-6 6-10 > 10 Knowledge 66 . 12 63.39 66.91 68.85 66 .41 66 . 76 N.S. At t i tudes 66 .51 60. 56 67.49 68 .15 68.48 64 . 53 N.S. Pract ices 79 .07 77.78 76 . 76 83.78 80.85 80 .60 N.S. S igni f icance l e v e l = 0.05 TABLE 32 MEAN PERCENTAGE SCORES OF RESPONDENTS FOP. NUTRITION KNOWLEDGE, ATTITUDES AND PRACTICES TESTS, IN TERMS OF SCHOOL NON-ATHLETIC ACTIVITIES Number of hours per week spent school non-a th le t i c a c t i v i t i e s in Test 0 <1 1-3 5-6 6-10 > 10 S igni f i cance Knowledge 66.33 65 .82 66 .01 70 .23 72.15 65 .10 N.S. At t i tudes 67.06 65.36 65.10 68.25 72 .90 63 .60 N.S. Pract ices 78 .82 82.40 77 .74 84 .82 82 .00 83 .10 N.S. S igni f icance l e v e l = 0.05 School l oca t ion The loca t ion of the school d id inf luence the test scores for n u t r i t i o n knowledge, a t t i tudes and prac t ices (Table 53). The mean n u t r i t i o n knowledge test score for students from school 3 d id not d i f f e r s i g n i f i c a n t l y from the mean scores of students attending schools 6, 5, 4 and 1, but was s i g n i f i c a n t l y d i f f e rent from the mean score of students at school 2 (p<0.05). The n u t r i t i o n at t i tudes mean score of students attending school 1 73 -d i f f e red s i g n i f i c a n t l y from the mean score atta ined by students from school 6, but ne i ther mean score d i f f e red s i g n i f i c a n t l y from the mean scores of students at the other four schools . The n u t r i t i o n prac t i ce s mean score of students from school 3 was s i g n i f i c a n t l y lower than the students ' mean scores from schools 5 and 1; the mean prac t i ce s scores of students from school 3 and from schools 5 and 1 were not s i g n i f i c a n t l y d i f f e rent from the scores obtained by students attending schools 6, 4 and 2. TABLE 33 MEAN PERCENTAGE SCORES OF RESPONDENTS FOR NUTRITION KNOWLEDGE, ATTITUDES AND PRACTICES TESTS, IN TERMS OF SCHOOL LOCATION Test School S ign i f i cance 1 2 3 4 5 6 Knowledge 68 .59 70.00 63.42 67.79 65.29 64.34 S. Att i tudes 71.29 67.41 64. 55 66.91 65 .27 63.49 S. Pract ices 84 .90 79.93 70.00 77 .49 83.80 76.41 S. S igni f i cance l e v e l = 0.05 Results of Scheffe 's test for d i f ferences between n u t r i t i o n knowledge, a t t i tudes and prac t i ce s mean test scores , in terms of school l oca t ion N u t r i t i o n knowledge 6 N u t r i t i o n a t t i tudes N u t r i t i o n prac t ices For school locat ions underl ined by the same l i n e , di f ferences in mean test scores were not s i g n i f i c a n t . 74 -Hypothesis 3, with regard to school v a r i a t e s , was p a r t i a l l y supported, as s i g n i f i c a n t r e l a t ionsh ip s were found between school l oca t ion and scores on tests of n u t r i t i o n knowledge, a t t i tudes and p r a c t i c e s . Comparison of Indiv idual Var iates and N u t r i t i o n Knowledge, At t i tudes and Pract ices (Hypothesis 4) Sex G i r l s scored s i g n i f i c a n t l y higher than boys on both n u t r i -t i o n knowledge and at t i tudes tests (Table 3 4 ) . No s i g n i f i c a n t di f ferences were found in scores for n u t r i t i o n p r a c t i c e s . Hypo-thes i s 4. regarding the r e l a t i o n s h i p of sex to n u t r i t i o n knowledge, a t t i tudes and p r a c t i c e s , was p a r t i a l l y supported in that n u t r i -t i o n knowledge and at t i tudes of boys and g i r l s , but not p r a c t i c e s , were found to be s i g n i f i c a n t l y d i f f e r e n t . m TABLE 34 MEAN PERCENTAGE SCORES OF RESPONDENTS FOR NUTRITION KNOWLEDGE, ATTITUDES AND PRACTICES TESTS, IN TERMS OF SEX Test Sex S igni f i cance Male Female Knowledge 65 .48 6 7 . 7 3 s . Att i tudes 65 .18 6 8 . 0 0 s . Pract ices 78 .09 79 .69 N.S. S igni f icance l e v e l = 0 .05 Age Analys i s of variance using the four age groups showed no s i g n i f i c a n t di f ferences between the scores of tests of n u t r i t i o n - 75 -knowledge, a t t i tudes and p r a c t i c e s . As the group of 15-year-olds was so smal l , a dec i s ion was made to repeat the test e l iminat ing t h i s group. When t h i s was done, Scheffe 's test revealed s i g n i f i -cant di f ferences in n u t r i t i o n at t i tudes and prac t i ce s scores (p<0.05); 14-year-olds scored s i g n i f i c a n t l y lower than 12-or 13-year-o lds . No s i g n i f i c a n t di f ference was found among n u t r i t i o n knowledge scores (Table 35) . TABLE 35 MEAN PERCENTAGE SCORES OF RESPONDENTS FOR NUTRITION KNOWLEDGE, ATTITUDES AND PRACTICES TESTS, IN TERMS OF AGE Test Age (Years) S igni f icance 12 13 14 15 Knowledge 67.30 67.17 64.49 62.68 N.S. At t i tudes 67.84 68.15 60.76 59 .70 S. Pract ices 83.49 80.95 73.30 68.00 S. S igni f icance l e v e l = 0.05 Results of Scheffe 's test for di f ferences between n u t r i t i o n a t t i -tudes and prac t ices mean test scores , in terms of age N u t r i t i o n a t t i tudes 14 12 13. N u t r i t i o n prac t ices 14 13 12 For ages underl ined by the same l i n e , d i f ferences in mean test scores were not s i g n i f i c a n t . Hypothesis 4, r e l a t i n g age and the three c r i t e r i o n v a r i a b l e s , was p a r t i a l l y supported in that a s i g n i f i c a n t r e l a t i o n s h i p was found between age and n u t r i t i o n at t i tudes and prac t ices but not n u t r i -t i o n knowledge. - 76 -Leisure a c t i v i t i e s The aspect of hypothesis 4 concerning l e i sure a c t i v i t i e s was not supported. No s i g n i f i c a n t di f ferences were detected between mean scores of tests of n u t r i t i o n knowledge, a t t i tudes and pract ices and the degree of involvement of the student in l e i sure a c t i v i t i e s (Table 36). TABLE 36 MEAN PERCENTAGE SCORES OF RESPONDENTS FOR NUTRITION KNOWLEDGE, ATTITUDES AND PRACTICES TESTS, IN TERMS OF LEISURE ACTIVITIES Test Number of hours per week spent in l e i sure a c t i v i t i e s S ign i f i cance 0 <1 1-3 3-6 6-10 >10 Knowledge 66 .20 70.70 67.42 66.97 64.73 67.67 N.S . At t i tudes 66.48 62 .48 67.07 66.14 63.34 71.46 N.S . Pract ices 77.39 81.60 80.90 84.42 86.22 82 .38 N.S. S igni f icance l e v e l = 0.05 Employment status No r e l a t i o n s h i p was found between mean scores for tests of n u t r i t i o n knowledge, a t t i tudes and prac t ices and employment status of the student (Table 37). With regard to employment s ta tus , hypothesis 4 was not accepted. Stepwise Regression Results The re l a t ionsh ip s of the non-manipulable var ia tes to the three c r i t e r i o n var iab les ( n u t r i t i o n knowledge, a t t i tudes and pract ices ) were inves t iga ted , in t u r n , by stepwise mul t ip le regression a n a l y s i s . As most var ia tes were not o r d i n a l , but nominal , bases for comparison were se lec ted . The base for - 77 -TABLE 37 MEAN PERCENTAGE SCORES OF RESPONDENTS FOR NUTRITION KNOWLEDGE, ATTITUDES AND PRACTICES TESTS, IN TERMS OF EMPLOYMENT STATUS Test Number of hours per week employment spent in S i g n i f i c a n t 0 <1 1-5 5-6 6-10 > 10 Knowledge 66 .10 65.09 66.14 68.81 68.55 65 .80 N.S. Att i tudes 65 .71 67 .08 65.59 71.20 69.95 66 .57 N.S . Pract ices 79 .75 75.20 75. 03 81.07 80.56 81 .38 N.S . S igni f icance l e v e l = 0.05 comparison of the r e l a t i o n s h i p of family s ize to n u t r i t i o n know-ledge, a t t i tudes and prac t ices was the s i n g l e - c h i l d fami ly . In the same manner, bases were chosen for the other v a r i a t e s ; soc io-# economic status base - - socio-economic l e v e l 1; school a c t i v i t i e s base - - no p a r t i c i p a t i o n in school a c t i v i t i e s ; school loca t ion base - - school 1; sex base - - female; l e i s u r e a c t i v i t i e s base - -no time spent in community sports a c t i v i t i e s ; and employment status base - - not employed. Age, as an o rd ina l v a r i a t e , needed no base. Stepwise regress ion analys i s showed that the i n d i v i d u a l v a r i a t e s , age, p a r t i c i p a t i o n in l e i su re a c t i v i t i e s and employment s tatus , and the school v a r i a t e , a t h l e t i c a c t i v i t y , were i n s i g n i f i -cant ly re la ted to n u t r i t i o n knowledge test scores. N u t r i t i o n knowledge was found to be s i g n i f i c a n t l y higher in fami l ies of 2 ch i ld ren when compared to s i n g l e - c h i l d fami l ies (Table 58). The highest socio-economic status l e v e l (7) was s i g n i f i c a n t l y re la ted to n u t r i t i o n knowledge. School loca t ion was also a s i g n i f i c a n t v a r i a t e ; students at school 2 had a s i g n i f i c a n t l y greater - 78 -knowledge of n u t r i t i o n than students from the base school 1, while students from school 3 had s i g n i f i c a n t l y less n u t r i t i o n knowledge than those from school 1. Boys scored s i g n i f i c a n t l y lower than g i r l s on the n u t r i t i o n knowledge t e s t . TABLE 38 STEPWISE REGRESSION RESULTS FOR VARIATES SIGNIFICANTLY RELATED TO MEAN PERCENTAGE SCORES FOR THE NUTRITION KNOWLEDGE TEST Var ia te Coe f f i c i en t Fprob Constant 66.58 Number of ch i ld ren in family : 2 Socio-economic s tatus : 7 Number of hours per week spent in school non-a th le t i c a c t i v i t i e s : 3-6 School l o c a t i o n : School 2 School 3 Sex: male 2 . 88 2 .96 3.41 2 .94 -2 .71 -2.37 0.019* 0.032* 0.038* 0.0 35. 0.044* 0.019 *p<0.05 These f indings thus supported hypothesis 2; some family var ia te s were found to be s i g n i f i c a n t l y re la ted to n u t r i t i o n knowledge. Hypothesis 3, concerning school v a r i a t e s , was p a r t i a l -l y supported in that the loca t ion of the school attended by the students was s i g n i f i c a n t l y re l a ted to students ' n u t r i t i o n know-ledge. It was not supported with respect to school a c t i v i t i e s , which were found to be unrelated to n u t r i t i o n knowledge. The i n d i v i d u a l v a r i a t e , sex, was s i g n i f i c a n t l y re l a ted to n u t r i t i o n knowledge and hypothesis 4 was p a r t i a l l y accepted. Other i n d i v i -dual var ia tes (age, l e i su re a c t i v i t i e s and employment status) 79 -were not s i g n i f i c a n t in determining n u t r i t i o n knowledge and th i s part of hypothesis 4 was re j ec ted . TABLE 39 STEPWISE REGRESSION RESULTS FOR VARIATES SIGNIFICANTLY RELATED TO MEAN PERCENTAGE SCORES FOR THE NUTRITION ATTITUDES TEST Var ia te Coef f i c i ent ^prob Constant 66'. 55 Number of ch i ld ren in family : > 5 Socio-economic s tatus : 7 Sex: male Age Number of hours per week spent in l e i sure a c t i v i t i e s : >10 -3.27 6 .42 -3.25 -2 .48 4.51 0.012* 0.000* 0 . 005 0.010* 0.021* *p<0.05 Students from famil ies with 5 or more ch i ld ren scored s i g n i f i c a n t l y lower on the n u t r i t i o n at t i tudes test than students from s i n g l e - c h i l d fami l ies (Table 39). S i g n i f i c a n t l y higher scores were achieved by those from a higher socio-economic l e v e l (7). The sex of the student was again a s i g n i f i c a n t var i a te with regard to n u t r i t i o n a t t i tudes ; boys scored s i g n i f i c a n t l y lower than g i r l s on the test of n u t r i t i o n opinions . Age was found to be negat ively and s i g n i f i c a n t l y re la ted to a t t i tudes toward n u t r i t i o n . I f students spent 10 hours or more per week a c t i v e l y involved in community sports ( l e i sure a c t i v i t i e s ) s i g n i f i c a n t l y higher scores for the n u t r i t i o n at t i tudes test were a t ta ined . School var iates ( a c t i v i t i e s and l o c a t i o n ) , and the i n d i v i -dual v a r i a t e , employment s tatus , were not s i g n i f i c a n t l y re la ted to n u t r i t i o n at t i tudes scores . - 80 -Hypothesis 2 was thus supported by these f ind ings ; family var ia tes were s i g n i f i c a n t l y re l a ted to n u t r i t i o n a t t i tude s . No s i g n i f i c a n t r e l a t i o n s h i p was found between school var ia tes and n u t r i t i o n at t i tudes (hypothesis 3) . P a r t i a l support for hypothes 4, the r e l a t i o n s h i p of i n d i v i d u a l var ia tes to the three c r i t e r i o n v a r i a b l e s , was ev ident , in that sex, age and l e i su re a c t i v i t i e s were s i g n i f i c a n t l y re l a ted to a t t i tudes toward n u t r i t i o n , while employment status was not . The c o e f f i c i e n t of determination (r?) for the stepwise regress ion analys i s of the n u t r i t i o n prac t i ce s test scores was 0.080 (Table 40); that i s , the var ia tes examined accounted for only 8% of the t o t a l variance in n u t r i t i o n p r a c t i c e s . Since nei ther of the family var ia tes (family s ize or socio-economic status) was found to be s i g n i f i c a n t l y re l a ted to n u t r i t i o n prac-t i c e s , hypothesis 2 was not supported. Although the number of hours per week spent in school a t h l e t i c a c t i v i t i e s was not s i g n i -f i cant in determining n u t r i t i o n p r a c t i c e s , school l o c a t i o n was a s i g n i f i c a n t v a r i a t e . Hence, hypothesis 3, concerning school v a r i a t e s , was p a r t i a l l y supported. Students at school 3 had s i g n i f i c a n t l y lower scores on the n u t r i t i o n prac t i ce s test than those from the base school . (These same students also had a s i g n i f i c a n t l y lower knoitfledge of n u t r i t i o n concepts as measured by the n u t r i t i o n knowledge test) . P a r t i c i p a t i o n in school non-a t h l e t i c a c t i v i t i e s for 3 to 6 hours per week was found to be s i g n i f i c a n t l y re la ted to n u t r i t i o n p r a c t i c e s . No l o g i c a l expla-nat ion of th i s f inding can be found, except that the var iates examined explain so l i t t l e of the v a r i a t i o n in n u t r i t i o n prac-t i c e s , that the analys is used has uncovered th i s anomoly. 81 -TABLE 40 STEPWISE REGRESSION RESULTS FOR VARIATES SIGNIFICANTLY RELATED TO MEAN PERCENTAGE SCORES FOR THE NUTRITION PRACTICES TEST Var ia te Coe f f i c i ent Fprob Constant 81.09 Number of hours per week spent in school non-a th le t i c a c t i v i t i e s : 3-6 School l o c a t i o n : School 3 Age 6.9 8 -8.45 -4.53 0.017* 0.001* 0.003 *p<0.05 As with n u t r i t i o n a t t i t u d e s , the i n d i v i d u a l v a r i a t e , age, was found to be negat ively and s i g n i f i c a n t l y re l a ted to n u t r i -t i o n p r a c t i c e s . Thus, hypothesis 4, with regard to age, was p a r t i a l l y supported. Other i n d i v i d u a l var ia te s were not s i g n i f i -cant ly re l a ted to n u t r i t i o n pract ices test scores , and these f indings did not support those sect ions of hypothesis 4 concerning sex, l e i sure a c t i v i t i e s and employment s ta tus . Discuss ion of the Relat ionships Among Selected Var ia tes and N u t r i t i o n Knowledge, At t i tudes and Pract ices Few reports have appeared in the l i t e r a t u r e r e l a t i n g adolescent n u t r i t i o n knowledge and at t i tudes to the environmental v a r i a t e s . The r e l a t i o n s h i p between d ie tary prac t ices and environ-mental var ia tes has been inves t iga ted , but as was shown in Chapter I I , the re su l t s are c o n f l i c t i n g . This sect ion of the report w i l l compare previous f indings with those of the present study. - 82 Sanjur (1971) , AuCoin et al_. (1972) and Schorr e_t a l . (1972) found no re l a t ionsh ip between family s ize and dietary p r a c t i c e s . This was confirmed in the present study. Cook e_t a l . (1973) concluded the number of s i b l i n g s in the family was not , in general , associated with s i g n i f i c a n t di f ferences in nut r i ent intake , though when nutr ient intake per 1000 k c a l . was considered, those from smaller fami l ies had a higher intake of a l l nutr ient s except carbohydrate. Thus, in some respects , the report of Cook et a l . was also confirmed. The present study d id not support the f ind ing of Sims and Morris (1974) that nutr ient intake was depen-dent on family s i z e . However, these researchers studied pre-school ch i ld ren rather than adolescents , and considered quanti-t a t ive rather than q u a l i t a t i v e aspects of d i e t . E a r l i e r s tudies through the 1960's reported a p o s i t i v e r e l a t i o n s h i p between socio-economic status and adolescent n u t r i -t i o n prac t ices (Hinton et_ a l . 1963; Dibble ejt al_. 1965 ; Hampton et a l . 1967; Huenemann et a l . 1968 ; Bree l ing 1970). More recent work by Robson (1971) and Cook e_t a l . (1975) suggested socio-economic status was not s i g n i f i c a n t l y re la ted to d ie tary prac-t i c e s among s choo lch i ld ren . The present study supported these l a t e r f ind ings . In the present study, the degree of p a r t i c i p a t i o n in a c t i -v i t i e s at school or in the community, as wel l as employment s t a tus , were not found to be s i g n i f i c a n t l y re l a ted to n u t r i t i o n p r a c t i c e s . Schorr et a l . (1972), in contra s t , reported s i g n i f i c a n t p o s i t i v e cor re la t ions between d ie tary prac t i ce s and the number of extra-c u r r i c u l a r a c t i v i t i e s in which the adolescent p a r t i c i p a t e d , and - 83 -between d ie tary pract ices and the employment status of the teenager. However, the l a t t e r study invest igated adolescents from a wider age range (grades 7 to 12), and although the researchers stated the 64 out of 182 students who d id not complete the questionnaires were a " representat ive l o s s " , i t i s poss ib le t h i s was not the case. Another poss ib le reason for the di f ference in the f indings may be the s ize of the sample surveyed; th i s was much smaller than that of the present study. The importance of age was discussed by AuCoin e t a_l. (1972) and Ohlson and Hart (1965), whose f indings of decreasing d ie tary adequacy with increas ing age were supported by th i s study. In contras t , no s i g n i f i c a n t c o r r e l a t i o n between age and d ie tary prac t ices was reported by Schorr e_t aJ. (1972) . This f ind ing was part of the study discussed above, and the same c r i t i c i s m s may be made. No s i g n i f i c a n t di f ferences were found between d ie tary prac-t i ce s of boys and g i r l s , confirming the report of AuCoin e_t a l . (1972) . Most studies have concluded that adolescent g i r l s have poorer d iets than adolescent boys (Kunkel and H a l l 1958; Milne e_t a l . 1963; Huenemann e_t a l . 1968 ; A l l e n et a l . 1970 ; Schorr et a l . 1972; N u t r i t i o n Canada National Survey 1973 and 1975). The di f ferences in f indings may be caused by di f ferences in ages of the group s tudied . Myers et al_. (1968) showed that boys of 9 to 13 years of age had poorer diets than g i r l s of s i m i l a r age, though as age increased, a more pronounced dec l ine in adequacy was seen with g i r l s than with boys. The majority of students in the present study were 13-years-old ; i f a study was conducted with older adolescents , the f indings may be d i f f e r e n t . - 84 -Inter -corre la t ions of N u t r i t i o n Knowledge, Att i tudes and Pract ices Highly s i g n i f i c a n t p o s i t i v e c o r r e l a t i o n c o e f f i c i e n t s were found for n u t r i t i o n knowledge and at t i tudes (0.500) and n u t r i t i o n at t i tudes and prac t ices (0.206) (Table 41). The c o r r e l a t i o n between n u t r i t i o n knowledge and pract ices was very low and non-s i g n i f i c a n t . The f indings of t h i s study supported the r e l a t i o n -ship of n u t r i t i o n knowledge to a t t i tudes and n u t r i t i o n at t i tudes to p r a c t i c e s , but f a i l e d to support the r e l a t i o n s h i p between n u t r i t i o n knowledge and prac t ices (hypothesis 1) . TABLE 41 PARTIAL CORRELATION OF MEAN PERCENTAGE SCORES FOR NUTRITION KNOWLEDGE, ATTITUDES, AND PRACTICES TESTS Knowledge Att i tudes Pract ices Knowledge 1.000 ** 1.000 Att i tudes 0.500 Pract ices 0.020 0.208** 1.000 p<0.01 Based on these f i n d i n g s , the K-A-P Model 1 (See page 33) was suggested as that which best described the i n t e r - r e l a t i o n s h i p s of n u t r i t i o n knowledge, a t t i tudes and pract ices of grade 8 students (Figure 3) . K-A-P MODEL 1 K < > A « > P Att i tudes mediate knowledge and pract ices Figure 3. Model of the suggested r e l a t i o n s h i p among n u t r i -t ion knowledge, a t t i tudes and pract ices - 85 -These f indings confirmed those of Schwartz (1975), who also found a p o s i t i v e r e l a t i o n s h i p between n u t r i t i o n knowledge and att i tudes and between n u t r i t i o n a t t i tudes and p r a c t i c e s , but no s i g n i f i c a n t r e l a t ionsh ip between n u t r i t i o n knowledge and p r a c t i c e s . Eppright e_t a l . (1972) reported a p o s i t i v e r e l a t i o n -ship between the n u t r i t i o n knowledge of mothers and t h e i r a t t i tudes toward meal-planning and food preparat ion . In another study of the n u t r i t i o n b e l i e f s and prac t i ce s of adult members of community organisations in New York State , Ja lso et a l . (1965) found a strong p o s i t i v e c o r r e l a t i o n between n u t r i t i o n opinions and prac t ices (r = 0.63). In that study, i t was suggested that t h i s f inding indicated that " n u t r i t i o n opinions are r e f l e c t e d in p r a c t i c e s " (p. 265). The f ind ing of a non- s ign i f i cant r e l a t i o n s h i p between n u t r i t i o n knowledge and prac t ices supported the f indings of Baker (1972) and Morris (1969) , both of whom found that an i n -crease in n u t r i t i o n knowledge caused no s i g n i f i c a n t changes in d ietary pract ices among s c h o o l c h i l d r e n . This study d id not confirm the work of Kunkel and H a l l (1958), Hinton et al.(1965) and Mirenda (1966). These researchers a l l reported a p o s i t i v e r e l a t ionsh ip between n u t r i t i o n knowledge and p r a c t i c e s . L imita t ions of the Study The inves t iga tor was aware of the fo l lowing l i m i t a t i o n s in th i s study: 1. To maximise co-operation from the schools , students for the study were selected by Mr. A. Moodie, Co-ordinator , Research 86 -Studies and Tes t ing , Vancouver School Board Education Depart-ment. This d id not permit random sampling of the grade 8 population in the C i ty of Vancouver. Vancouver School Board regulat ions are designed to ensure the pr ivacy of students. Hence, information on ce r t a in aspects of the students ' family background, s e p c i f i c a l l y , parenta l education and occupation, family income and e t h n i c i t y , could not be sought. These var ia tes were excluded from the study In an attempt to minimise disturbances to s c h o o l - l i f e during the f i r s t month of an academic year , studies can only be conducted in the months fo l lowing September. Therefore , although scheduled e a r l i e r , the study d id not take place u n t i l October 1974 Scheduling of c lasses va r i ed great ly from school to school and i t became impossible to conduct the survey at the same time of day, for every c l a s s , in a l l s ix schools - 87 -CHAPTER V SUMMARY AND IMPLICATIONS This chapter reviews the purpose and nature of the study reported h e r e i n , the major f i n d i n g s , conclusions that may be drawn and impl icat ions that become apparent from in terpre ta t ions of the f ind ings . Summary The study was designed to inves t igate the nature of the re-l a t i o n s h i p between selected environmental var ia tes and the n u t r i -t i o n knowledge, a t t i tudes and prac t ices of eighth grade secondary school students in the C i ty of Vancouver, B r i t i s h Columbia. The i n t e r - r e l a t i o n s h i p among n u t r i t i o n knowledge, a t t i tudes and prac-t i ce s were also assessed. The fo l lowing object ives were def ined: 1. To ascerta in the n u t r i t i o n knowledge, a t t i tudes and prac t ices of grade 8 secondary school students in Vancouver 2. To determine among grade 8 students, the r e l a t i o n s h i p between n u t r i t i o n a) Knowledge and at t i tudes b) Att i tudes and prac t ices c) Knowledge and prac t ices 3. To determine among grade 8 students, the r e l a t i o n s h i p between n u t r i t i o n knowledge, a t t i tudes and p r a c t i c e s , and the fol low-ing environmental v a r i a t e s : a) Family var ia tes (1) Family s ize 88 -(2) Socio-economic status b) School var ia tes (1) A c t i v i t i e s (a) A t h l e t i c (b) Non-athle t ic (2) School l oca t ion c) Indiv idua l var ia tes (1) Sex (2) Age (3) Leisure a c t i v i t i e s (4) Employment status Data c o l l e c t i o n instruments were designed for th i s study, to assess the n u t r i t i o n knowledge, a t t i tudes and prac t ices of grade 8 students. In October 1974, the va l ida ted quest ionnaire was administered to two classes of students, in each of s ix schools . The t o t a l number of quest ionnaires completed was 366. N u t r i t i o n knowledge was assessed by a test cons i s t ing of 20 statements re l a ted to general knowledge of basic n u t r i t i o n p r i n -c i p l e s . At t i tudes toward n u t r i t i o n were invest igated using a test containing 15 statements, r e f l e c t i n g a t t i tudes concerning food se l ec t ion and diet adequacy, and the importance of n u t r i t i o n with regard to h e a l t h . A se l f -admini s tered , 24-hour d ietary r e c a l l provided information from which an assessment of n u t r i t i o n pract ices was made. The n u t r i t i o n prac t i ce s score was based upon recommended intakes of foods from each of the four food groups, together with an evaluat ion of vitamin D intake . Mean scores for each of the three c r i t e r i o n v a r i a b l e s , n u t r i t i o n - 89 -knowledge, a t t i tudes and p r a c t i c e s , were c a l c u l a t e d . Demographic data concerning the selected environmental var ia tes were c o l l e c t e d in a sect ion of the quest ionnaire e n t i t l e d "Information about You" . The data were coded, key-punched on cards and treated s t a t i s t i c a l l y to test the fo l lowing hypotheses: 1. There w i l l be a p o s i t i v e c o r r e l a t i o n between the scores of tests in n u t r i t i o n : a) Knowledge and a t t i tudes b) At t i tudes and prac t ices c) Knowledge and prac t i ce s 2. There w i l l be a s i g n i f i c a n t r e l a t i o n s h i p between the values for each of the " fami ly v a r i a t e s " (family s ize and socio-economic status) and scores in tests of n u t r i t i o n knowledge, a t t i tudes and prac t ices of grade 8 students 3. There w i l l be a s i g n i f i c a n t r e l a t i o n s h i p between the values for each of the "school v a r i a t e s " (school a c t i v i t i e s and locat ion) and the scores in tests of n u t r i t i o n knowledge, a t t i tudes and prac t i ce s of grade 8 students 4. There w i l l be a s i g n i f i c a n t r e l a t i o n s h i p between the values for each of the " i n d i v i d u a l v a r i a t e s " (sex, age, l e i su re a c t i v i t i e s and employment status) and the scores in tests of n u t r i t i o n knowledge, a t t i tudes and prac t i ce s of grade 8 students Analyses of variance were c a r r i e d out to determine the r e l a t i o n s h i p of scores in tests of n u t r i t i o n knowledge, at t i tudes and pract ices to se lec ted , non-manipulable v a r i a t e s . P a r t i a l c o r r e l a t i o n analys i s was employed to test the i n t e r - r e l a t i o n s h i p s - 90 -among the three c r i t e r i o n v a r i a b l e s . A l l the hypothesis were tested at the 5% l e v e l of s i g n i f i c a n c e . The major f indings of the study were: 1. The mean scores in tests of n u t r i t i o n knowledge, a t t i tudes and prac t ices among eighth grade secondary school students were 66.67%, 66.94% and 81.32% re spec t ive ly 2. The lowest mean scores for n u t r i t i o n knowledge statements indicated that the areas in which grade 8 students had poor knowledge inc luded : a) supplementation of the d iet with vitamins or minera l s , or other spec ia l supplements b) food composit ion, p a r t i c u l a r l y in r e l a t i o n to pro te in subst i tutes 3. The undesirable a t t i tude as soc ia t ing " d i s l i k e d " foods and good n u t r i o n a l value was common among t h i s group of students 4. N u t r i t i o n prac t i ce s scores were high with 73% of respondents achieving d ie tary adequacy 5. It was evident from examination of n u t r i t i o n prac t ices in terms of food group intake that : a) adequate milk group intake was recorded by 62% of the subj ects b) seventy-eight percent achieved adequacy in the f r u i t and vegetables group c) two servings of foods from the meat group were consumed by 74% of the respondents, who achieved the maximum score for th i s food group d) adequate intake of foods from the cereals group was reported by 95% of the respondents - 91 -e) vitamin D intake was poor, with only 38% achieving adequacy 6. Vitamin-mineral supplementation was recorded by 32% of the respondents 7. Frequency of food intake was h igh ; 85% of the students con-sumed food 4 to 6 times per day 8. Students from fami l ies of 2 ch i ld ren scored s i g n i f i c a n t l y higher on the n u t r i t i o n knowledge test than did those from s i n g l e - c h i l d f a m i l i e s . N u t r i t i o n at t i tudes test scores of respondents from 2-chi ldren fami l ies were shown to be s i g n i -f i c a n t l y higher than those of students from famil ies of 5 or more ch i ld ren when analysed by Scheffe 's t e s t . Family s ize was not s i g n i f i c a n t l y re la ted to d ie tary pract ices 9. Respondents from the highest socio-economic l e v e l (7) achieved s i g n i f i c a n t l y higher scores in tests of both n u t r i t i o n know-ledge and a t t i tudes . Socio-economic status was not found to be a s i g n i f i c a n t var ia te with regard to n u t r i t i o n prac t i ce s 10. No consistent s i g n i f i c a n t r e l a t i o n s h i p was evident between the degree of p a r t i c i p a t i o n i n school a c t i v i t i e s ( a t h l e t i c or non-athle t ic ) and the three c r i t e r i o n v a r i a b l e s , n u t r i t i o n knowledge, a t t i tudes and prac t i ce s 11. School loca t ion was s i g n i f i c a n t l y re la ted to the n u t r i t i o n knowledge, a t t i tudes and prac t ices of. students attending the school . Stepwise regress ion analys is showed that the n u t r i -t ion knowledge test scores of students from school 2 were s i g n i f i c a n t l y higher and the scores of students from school 3 s i g n i f i c a n t l y lower than those achieved by students from - 92 -school 1, the base school . Analys i s using Scheffe 's test revealed the n u t r i t i o n a t t i tudes test scores of students from school 1 were s i g n i f i c a n t l y higher than the scores achieved by students from schools 3 and 6. Students from school 3 also scored s i g n i f i c a n t l y lower on the n u t r i t i o n pract ices test than did those students from schools 5 and 1 12. S i gn i f i c an t di f ferences were found between boys and g i r l s for both n u t r i t i o n knowledge and at t i tudes test scores . Boys cons i s t ent ly scored lower than g i r l s . There were no s i g n i f i c a n t di f ferences between the n u t r i t i o n prac t i ce s scores of boys and g i r l s 13. Age was negat ive ly and s i g n i f i c a n t l y re la ted to n u t r i t i o n att i tudes and prac t i ce s test scores . No s i g n i f i c a n t r e l a -t ionship was found between n u t r i t i o n knowledge test scores and age 14. No consistent s i g n i f i c a n t r e l a t i o n s h i p was evident between l e i sure a c t i v i t i e s (measured for the purposes of th i s study, as the time spent in community sports a c t i v i t i e s per week) and the three c r i t e r i o n v a r i a b l e s , n u t r i t i o n knowledge, a t t i tudes and prac t ices 15. Employment status of the students was not s i g n i f i c a n t l y re la ted to t h e i r n u t r i t i o n knowledge, a t t i tudes and prac-t i ce s test scores 16. S i gn i f i c an t c o r r e l a t i o n c o e f f i c i e n t s were found for n u t r i -t ion knowledge and at t i tudes (0.500) and for n u t r i t i o n a t t i -tudes and prac t ices (0.208). The c o r r e l a t i o n between n u t r i -t ion knowledge and pract ices was very low and non-s ign i f i cant - 93 -Implicat ions Some f indings of th i s study may be pleas ing to n u t r i t i o n educators. The reasonably sound n u t r i t i o n knowledge among the eighth grade students was perhaps surpr i s ing and c e r t a i n l y a favourable f i n d i n g . It may indicate that , as Leverton stated at the Nat ional N u t r i t i o n Education Conference, Washington, D.C. (1971), " . . . young persons are capable of absorbing more de ta i l ed s c i e n t i f i c information than they are given c red i t f o r . " An eighth grade student may be bet ter motivated by a course in n u t r i t i o n that provides a greater challenge to that student. At t i tudes toward n u t r i t i o n also appeared to be s a t i s f a c t o r y . Consumption of an adequate d iet by 731 of the subjects together with the favourable n u t r i t i o n knowledge and at t i tudes recorded must be considered encouraging by those concerned with the n u t r i -t i o n and heal th of Canadian adolescents and Canadians in general . Other resu l t s indicated the need for further study in t h i s area. The common misconceptions of the students were those frequently found among the general pub l i c inc lud ing p o s s i b l y , the students ' parents . Analys i s revealed that knowledge in the area of p ro te in subst i tutes was poor. As animal prote in becomes l e s s -ava i l ab le and/or increa s ing ly expensive, knowledge concerning a l t e rna t ive sources of p ro te in may become e s s e n t i a l . Another area in which knowledge should be improved i s that of d ietary supplemen-t a t i o n . Many students considered that vitamin or mineral supple-ments were necessary for good h e a l t h . The prac t i ce of d ie tary supplementation may again lead to unnecessary expenditure of money by those who continue th i s hab i t . Poss ib ly of greater - 94 -importance is the false sense of secur i ty with regard to n u t r i -t ion that may develop. As long as vitamin or mineral supplements are added to the d i e t , l i t t l e thought may be given to s e l e c t i o n of the food that w i l l provide an adequate intake of n u t r i e n t s . The r e l a t ionsh ip between adequate d ie tary prac t ices and good hea l th w i l l not be emphasised. These two areas of knowledge, (protein subs t i tu t ion and d ie tary supplementation), should be stressed more s trongly in any n u t r i t i o n education programmes developed for the adolescent. The a t t i tude equating n u t r i t i o u s foods or "foods that are good for you" with frequently " d i s l i k e d " foods indicates that education i s also needed in th i s area. Exposure of students at an ear ly age to a wide v a r i e t y of foods may increase the accep-tance of such foods. Many poor at t i tudes were found to r e f l e c t inadequate n u t r i t i o n knowledge. In a d d i t i o n , the high cor re l a -t i o n shown between n u t r i t i o n knowledge and at t i tudes suggests that sound knowledge of n u t r i t i o n concepts w i l l lead to p o s i t i v e n u t r i t i o n a t t i tude s . This is another reason for encouraging the establishment of s t imulat ing n u t r i t i o n education programmes in the school system. Dietary habits or n u t r i t i o n prac t i ce s f indings demonstrated once again that the adolescent populat ion i s one that consumes many small meals per day, rather than three l a rger meals. Accepting t h i s , n u t r i t i o n educators should demonstrate how n u t r i t i o u s small "meals" may be subst i tuted for "empty-ca lor ie " snacks. Diet appeared adequate in a l l respects except for the intake of foods from the milk group and vitamin D intake. - 95 -Students should be educated in the area of d ietary s u b s t i t u t i o n , to increase the intake of nutr ients that are usua l ly provided by the consumption of milk i t s e l f . This may be achieved by increas ing the acceptance by adolescents of other milk products . A l t e r n a t i v e l y , knowledge concerning nutr ient sources would enable students to se lect foods that are high in those nutr ient s f re-quently found lacking in adolescents ' d i e t s . As stated in the B r i t i s h Columbia Survey Report (1974): Improvement [in the dietary intake of calcium and vitamin D] could be achieved by the consumption of more dairy products , but motivation for changes in d ie tary patterns can only begin through n u t r i t i o n education programs (p. 102). N u t r i t i o n education programmes are continuously proposed as the means by which des irable d ie tary behaviour may be e f fected . The r e l a t i o n s h i p found between n u t r i t i o n at t i tudes and prac t ices i s again encouraging. I f sound n u t r i t i o n knowledge i s e s t ab l i shed , good n u t r i t i o n a t t i tudes w i l l develop, and, in t u r n , acceptable d ie tary prac t ices be i n s t i t u t e d . The need for c loser study of the r e l a t i o n s h i p between environmental var ia tes and n u t r i t i o n knowledge, a t t i tudes and pract ices i s ind ica ted by the f indings of th i s study. N u t r i t i o n knowledge and a t t i tudes were found to be bet ter among g i r l s than boys, s t res s ing the need for n u t r i t i o n education programmes for boys. The B r i t i s h Columbia School Trustees Assoc ia t ion (1974) reports : There i s a need for a n u t r i t i o n education program in the schools from Kindergarten to Grade 12 . . . i t i s incumbent upon the schools of th i s Province to provide students with knowledge for l i v i n g . C l e a r l y , both male and female students require some sound, basic knowledge about t h e i r bodies and the food that they put. into them Cp. 7) . - 96 -Such programmes are beginning in some schools , but n u t r i t i o n must become an acceptable subject to boys and education programmes developed to achieve th i s goal . Respondents scored h igh ly on the a t t i tude statement " I t i s as important for boys to know about n u t r i t i o n as i t i s for g i r l s " ; i f th i s a t t i tude i s accepted, knowledge must be improved in other areas to provide a basis for acceptable at t i tudes toward n u t r i t i o n . Age appears to be an important determinant of n u t r i t i o n at t i tudes and pract ices among adolescents . This i s the per iod of l i f e when i n d i v i d u a l s struggle to e s t ab l i sh t h e i r i d e n t i t y . Frequently th i s struggle manifests i t s e l f in r e b e l l i o n against the n u t r i t i o n knowledge, a t t i tudes and prac t i ce s that have been establ i shed in the home. These are often replaced by those acceptable to the peer group, which may be de le ter ious to the heal th of the teenager. A l t e r n a t i v e means of expressing se l f -re l i ance should be made ava i lab le to the adolescent. The f ind ing that school l o c a t i o n was also l inked with n u t r i t i o n knowledge, a t t i tudes and prac t i ce s should be further inves t iga ted . This may depend on the type of n u t r i t i o n education programme offered at the school . The programme may be.more motivating to the students, increas ing t h e i r knowledge and i n f l u -encing both t h e i r a t t i tudes toward n u t r i t i o n and t h e i r d ie tary p r a c t i c e s . A second reason for the f ind ing may be the socio-economic area in which the school was loca ted , as socio-economic status was also found to be s i g n i f i c a n t l y re la ted to n u t r i t i o n knowledge and a t t i tudes . In the present study, no formal n u t r i -t ion education had been received by the students and, thus , the - 97 -f i r s t reason suggested v/as not substant iated. One major question remains: the var ia tes examined account for only a small percentage of the variance in n u t r i t i o n know-ledge, a t t i tudes and p r a c t i c e s . What are the "o ther " factors a f fect ing n u t r i t i o n knowledge, a t t i tudes and pract ices? Do those family var i a te s , such as maternal education, family income and others , not inves t iga ted in th i s study, account for the variance not yet explained? Are there s t i l l other v a r i a t e s , of greater importance, which determine the n u t r i t i o n knowledge, a t t i tudes and prac t ices of adolescents? In conc lus ion , i t has been suggested that the school system is one of the best channels through which n u t r i t i o n education may be disseminated. The Food and Drug Adminis t ra t ion consumer survey found that "The people who r e a l l y knew the most about n u t r i t i o n sa id they learned about i t in schoo l " (Dunning 1974) . A well-executed n u t r i t i o n education programme with in the school curriculum has long been recognised as a very e f fec t ive means of improving n u t r i t i o n knowledge and of provid ing s u f f i c i e n t motiva-t i o n to change both n u t r i t i o n a t t i tudes and p r a c t i c e s . N u t r i t i o n i s t s are wel l aware of the b e n e f i c i a l inf luence of a well-executed n u t r i t i o n component in the school curr iculum on eat ing pract ices (Nutr i t ion Canada Nat ional  Survey 1974 , p. 120) . The report continues : N u t r i t i o n i s an e s sen t i a l part of heal th and should be adequately emphasised in school c u r r i c u l a . The subject should be taught in p r a c t i c a l terms and re la te to f a c i l i t i e s and prac t ices in the home and in the school . Eat ing f a c i l i t i e s and food se lec t ions in school should encourage sound eating habits (p. 120). - 98 -Not only may schoolchi ldren be inf luenced by a meaningful n u t r i t i o n education programme wi th in the school system, but t h e i r family at home and other associates wi th in the community as w e l l . The B r i t i s h Columbia School Trustees Assoc ia t ion Report of the Committee on N u t r i t i o n (1974) s ta ted : . . . there i s a necess i ty for a comprehensive n u t r i t i o n education program d i rec ted not only to school c h i l d r e n , but to a l l c i t i z e n s in the Province . A program of th i s nature requires comprehensive p o l i c i e s at the p r o v i n c i a l , l e v e l , to ensure that the program in the schools , for instance , i s in tune with the program that is being d i rec ted to the populat ion at large (p. 10). In order to achieve t h i s goal of a comprehensive n u t r i t i o n educa-t i o n for a l l , the co-operation of many profess ional s - - n u t r i t i o n -i s t s , phys i c i ans , teachers ( p a r t i c u l a r l y phys ica l education experts ) , communications s p e c i a l i s t s , p u b l i c heal th nurses and s o c i a l workers - - w i l l be requi red . It i s hoped that the f indings of th i s study may provide some data from which "meaningful" n u t r i t i o n education programmes for adolescents may be developed. As more students are exposed to n u t r i t i o n education through school programmes, t h e i r p r a c t i c a l knowledge of n u t r i t i o n w i l l increase , t h e i r a t t i tudes toward food and n u t r i t i o n w i l l improve, and consequently, t h e i r n u t r i t i o n pract ices w i l l r i s e to a l e v e l of d ie tary adequacy. - 99 -LITERATURE CITED A l l e n , D . E . , A . J . Patterson and C . L . Warren. 1970. 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Relat ion of knowledge to p r a c t i c e s . J . Amer. D i e t e t . Assoc. 32: 321. 107 -Young, C M . , G .C . Hagan, R . E . Tucker and W.D. Fos ter . 1952. A comparison of d ietary study methods. II . Dietary h i s tory versus 7-day record versus 24-hour r e c a l l . J . Amer. D ie te t . Assoc. 28: 218. Young, C M . , B.G. Waldner and K. Berres ford . 1956. What the homemaker knows about n u t r i t i o n . I I . Level of n u t r i t i o n knowledge. J . Amer. D ie te t . Assoc. 52: 218. Young, C M . and M.F . Tru l son . 1960. Methodology for d ietary studies in epidemiological surveys. I I . Strengths and weaknesses of ex i s t ing methods. Amer. J . Publ . Health 50: 805. : Zar, J . H . 1974. B i o s t a t i s t i c a l A n a l y s i s . Englewood C l i f f s , New Jersey. P r e n t i c e - H a l l , Inc. - 108 -APPENDIX A DATA COLLECTION INSTRUMENTS - 109 -NUTRITION KNOWLEDGE Read the s t a t e m e n t s below and d e c i d e whether each one i s TRUE (T) o r FALSE ( F ) . Check T (tr u e ) o r F ( f a l s e ) i n t h e box b e s i d e t h e s t a t e m e n t . Example: Steak c o n t a i n s p r o t e i n . T F A l s o , d e c i d e how c e r t a i n you a r e about y o u r d e c i s i o n and a g a i n , check one o f th e f o u r boxes a t the r i g h t - h a n d s i d e o f t h e q u e s t i o n n a i r e . Check: 1 i f you a r e VERY DOUBTFUL about y o u r answer (T o r F) 2 i f you a r e MODERATELY DOUBTFUL about y o u r answer 3 i f you a r e MODERATELY CERTAIN about your answer 4 i f you a r e VERY CERTAIN about y o u r answer. 1 2 3 i—-—i i~ Example: S t e a k c o n t a i n s p r o t e i n . T F The s t u d e n t i s v e r y c e r t a i n t h a t t h e s t a t e m e n t i s t r u e . I f you do n o t u n d e r s t a n d t h e s e i n s t r u c t i o n s , a s k t h e i n s t r u c t o r t o e x p l a i n . T rue o r Degree o f F a l s e C e r t a i n t y D i s -r e g a r d t h i s Column 1. Good e a t i n g h a b i t s a r e i m p o r t a n t t o h e a l t h . 2. E x e r c i s e u s e s up c a l o r i e s . 3. A t h l e t e s s h o u l d e a t s p e c i a l h i g h -p r o t e i n supplements w i t h t h e i r meals. 4. Teenagers need m u l t i p l e v i t a m i n p i l l s d a i l y t o ensure good h e a l t h . 5. Most f a t p e o p l e have g l a n d u l a r problems. 6. A slimming d i e t s h o u l d n o t c o n t a i n any b r e a d o r p o t a t o e s . 7. I f a p e r s o n e a t s t h r e e meals a day, he s h o u l d be c o n s i d e r e d t o have good e a t i n g h a b i t s . 8. H i g h i n t a k e s o f c e r t a i n v i t a m i n p i l l s may be h a r m f u l . T F T F T F T F T F T F T F 110 -9. M e n t a l work uses up as many c a l o r i e s a s p h y s i c a l work. 10. M i l k c o n t a i n s a l l t h e e s s e n t i a l elements o f a good d i e t . 11. I r o n i s needed i n t h e d i e t t o make b l o o d . 12. The amount o f f o o d e a t e n i s more impor-t a n t t o h e a l t h t h a n t h e k i n d o f f o o d . 13. E q u a l amounts o f f i s h o r b e e f have t h e same amounts o f p r o t e i n . 14. C a l c i u m i s needed t o h e l p b u i l d s t r o n g bones and t e e t h . 15. Only s o l i d f oods c o n t a i n c a l o r i e s ; l i q u i d s do n o t . 16. Most d a i r y p r o d u c t s a r e r i c h i n c a l c i u m . 17. Snacks between meals do n o t have any c a l o r i e s i n them; o n l y f o o d s e a t e n a t meals do. 18. E x c e s s energy i n t h e f o o d s we e a t c a n go i n t o f a t s t o r e s i n t h e body. 19. Dry beans, peas and n u t s can r e p l a c e p a r t o f t h e d a i l y need f o r meat, f i s h o r p o u l t r y . 20. Meat and eggs a r e r i c h i n i r o n . T r u e o r F a l s e F M Trn * L J T F T F Degree o f C e r t a i n t y 1 2 3 4 D i s -r e g a r d t h i s Column NUTRITION OPINIONS Read t h e s t a t e m e n t s below and d e c i d e i f you agree o r d i s a g r e e w i t h what i s w r i t t e n . Check t h e box A ( f o r agree) o r D ( f o r d i s a g r e e ) . A l s o , i n d i c a t e how c e r t a i n you a r e about your d e c i s i o n , and a g a i n , check: 1 i f you a r e VERY DOUBTFUL about your d e c i s i o n (A o r D) 2 i f you a r e MODERATELY DOUBTFUL about your d e c i s i o n 3 i f you a r e MODERATELY CERTAIN about your d e c i s i o n 4 i f you a r e VERY CERTAIN ab o u t your d e c i s i o n . -2-I l l 10. 11. S i n c e n u t r i t i o n i s i m p o r t a n t , I s h o u l d not be c a r e l e s s about s e l e c t i o n o f t h e f o o d s I e a t . As l o n g as I am n o t s i c k , I must be e a t i n g t h e r i g h t f o o d s . I f I t a k e v i t a m i n p i l l s , I need n o t be conc e r n e d about t h e f o o d s I e a t . I f I d r i n k m i l k , I don ' t have t o worry about t h e r e s t o f my d i e t . A p e r s o n has a tendency t o l i k e t h e f o o d s h i s f r i e n d s and f a m i l y l i k e . I t d o e s n ' t m a t t e r i f I s k i p b r e a k f a s t as l o n g as I e a t enough f o o d d u r i n g . th e r e s t o f t h e day. I t i s j u s t as i m p o r t a n t f o r boys t o know about n u t r i t i o n as i t i s f o r g i r l s . I f I e a t a b a l a n c e d d i e t , I e a t t h r e e meals a day. Even i f I want t o l o s e w e i g h t , I can s t i l l e a t some b r e a d and p o t a t o e s . An a t h l e t e does n o t have t o e a t h i g h -p r o t e i n supplements. What I e a t i s n o t i m p o r t a n t , as l o n g a s I e a t a l o t . 12. A v e r y a c t i v e p e r s o n needs some c o n c e n -t r a t e d sweets e v e r y day. 13. As l o n g as I e n j o y my f o o d , i t d o e s n ' t m a t t e r what I e a t . 14. Foods t h a t a r e good f o r me, a r e n o t u s u a l l y t h o s e t h a t I l i k e t h e most. 15. I f I want t o l o s e weight, I s h o u l d e x e r c i s e more. Agree o r D i s a g r e e »B °B SB A D °B SB A D A D A D A D A D Degree o f C e r t a i n t y D i s -r e g a r d t h i s Column PLEASE CHECK TO MAKE SURE THAT ALL STATEMENTS IN THESE TWO SECTIONS HAVE BEEN ANSWERED. -3-- 112 INFORMATION ABOUT YOU Date: Age: A d d r e s s ( B l o c k number and S t r e e t o r Avenue number ONLY) Check t h e a p p r o p r i a t e boxes below: \V | D i s -r e g a r d t h i s Column Sex: Male { | Female 1 | Number o f c h i l d r e n i n f a m i l y ( i n c l u d i n g y o u r s e l f ) 1 2 3 4 5 o r more SCHOOL ACTIVITIES: 1. a) Do you p a r t i c i p a t e i n s c h o o l s p o r t s ( t h i s i n c l u d e s s c h o o l teams, i n t r a m u r a l teams and i n d i v i d u a l s p o r t s ) ? b) I f y e s , i n d i c a t e t h e a v e r a g e t i m e s p e n t p e r week i n s c h o o l s p o r t s a c t i v i t y . a) Do you p a r t i c i p a t e i n n o n - a t h l e t i c e x t r a - c u r r i c u l a r a c t i v i t i e s a t s c h o o l (e.g. drama, music, c h e e r l e a d e r s , s t u d e n t c o u n c i l ) ? b) I f y e s , i n d i c a t e t h e average t i m e s p e n t p e r week i n t h e s e a c t i v i t i e s . Yes No L e s s t h a n 1 h r . 1-3 h r . 3-6 h r . 6-10 h r . More t h a n 10 h r . Yes No L e s s t h a n 1 h r . 1-3 h r . 3-6 h r . 6-10 h r . More t h a n 10 h r . OUT-OF-SCHOOL ACTIVITIES: 1. a) A r e you employed? b) I f y e s , how many hours p e r week do you work? Yes No L e s s t h a n 1 h r . 1-3 h r . 3-6 h r . 6-10 h r . More than 10 hr. -4-- 113 -D i s -r e g a r d t h i s Column a) Do you p a r t i c i p a t e i n community s p o r t s a c t i v i t i e s ? Yes No b) I f y e s , i n d i c a t e t h e a v e r a g e time s p e n t p e r week i n community s p o r t s a c t i v i t i e s . L e s s t h a n 1 h r . 1-3 h r . 3-6 h r . 6-10 h r . More than 10 h r . FOODS EATEN DURING THE LAST 24 HOURS P l e a s e w r i t e down i n t h e spaces p r o v i d e d , a l l t h a t you a t e and drank y e s t e r d a y . E s t i m a t e t h e amounts as a c c u r a t e l y as p o s s i b l e (e.g. 2_ s l i c e s o f b r e a d , lh cups o f m i l k ) , and make s u r e t h a t you d e s c r i b e t h e f o o d s c a r e f u l l y (e.g. brown b r e a d , tuna and mayonnaise f i l l i n g ) . K i n d o f f o o d o r Amount P l a c e o f With Time o f D r i n k . Consumed E a t i n g Whom Day B e f o r e S c h o o l A t S c h o o l , b e f o r e noon Noon Between Noon and E v e n i n g Meal E v e n i n g meal A f t e r E v e n i n g meal, b e f o r e bedtime - 114 - D i s -r e g a r d t h i s Column 1. D i d you t a k e a v i t a m i n / m i n e r a l supplement? Yes No 2. Do you t h i n k t h a t what you a t e y e s t e r d a y was t y p i c a l Yes o f your u s u a l meal p a t t e r n ? No SCORE CHART FOR FOOD EATEN FOOD GROUPS: HOW TO SCORE MAXIMUM SCORE SCORE OBTAINED M i l k and M i l k P r o d u c t s 1 cup .milk, 1 cup y o g u r t , 1 cup c o t t a g e cheese, 3 medium scoops i c e - c r e a m , 1 o z . f i r m cheese, o r 2 o z . p r o c e s s e d c h e e s e . s e r v i n g s . s e r v i n g s , s e r v i n g s , s e r v i n g . . .4 p o i n t s .3 p o i n t s .2 p o i n t s .1 p o i n t 2. F r u i t and V e g e t a b l e s h cup raw o r cooked f r u i t o r v e g e t a b l e s , o r t h e i r j u i c e s . S o u r c e s o f v i t a m i n C a r e c i t r u s f r u i t s , v i t a m i n i z e d a p p l e j u i c e , tomatoes, p o t t o e s , raw cabbage, e t c . 3 s e r v i n g s . . . 6 p o i n t s 7. 2 s e r v i n g s . . . 4 p o i n t s 1 s e r v i n g . . . . 2 p o i n t s Source o f v i t a m i n C ...+1 p o i n t Meat o r A l t e r n a t e s 2 s e r v i n g s . . . 6 p o i n t s , „ ^ ^- , 1 s e r v i n g . . . . 3 p o i n t s 3-4 o z . meat, f i s h o r p o u l t r y , 2 eggs, 4 tbsp. peanut b u t t e r , o r 1 cup baked beans. C e r e a l s , Bread o r P a s t a 3 s e r v i n g s . . . 6 p o i n t s . , , , , 2 s e r v i n g s . . . 4 p o i n t s 1 s l i c e e n r i c h e d o r whole- , . . . , 1 s e r v i n g . . . . 2 p o i n t s g r a m b r e a d , 1 hamburger o r hot-dog bun, 3/4 cup oatmeal, 1 cup b r a n f l a k e s , 3/4 cup e n r i c h e d m a c a r o n i , o r n o o d l e s , o r s p a g h e t t i . 5. V i t a m i n D Source 400 i . u . . . . 2 p o i n t s F o r t i f i e d m i l k o r m a r g a r i n e 2 APPENDIX B SCORING SYSTEMS FOR NUTRITION KNOWLEDGE, ATTITUDES AND PRACTICES TESTS - 116 -SCORING SYSTEM FOR NUTRITION KNOWLEDGE TEST Test Key Response Degree of Certa inty Very Doubtful 1 Moderately Doubtful 2 Moderately Confident 3 Very Confident 4 True True 4 5 6 7 False 3 2 1 0 False False 4 5 . 6 7 True 3 2 1 0 SCORING SYSTEM FOR NUTRITION ATTITUDE TEST Test Key Response Degree of Cer ta inty Very Doubtful 1 • Moderately Doubtful 2 Moderately Confident 3 Very Confident 4 Agree Agree 4 5 6 7 Disagree 3 2 1 0 Disagree Disagree 4 5 6 7 Agree 3 2 1 0 - 117 -ANSWER KEY FOR NUTRITION KNOWLEDGE TEST Statement No. Correct Response 1 True 2 True 3 False 4 False 5 False 6 False 7 False 8 True 9 False 10 False 11 True 12 False 13 True 14 True 15 False 16 True 17 False 18 True 19 True 20 True - 118 -ANSWER KEY FOR NUTRITION ATTITUDES TEST Statement No. Correct Response 1 Agree 2 Disagree 3 Disagree 4 Disagree 5 Agree 6 Disagree 7 Agree 8 Disagree 9 Agree 10 Agree 11 Disagree 12 Disagree 13 Disagree 14 Disagree 15 Agree - 119 -SCORING SYSTEM FOR NUTRITION PRACTICES TEST Food Groups Maximum Score MILK AND MILK PRODUCTS 4 servings . . . 4 points 3 servings . . . 3 points 2 servings . . . 2 points 1 serving . . . . 1 point 4 Examples of one serving : 1 eight-ounce cup of mi lk , cottage cheese or yoghurt 3 medium scoops of ice-cream 1 ounce of cheddar cheese 2 ounces of processed cheese FRUIT AND VEGETABLES 3 servings . . . 2 points per serving (maximum of 6) Vitamin C source . . . 1 point 7 Examples of one serv ing : 1/2 cup of raw or cooked f r u i t , vegetables or t h e i r ju ices Sources of Vitamin C are: v i taminised apple j u i c e , tomatoes, c i t r u s f r u i t , potatoes , t u r n i p , raw cabbage, e t c . MEAT AND ALTERNATES 2 servings . . . 6 points 1 serving . . . 3 points 6 Examples of one serv ing : 3-4 ounces of meat, f i s h or poul t ry 2 eggs 4 tablespoons of peanut butter 1 cup of baked beans i - 120 -Food Groups Maximum Score CEREALS, BREAD AND PASTAS 3 servings . . . 2 points per serving Examples of one serving : 3/4 cup of oatmeal 1 cup of bran flakes 1 s l i c e of enriched bread 3/4 cup of enriched macaroni 6 VITAMIN D SOURCE 400 I . U . . . . 2 points Sources: F o r t i f i e d milk and margarine or Vitamin preparat ions . 2 MAXIMUM SCORE 25 Source: Milk Foundation of B r i t i s h Columbia, Guide to Good Eat ing Every Day. - 121 -\ APPENDIX C PRETEST QUESTIONNAIRE - 122 -PRETEST Please make addi t iona l ' comments af ter the quest ions . GENERAL LAYOUT 1. Do you think the order of the sections i . e . knowledge-opinions- informat ion-dietary prac t ices i s appropriate? Yes No ANSWERING SCHEME 1. Are the ins t ruc t ions for answering c lear? Yes No 2. Is i t easy to fol low the answering scheme? Yes No 3. Is there adequate space for the answers? Yes No STATEMENTS 1. Are any of the statements: Section and # Comments ambiguous obviously biased not complete too long too easy or too d i f f i c u l t 2. Do any questions use s p e c i a l i s e d language that would not be su i tab le for grade 8 students? Yes No If yes , which ones? 3. Do you think the statements are adequate to obtain information on the knowledge, a t t i tudes and pract ices of grade 8 students? Yes No OVERALL QUESTIONNAIRE 1. Is the quest ionnaire too long? Yes No 2. Is the questionnaire too time-consuming? Yes No ANY OTHER COMMENTS - 123 -APPENDIX D INSTRUCTIONS TO STUDENTS FOR COMPLETION OF THE QUESTIONNAIRE 124 -Students were given a b r i e f out l ine of the object ives of the study, as fo l lows : 1. To determine the extent of n u t r i t i o n knowledge among Grade 8 students in Vancouver (what you know about food and eating habits) . 2. To determine the n u t r i t i o n at t i tudes or opinions among Grade 8 students in Vancouver (what you think about food and n u t r i t i o n ) . 3. To determine n u t r i t i o n prac t ices among Grade 8 students in Vancouver (to f ind out what you ate yesterday, as an i n d i c a -t i o n of that which you usua l ly eat ) . The data c o l l e c t i o n instruments were then handed to the students and d i rec t ions for completion of the quest ionnaire provided. "Could you take a look at the quest ionnaire . You can see that i t has four parts to i t . Please check to make sure that you have no blank pages. Would you please read the in s t ruc t ions given for the n u t r i -t i o n knowledge sect ion (the f i r s t p a r t ) . Read over each state-ment and decide whether i t i s true or f a l s e . Place a check mark in the f i r s t box, against T or F. Decide a l s o , how cer ta in you are about your answer, and check one of the boxes, l to 4. [Explain degree of c e r t a i n t y ] . There are 20 statements a l together ; please make sure that you have answered a l l the statements. This w i l l mean two checkmarks against each statement. N u t r i t i o n opinions , the second par t , i s very s i m i l a r . Read the statements and decide i f you agree (A) or disagree (D) , and 125 -how cer ta in you are about your answers. Please check again to make sure that a l l the statements have been f u l l y answered (that i s , two checkmarks against each) . The t h i r d sect ion i s e n t i t l e d "Information about You" . In the a c t i v i t i e s sec t ions , af ter checking "Yes" or "No" , you are asked to make a "guestimate" of how many hours per week you p a r t i c i p a t e in such a c t i v i t i e s as f o o t b a l l , drama, cheerleaders , e t c . Note that employment does include a paper-round or baby-s i t t i n g . The l a s t part "Foods eaten during the l a s t 24 hours" , should provide you with some information as wel l as me. Beginning with yesterday morning, immediately a f ter get t ing up, I would l i k e you to l i s t everything you ate or drank throughout the day. This means you w i l l have to think r e a l l y hard, and you may or may not remember everything . Sometimes, i t i s useful to think about other things that you did during the day; t h i s helps you to remember where you ate , at what t ime, with whom, as we l l as what you ate. Describe very c a r e f u l l y , as f u l l y as you can, each food or drink that you l i s t . [Show overhead transparency of an example of a " t y p i c a l day's d i e t " ] . The amounts need only be given in household measures [give examples]. Sandwich f i l l i n g s , casseroles and other mixed dishes are sometimes hard to descr ibe . Please t ry your best do describe them f u l l y . [Show overhead transparency of the scor ing system to be used in evaluat ing the day's d i e t . Have the students score t h e i r own d i e t . This should provide an add i t iona l incent ive for the s tudent] . Note: 1 cup of milk contains 80 i . u . of Vitamin D. 126 -I f you run i n t o problems, p l e a s e do not h e s i t a t e to ask f o r he l p . F i n a l l y , p a r t i c i p a n t s i n t h i s study are to remain anonymous, so (1) do not r e c o r d your name on the q u e s t i o n n a i r e , or (2) do not g i v e me your f u l l address on page 4; the b l o c k and S t r e e t or Avenue number i s a l l that i s r e q u i r e d . " Students were thanked f o r t h e i r h elp at the c o n c l u s i o n of the study. 

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