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Adolescents’ perceptions of food and food behaviors : an interpretive study Lynam, Mary Judith 1982-12-31

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ADOLESCENTS' PERCEPTIONS OF FOOD AND FOOD BEHAVIORS: AN INTERPRETIVE STUDY  by MARY JUDITH LYNAM B.Sc.(N)., M c G i l l U n i v e r s i t y , 1974 A THESIS SUBMITTED IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF SCIENCE IN NURSING in THE FACULTY OF GRADUATE STUDIES The School o f Nursing  We accept t h i s t h e s i s as conforming to the required standard  THE UNIVERSITY OF BRITISH COLUMBIA March, 1982 ©  Mary J u d i t h Lynam, 1982  In presenting t h i s t h e s i s in p a r t i a l f u l f i l m e n t of the requirements f o r an  advanced degree at the U n i v e r s i t y of B r i t i s h Columbia, I agree that  the L i b r a r y s h a l l make i t f r e e l y a v a i l a b l e f o r reference and study. f u r t h e r agree that permission  I  f o r extensive copying of t h i s t h e s i s f o r  s c h o l a r l y purposes may be granted by the head of my department or by his or her r e p r e s e n t a t i v e s .  It i s understood that copying or p u b l i c a t i o n of  t h i s t h e s i s f o r f i n a n c i a l gain s h a l l not be allowed without my permission.  written  ii  Abstract T h i s study r e p o r t s an i n v e s t i g a t i o n of teenagers' perceptions of food and t h e i r food behaviors.  The study was q u a l i t a t i v e in design.  Data were c o l l e c t e d on eleven teenagers i n t h e i r homes through interviews and o b s e r v a t i o n s .  Data were analysed using the method of constant  comparative a n a l y s i s . The adolescents' r a t i o n a l e s f o r t h e i r food behaviors r e f l e c t e d both t h e i r perceptions of what was important regarding foods and food behaviors and how these perceptions or actual behaviors might change over time or as s i t u a t i o n s changed.  The data were i n t e r p r e t e d to show t h a t  teenagers have frameworks which guide t h e i r d e c i s i o n making about food. Processes which c o n t r i b u t e d to the development of the adolescents' frameworks were t h e i r i n t e r p r e t a t i o n of cues and knowledge, the comparison of themselves with others and the d e s i r e to resolve issues of personal concern.  The adolescents were also described as having food  behaviors d i r e c t e d by issues r e l a t e d to e i t h e r " c o n v i c t i o n s " or "convenience." The knowledge guiding the teenagers' d e c i s i o n making was based on t h e i r i n t e r p r e t a t i o n s of information and personal experiences. Adolescents assessed the usefulness of information presented to them by examining i t s relevancy to t h e i r own s i t u a t i o n , i t s c o m p a t i b i l i t y with personal b e l i e f s and i t s consistency with sources i d e n t i f i e d as c r e d i b l e . Such c r e d i b l e sources might i n c l u d e parents, nurses or teachers.  ii i As well as presenting the view that t h e i r food behaviors were good, the boys and g i r l s held b e l i e f s about p a r t i c u l a r foods and the e f f e c t s of c e r t a i n foods on p h y s i c a l development or sense of well being. They d i s c u s s e d food i n r e l a t i o n to general concerns such as body image, a t h l e t i c a b i l i t y or the d e s i r e to have f r i e n d s . Two food behavior patterns were d e s c r i b e d .  Behavior patterns  a s s o c i a t e d with " c o n v i c t i o n s " were c h a r a c t e r i z e d by d e c i s i o n making about food which was guided by s t a t e d b e l i e f s or r a t i o n a l e s . A s s o c i a t e d food behaviors were c o n s i s t e n t across s i t u a t i o n s . The second food behavior pattern was r e l a t e d to "convenience."  D e c i s i o n making about food was  guided by issues of convenience such as a v a i l a b i l i t y and food behaviors were more s i t u a t i o n a l l y dependent. The study's f i n d i n g s are discussed in r e l a t i o n to other s t u d i e s about n u t r i t i o n .  As well as p r o v i d i n g new explanations f o r behavior  patterns described i n reviewed l i t e r a t u r e the reported study new i n t e r p r e t a t i o n s of teenagers' food behaviors.  provides  The d e c r i p t i o n of the  processes i n v o l v e d as adolescents develop the frameworks on which they base t h e i r food d e c i s i o n s and the two behavioral patterns d e s c r i b e d c o n c e p t u a l i z e the adolescents' p e r s p e c t i v e s d i f f e r e n t l y from what has been proposed in the l i t e r a t u r e reviewed.  Implications f o r health care  are addressed, and questions f o r f u r t h e r research are r a i s e d .  iv TABLE OF CONTENTS Abstract  ii  Table of Contents  iv  Acknowledgements  vi  Chapter I:  INTRODUCTION  Background o f the Problem Statement o f the Problem and Purposes D e f i n i t i o n o f Terms Introduction to the T h e o r e t i c a l P e r s p e c t i v e Assumptions Limitations Summary Chapter I I :  1 5 5 6 8 9 9  REVIEW OF RELATED LITERATURE  S t u d i e s o f the I n i t i t i a t i o n and Maintenance of Change i n Health Behaviors Studies o f N u t r i t i o n Food P a t t e r n s as an Element of Culture Studies o f Adolescent N u t r i t i o n and Food P a t t e r n s . . T h e o r e t i c a l p e r s p e c t i v e s and methodologies . . . . P a t t e r n s o f food consumption during adolescence . . Described i n f l u e n c e s on teenagers' food behaviors . Teenagers' knowledge o f n u t r i t i o n Influence of s o c i a l status and family Summary  10 16 17 21 21 24 26 27 29 31  Chapter I I I : METHODOLOGY S e l e c t i o n of the Study Group Criteria for Participation Procedure f o r P a r t i c i p a n t S e l e c t i o n C h a r a c t e r i s t i c s of the P a r t i c i p a n t s Data C o l l e c t i o n Ethical Considerations Data C o l l e c t i o n Procedure Data A n a l y s i s Summary  34 34 35 36 38 38 39 40 43  V  Chapter IV:  PRESENTATION AND DISCUSSION OF ACCOUNTS  C o n s t r u c t i o n of Accounts R e l a t i o n s h i p of "Accounts" to the Study's Purposes ... I n t e r p r e t a t i o n s of Accounts I n t e r p r e t i n g Cues and Applying Knowledge The Process of Comparing Oneself to Others Personal Issues Food P a t t e r n s A s s o c i a t e d with C o n v i c t i o n s Food Patterns A s s o c i a t e d with Convenience D i s c u s s i o n of Accounts I n i t i a t i o n and Maintenance of Change i n Health Behaviors Studies of N u t r i t i o n Food Patterns as an Element of C u l t u r e Studies of Adolescent N u t r i t i o n and Food Patterns . P a t t e r n s of food consumption during adolescence Described i n f l u e n c e s on teenagers' food behaviors Teenagers' knowledge of n u t r i t i o n i n f l u e n c e of s o c i a l status and f a m i l y Summary Chapter V:  45 48 49 50 57 58 64 67 70 70 74 74 78 78 79 80 82 83  SUMMARY, CONCLUSIONS, IMPLICATIONS, AND RECOMMENDATIONS FOR FURTHER STUDY Summary Conclusions Implications Recommendations f o r F u r t h e r Study  86 90 91 93  Reference Notes  96  Bibliography  97  Appendix A  107  Appendix B  109  vi  Acknowledgements C a r r y i n g o u t a study such as t h i s one r e q u i r e s the a s s i s t a n c e o f many people.  I t i s here the w r i t e r acknowledges  their contributions.  Dr. Joan Anderson, chairman of my t h e s i s committee shared her knowledge and provided a c h a l l e n g e . Dr. M a r i l y n Will man l i s t e n e d as I wrestled with ideas and provided c o n s t r u c t i v e c r i t i c i s m and encouragement throughout the process.  I thank both o f you f o r h e l p i n g me to l e a r n .  The teenagers who p a r t i c i p a t e d i n the study deserve s p e c i a l thanks.  They, and t h e i r f a m i l i e s gave many hours and welcomed me i n t o  t h e i r homes.  In doing so and by sharing t h e i r perceptions with me they  made t h i s study p o s s i b l e and enjoyable. I am indebted to those who helped by e n l i s t i n g study p a r t i c i p a n t s and to colleagues who provided support and c r i t i c a l review throughout the research process. F i n a l l y , I am most g r a t e f u l to my f a m i l y and f r i e n d s who d i d not allow geography or timetables to diminish t h e i r innumerable demonstrations o f c a r i n g and support.  Chapter I INTRODUCTION Background of the Problem As a r e s u l t of the health p o l i c y e s t a b l i s h e d by Lalonde  (1974),  Canadian health care workers in general and nurses i n p a r t i c u l a r have i n v o l v e d themselves i n i n t e r v e n t i o n programmes and research aimed at the m o d i f i c a t i o n of l i f e s t y l e s (Saucier & Gauthier, Note 2 ) .  The t o p i c o f  health behaviors has become a matter of concern to health p r o f e s s i o n a l s . A goal of nurses i n v o l v e d i n prevention o r i e n t e d programmes i s to see t h a t behavior patterns supportive of health are e s t a b l i s h e d or maintained.  One category of health behavior c l e a r l y l i n k e d to both long  and short term health status i s d i e t (Caliendo, 1981; Valadian, Berkey & Reed, 1981).  The study described here was designed to explore  one  category of health behaviors, s p e c i f i c a l l y , the n u t r i t i o n a l behavior of teenagers. From observations of teenagers i n a v a r i e t y of s e t t i n g s ( i . e . , schools, h o s p i t a l s and r e s i d e n t i a l treatment f a c i l i t i e s ) , i t appears the meaning d i e t holds f o r adolescents i s i n f l u e n c e d by a v a r i e t y of f a c t o r s and may vary from s i t u a t i o n to s i t u a t i o n . Moreover, teenagers to lack r e c e p t i v i t y to  appeared  teaching programmes and have t h e i r own set of  values and b e l i e f s about d i e t a r y h a b i t s .  While some w r i t e r s mention the  need to explore the meaning of foods f o r i n d i v i d u a l s as well as t h e i r a t t i t u d e s towards foods (Mead, 1964), t h i s has not been done f o r the adolescent age group. A m a j o r i t y of studies addressing teenagers' n u t r i t i o n have 1  2 explored elements and consequences of the food behaviors of t h i s age group.  These s t u d i e s i n c l u d e d e s c r i p t i o n s of meal patterns ( Hinton,  E p p r i g h t , Chadderdon, & Wolins, 1963; Huenemann, Shapiro, Hampton, & M i t c h e l l , 1966), biochemical d e f i c i e n c i e s ( F a i g l e , 1973; N u t r i t i o n , 1973; N u t r i t i o n Canada, 1975), and changing n u t r i t i o n a l needs as a r e s u l t of growth (Cohen, 1979; Marino & King, 1980; Stare & McWilliams, 1973).  In  order to understand why some teenagers choose healthy d i e t s and others do not, some r e s e a r c h e r s have examined the r e l a t i o n s h i p between a t t i t u d e s towards foods and food p r a c t i c e s (Thompson & Schwartz, 1977) as well as knowledge of n u t r i t i o n and food p r a c t i c e s (Saucier & Gauthier, Note 2 ) . What i s most s t r i k i n g about the l i t e r a t u r e i s the lack of s t u d i e s seeking the teenagers' p e r s p e c t i v e s on food. I t i s c l e a r from p r i o r s t u d i e s t h a t teenagers' e a t i n g patterns and n u t r i t i o n a l needs are d i f f e r e n t from those of both younger and o l d e r groups.  Nonetheless,  there i s a lack of understanding of how teenagers i n t e r p r e t or make sense of f a c t s , how teenagers develop t h e i r a t t i t u d e s and i n t u r n , how they make d e c i s i o n s about t h e i r food behaviors. L i t e r a t u r e from the s o c i a l science p e r s p e c t i v e supports the view that food i s an element of c u l t u r e . D i e t and d i e t a r y behaviors are seen to be l e a r n e d as a r e s u l t of s o c i a l i z a t i o n p r a c t i c e s and  everyday  experience ( C u s s l e r & De Give, 1952; Mead, 1964). Nonetheless,  few  s t u d i e s have sought to describe adolescent n u t r i t i o n a l behaviors by viewing adolescents as a c u l t u r a l group or by examining t h e i r everyday experiences.  Some authors suggest that l i f e s t y l e (Schorr, Sanjur &  E r i k s o n , 1972) or s o c i a l s i t u a t i o n s (Huenemann et a l , 1966; Roth, a c t to mold or modify behavior p a t t e r n s .  1960)  However, l i t t l e research has  3  been done which describes teenagers' b e l i e f s about n u t r i t i o n or t h e i r n u t r i t i o n a l behavior i n d i f f e r i n g s o c i a l s i t u a t i o n s . Moreover, there are no d e s c r i p t i o n s of how food f i t s into the teenager's l i f e s t y l e . assumptions  There i s a l s o evidence that p r o f e s s i o n a l s '  about teenagers' food preferences are inaccurate o r  exaggerated (Crawford, 1977). There are few studies which d e s c r i b e the f a c t o r s that are important to teenagers as they make d e c i s i o n s regarding food.  Recognizing the need to understand  teenagers'  points o f view, some s t u d i e s have examined broader c a t e g o r i e s of health behaviors ( S a u c i e r , Note 1) and b e l i e f s (Gochman, 1972; S a u c i e r , Note 1) as well as e l i c i t i n g adolescents' p e r s p e c t i v e s on i l l n e s s (Radius, D i l l m a n , Becker, Rosenstock, & Horvath, 1980). In the present study, adolescents are considered to be a c u l t u r a l group.  Adolescence i s a period o f a c c e l e r a t e d physical growth as well as  a time o f l e a r n i n g and developing s o c i a l r o l e s .  Teenagers'  everyday  experiences, such as those with f a m i l i e s and i n high s c h o o l s , c o n t r i b u t e to the development of l i f e s t y l e s and i n t e r e s t s which d i f f e r from those o f other s o c i a l  groups.  While there are a few s t u d i e s examining food behaviors i n t h e i r s o c i a l developmental  context, and other researchers have studied health  r e l a t e d issues from a s o c i a l c u l t u r a l p e r s p e c t i v e , there are no s t u d i e s examining teenagers' behaviors i n t h i s context.  Several reasons f o r  seeking t o understand the p e r s p e c t i v e o f a group or i n d i v i d u a l on a p a r t i c u l a r issue may be c i t e d .  Kleinman  (1978) and L e i n i n g e r (1978) have  examined c u l t u r a l i n f l u e n c e s on i n d i v i d u a l ' s health behaviors.  Both  researchers were motivated by the f e l t need f o r p r a c t i t i o n e r s to provide health care i n a manner which would be c u l t u r a l l y acceptable to the  4  clients.  Both document that t a k i n g i n t o account the c l i e n t ' s c u l t u r e i n  the p r o v i s i o n of health care increases the c l i e n t ' s s a t i s f a c t i o n with care.  Considering c u l t u r a l background i s a l s o seen as i n c r e a s i n g the  l i k e l i h o o d that i n d i v i d u a l s w i l l comply with p r e s c r i b e d regimens.  Cassel  (1957), f o r example, documents that awareness of a c u l t u r a l group's food b e l i e f s , values and h i s t o r i c a l e v o l u t i o n allowed health care workers to s u c c e s s f u l l y design and implement n u t r i t i o n i n t e r v e n t i o n programmes. More r e c e n t l y , i n d i s c u s s i n g the s t a t e of nursing knowledge concerning the e f f e c t i v e n e s s of nursing i n t e r v e n t i o n s and teaching programmes, Hogue (1979) i n c l u d e s as a concern of nursing the i n i t i a t i o n and maintenance of healthy behaviors in c l i e n t s .  Awareness of the  c l i e n t ' s p o i n t of view i s seen to f a c i l i t a t e the p r o v i s i o n of information which i s r e l e v a n t to the c l i e n t , thereby enhancing  compliance.  In summary, the value of the i n d i v i d u a l p e r s p e c t i v e i s twofold. F i r s t , i t gives the researcher a c l e a r e r p i c t u r e of the cues or events which have acted to shape the i n d i v i d u a l ' s perception of the s i t u a t i o n . A d d i t i o n a l l y , in attempting to describe the i n d i v i d u a l ' s b e l i e f s , the importance of the b e l i e f s to him or her and the o r i g i n of the b e l i e f s , the researcher may come both to understand how observed patterns have evolved and to p o s t u l a t e how they might be sustained, changed or modified.  In the present study, information gained w i l l c o n t r i b u t e t o  our understanding of teenagers' perceptions of t h e i r s i t u a t i o n s , a i d in designing teaching programmes aimed at the adolescent population and guide the p r o v i s i o n of nursing care to i n d i v i d u a l teenagers.  5  Statement of the Problem and Purposes Some s t u d i e s have explored adolescents' n u t r i t i o n a l patterns by examining what i t i s that teenagers eat.  There are no s t u d i e s which have  sought to explore teenagers' reasons f o r e a t i n g as they do. There i s a lack o f understanding o f how adolescents i n t e r p r e t or make sense o f knowledge or f a c t s , how they develop t h e i r a t t i t u d e s and i n turn how they make d e c i s i o n s about t h e i r food behaviors.  There i s a general lack o f  knowledge o f what teenagers consider to be important or what they p e r c e i v e to i n f l u e n c e t h e i r food b e l i e f s or behaviors.  Based on the  d e s c r i b e d lack of i n f o r m a t i o n , observations i n c l i n i c a l s e t t i n g s , and a review of l i t e r a t u r e addressing problems of teenage n u t r i t i o n , the proposed study was designed f o r the f o l l o w i n g purposes: - to describe adolescents' perceptions of t h e i r food r e l a t e d behaviors. - to develop an understanding o f the p o s i t i o n food and food r e l a t e d behaviors have w i t h i n the values of the adolescent group. - to describe v a r i a t i o n s or changes i n food r e l a t e d a c t i v i t i e s as adolescents are observed i n s e l e c t e d s i t u a t i o n s a t s e l e c t e d times. D e f i n i t i o n o f Terms Adolescent or teenager - a youth, male or female, aged 12-17 years i n c l u s i v e . A t t i t u d e s - expressions o f personal sentiment, which may range from p o s i t i v e to negative, about an o b j e c t or event. Food - any oral intake. Food b e l i e f s - may i n c l u d e a t t i t u d e s towards food but as well include notions of e f f e c t s o f consuming or avoiding c e r t a i n foods or food combinations. Food r e l a t e d behaviors - a c t i v i t i e s a s s o c i a t e d with the planning, p r e p a r a t i o n , or consumption o f any oral i n t a k e .  6 Health behavior - any a c t i v i t y undertaken by a person f o r the purpose of p r e v e n t i n g d i s e a s e or d e t e c t i n g d i s e a s e i n an asymptomatic stage (Rosenstock, 1974) or the promotion of well being. P e r c e p t i o n s - thoughts, f e e l i n g s and a t t i t u d e s of i n d i v i d u a l s about o b j e c t s or events as r e l a t e d v e r b a l l y . I n t r o d u c t i o n to the T h e o r e t i c a l P e r s p e c t i v e This study was guided by the p e r s p e c t i v e d e r i v e d from the i n t e r p r e t i v e s c h o o l . T h i s school takes d i r e c t i o n from the p h i l o s o p h i c a l works of Husserl (1964) and Schutz (1973, 1970).  I t was developed by  researchers who were concerned about studying the everyday world, l i f e and r a t i o n a l i t y .  Researchers who have used t h i s p e r s p e c t i v e i n t h e i r  work i n c l u d e Anderson (1981), Becker (1973), Lindemann (1974), Shaw (1966), and Spradley (1970).  T h i s p e r s p e c t i v e seeks to understand the  i n d i v i d u a l ' s p o i n t of view: Theory i s developed from an understanding of the experiences of the p a r t i c i p a n t and the observer. The i n v e s t i g a t o r begins with f i r s t hand knowledge of events ( R i s t , 1979, p.19). The appropriateness of the method i n c l i n i c a l nursing i s s t r e s s e d by Davis (1978).  She argues t h a t a major concern of nursing i s the a b i l i t y  to understand and take d i r e c t i o n from the c l i e n t . Other aspects of t h i s research process are the f o l l o w i n g : i n t e r s u b j e c t i v i t y , s e l e c t i o n of p a r t i c i p a n t s , theory development, and validity.  While research methods based on the tenets of natural science  support the view t h a t there i s an o b j e c t i v e , measurable s o c i a l r e a l i t y ( R i s t , 1979), the i n t e r p r e t i v e school c o n s i d e r s a l l knowledge to be s o c i a l l y c o n s t r u c t e d . I n d i v i d u a l s produce information w i t h i n t h e i r s o c i a l and c u l t u r a l context ( R i s t , 1979).  As such, the research process  7 i s i n t e r s u b j e c t i v e . The researcher i s i n c o r p o r a t e d i n t o the study process and c o n s t r u c t s accounts o f events with i n d i v i d u a l p a r t i c i p a n t s . In a study o f t h i s nature i n d i v i d u a l p a r t i c i p a n t s are s e l e c t e d for t h e i r a b i l i t y to address issues o f concern: On the assumption t h a t a l l members o f a c u l t u r e are c a r r i e r s of that c u l t u r e , any person who belongs to the group under study i s a p o s s i b l e informant (Brink & Wood, 1978, p. 123). How might one formulate c o n s t r u c t s from data c o l l e c t e d f o r the purposes described?  D i r e c t i o n i n responding to t h i s  question may be taken from  the works o f G l a s e r and Strauss (1967) as they d i s c u s s the formulation o f a theory.  G l a s e r and Strauss take the approach that i t i s through the  c o l l e c t i o n of q u a l i t a t i v e data, v i a p a r t i c i p a n t o b s e r v a t i o n , that one may generate a theory. the data.  Theory i s developed based on observations grounded i n  A theory or c o n c e p t u a l i z a t i o n of the process under study i s  developed as the researcher makes sense o f the data.  The technique i s  based on observations of the way people are seen to question and make sense of t h e i r world: What the f i e l d worker does i s to make t h i s normal strategy of r e f l e c t i v e persons i n t o a s u c c e s s f u l research s t r a t e g y ( G l a s e r & S t r a u s s , 1965a, p.9). In t h i s research approach the process o f data c o l l e c t i o n and a n a l y s i s are i n t e r t w i n e d and occur simultaneously.  Based on i n i t i a l  observations and recorded data, the researcher begins to develop categories.  These c a t e g o r i e s are then r e f i n e d and v a l i d a t e d by seeking  out new information i n the f i e l d s e t t i n g (Glaser & S t r a u s s , 1965a). Having explored c o n d i t i o n s i n one group or s e t t i n g , the researcher may choose to examine developing c a t e g o r i e s and c o n s t r u c t s , or p o s t u l a t i o n s  8  concerning the r e l a t i o n s h i p s between t h e i r dimensions in a new s e t t i n g or with a comparison group. The purpose of t h i s a c t i v i t y i s to  understand  b e t t e r under what sets of s t r u c t u r a l c o n d i t i o n s these c a t e g o r i e s are minimized and maximized (Glaser & S t r a u s s , 1965a). The t h e o r i e s and c o n c e p t u a l i z a t i o n s are grounded i n the data. The reader i s given i n s i g h t i n t o how c a t e g o r i e s were constructed.  Theory  developed i n t h i s way has demonstrated usefulness i n a p p l i c a t i o n to c l i n i c a l s e t t i n g s (Glaser & S t r a u s s , 1965b; Lindemann, 1974; Quint and has been used to provide i n t e r p r e t a t i o n s of s t a t i s t i c a l  1966)  data  (Lindemann, 1974). In d i s c u s s i n g the t h e o r e t i c a l foundation of t h i s study four points have been addressed.  F i r s t , i n research of t h i s nature the  c l i e n t ' s p e r s p e c t i v e i s valued.  Second, conceptual c a t e g o r i e s  the nature of health r e l a t e d i n t e r a c t i o n s are developed  concerning  from the data.  T h i r d , the researcher and c l i e n t are involved i n the process of c o n s t r u c t i n g accounts of events.  Fourth, the processes of data  c o l l e c t i o n and a n a l y s i s are i n t e r t w i n e d and study f i n d i n g s are based on observations grounded i n the data. Assumptions I t i s assumed that i n d i v i d u a l s act p u r p o s e f u l l y and that patterns o f a c t i o n are i n f l u e n c e d by the i n d i v i d u a l ' s i n t e r p r e t a t i o n of the s e t t i n g or behavior of i n d i v i d u a l s i n the s e t t i n g . I t i s f u r t h e r assumed that as a r e s u l t of t h e i r d a i l y experiences and growth needs, teenagers' p e r c e p t i o n s , a t t i t u d e s and values may d i f f e r from those of adults and younger c h i l d r e n .  I t has been noted that a p r i n c i p l e guiding the  s e l e c t i o n of p a r t i c i p a n t s i s the assumption that a l l members of a c u l t u r e  9  are c a r r i e r s of t h a t c u l t u r e , and any member i s a p o s s i b l e informant.  It  i s a l s o assumed the s e l e c t i o n of informants i s dependent upon t h e i r a b i l i t y and w i l l i n g n e s s to communicate perceptions v e r b a l l y . Limitations While the researcher seeks common themes in c o n s t r u c t e d accounts, there are l i m i t a t i o n s to the g e n e r a l i z a b i l i t y of accounts to other groups.  T h i s study was l i m i t e d to a group of middle c l a s s teenagers.  Without f u r t h e r study one may not know the d i f f e r e n c e s or s i m i l a r i t i e s between t h i s group and teenagers of other socio-economic or c u l t u r a l groups.  Furthermore, d e s p i t e the knowledge shared by members of a  community or c u l t u r a l group, there i s a unique aspect of an i n d i v i d u a l ' s knowledge which may preclude complete understanding of an i n d i v i d u a l ' s situation. Summary Several t h e o r i s t s have presented the view that an understanding of the c l i e n t ' s p e r s p e c t i v e i s c r i t i c a l to the e f f e c t i v e p r o v i s i o n o f care.  P r o v i s i o n of care i n the context of t h i s study would mean  communicating  n u t r i t i o n information i n a manner that would be acceptable  to teenagers and r e s u l t i n t h e i r adoption of the recommended e a t i n g patterns. T h i s study has been designed to c o n t r i b u t e to the development  by  nurses of an understanding of teenagers' notions of t h e i r food behaviors. By doing so i t w i l l c o n t r i b u t e to another g o a l : the p r o v i s i o n of e f f e c t i v e care.  Chapter II REVIEW OF RELATED LITERATURE  The t o p i c of concern i n t h i s study i s a p a r t i c u l a r category of health behaviors, the d i e t a r y habits of adolescents.  As h e a l t h  p r o f e s s i o n a l s i n t e r a c t with teenagers in health care s e t t i n g s or design i n t e r v e n t i o n programmes they question how they might increase the e f f e c t i v e n e s s of t h e i r i n t e r v e n t i o n s . As has been suggested, t h i s study i s designed to c o n t r i b u t e to understanding the problem of teenagers' n u t r i t i o n by studying t h e i r perceptions and points of view.  The  l a c k of  l i t e r a t u r e which bears d i r e c t l y on t h i s problem n e c e s s i t a t e s the i n c l u s i o n i n t h i s review not only of l i t e r a t u r e r e l a t e d to the t o p i c of teenagers' n u t r i t i o n , but a l s o of studies r e l a t e d to health behavior and n u t r i t i o n i n general.  In the review, both the methodologies  used i n the  study of health behaviors and n u t r i t i o n and the f i n d i n g s of previous s t u d i e s of health behaviors, n u t r i t i o n i n general and adolescent n u t r i t i o n i n p a r t i c u l a r are d i s c u s s e d . The l i t e r a t u r e review i s organized i n t o three major s e c t i o n s : f i r s t , studies of the i n i t i a t i o n and maintenance of change i n health behaviors; second, general studies of n u t r i t i o n ; and t h i r d , s t u d i e s of adolescent n u t r i t i o n and food p a t t e r n s .  Studies of the I n i t i a t i o n and Maintenance of Change in Health Behaviors Assuming food behaviors are a category of health behaviors and that the adoption of healthy e a t i n g habits i s seen to c o n t r i b u t e to long 10  11 term h e a l t h , s t u d i e s which have examined issues r e l a t e d to the i n s t i t u t i o n and maintenance of change i n health and l i f e s t y l e are explored below.  behaviors  Research which has examined l i f e s t y l e issues i n  general i s important to an understanding  of food behaviors i n p a r t i c u l a r  because of four f a c t o r s they are seen to have i n common. One f a c t o r i s t h a t p r e s c r i b e d behaviors are a s s o c i a t e d with, but do not n e c e s s a r i l y r e s u l t i n good h e a l t h .  A second i s that the reasons f o r i n i t i a t i n g the  recommended behavioral pattern may be v a r i e d . may,  The non-healthy  or may not, be c r e a t i n g a problem f o r the i n d i v i d u a l . The  pattern unhealthy  behavior may not create a problem, but may increase the r i s k of problems. T h i r d , the l i f e s t y l e change i s u s u a l l y dependent upon the m o d i f i c a t i o n of a range of behaviors, not simply one behavior.  Fourth, the nature of the  recommended l i f e s t y l e change, l i k e changes i n food behaviors, u s u a l l y r e q u i r e s long term or l i f e t i m e maintenance (Hulka, 1979). Several themes emerge from t h i s category of l i t e r a t u r e .  A  c o n c l u s i o n of Powers and Ford (1976) as they reviewed nursing l i t e r a t u r e r e l a t e s to the type of knowledge needed to guide s u c c e s s f u l i n t e r v e n t i o n s ; " . . . t r u l y e f f e c t i v e i n t e r v e n t i o n s must be based not only upon knowledge per se but also knowledge of the way the p a t i e n t defines h i s s i t u a t i o n " (p. 59).  Compliance i s often a measure a c c o c i a t e d with  effective interventions.  As researchers have examined compliance with  p r e s c r i b e d regimens r e q u i r i n g long term m o d i f i c a t i o n of healthy behaviors, they have g e n e r a l l y concluded, l i k e Powers and Ford, that the i n d i v i d u a l ' s knowledge and perceptions of the s i t u a t i o n are f a c t o r s a s s o c i a t e d with compliance.  T a y l o r (1979), f o r example, as he s t u d i e d  12 p a t i e n t s on regimens to control t h e i r blood pressure, suggested t h a t knowledge of hypertension  alone was not a good p r e d i c t o r of compliance.  Rather, p a t i e n t s ' perceptions of safety of the drugs, as well as perceived seriousness of the i l l n e s s were b e t t e r p r e d i c t o r s . Further evidence t h a t perceptions of the s i t u a t i o n c o n t r i b u t e to behaviors may be c i t e d . The mother's perceptions of how obesity a f f e c t s her c h i l d ' s health and s o c i a l a c t i v i t i e s , f o r example, have been described as i n f l u e n c i n g compliance with a weight reduction programme f o r her c h i l d r e n (Becker, Maiman, K i r s c h t , Haefner, & Drachman, 1979).  One  might assume s i m i l a r f a c t o r s may i n f l u e n c e i n d i v i d u a l s as they make d e c i s i o n s about t h e i r food  behaviors.  Working with the i n d i v i d u a l ' s s i t u a t i o n also increases the successfulness of i n t e r v e n t i o n s .  This might be done by  i n d i v i d u a l needs ( S e l l e r s , Cappell & Marshman, 1979)  addressing  or communicating  e f f e c t i v e l y to decrease the e f f e c t s of s o c i o - c u l t u r a l d i f f e r e n c e s (Hogue, 1979).  S t r a t e g i e s useful in i n i t i a t i n g change r e l a t e to appealing to  perceived needs (Becker, Maiman, K i r s c h t , Haefner, & Drachman, 1979), a t t i t u d e s or enhancing a c c e s s i b i l i t y of s e r v i c e s (Green, 1979).  The  maintenance of change i s more l i k e l y i f one i s aware of and seeks to i n v o l v e the i n d i v i d u a l ' s support system (Hogue, 1979).  However, the most  e f f e c t i v e p r e d i c t o r of long term compliance i s the i n d i v i d u a l ' s commitment to s u s t a i n the behaviors (Becker, Maiman, K i r s c h t , Haefner, & Drachman, 1979; T a y l o r , 1979). The f i n d i n g s of the above c i t e d s t u d i e s both emphasize the value of understanding  the i n d i v i d u a l ' s perception of his s i t u a t i o n and d i r e c t  13 the e x p l o r a t i o n of p a r t i c u l a r aspects of i n d i v i d u a l s ' perceptions.  These  f i n d i n g s suggest the researcher should examine and c l a r i f y i n d i v i d u a l s ' perceptions of t h e i r s i t u a t i o n s . The i n t e r p r e t i v e method i s appropriate to explore questions of t h i s nature. Rosenstock (1966, 1974) has w r i t t e n about the Health B e l i e f Model which was developed by behavior s c i e n t i s t s i n the 1960's to provide an e x p l a n a t i o n f o r patterns of health behavior.  The Model i s considered  here because i t deals with the i n d i v i d u a l ' s point of view and p o s t u l a t e s how point of view or b e l i e f s a c t to i n f l u e n c e health behavior.  The Model  i s a l s o considered because i t has been useful in the study of h e a l t h , l i f e s t y l e and compliance issues since i t s i n c e p t i o n (Becker, Maiman, K i r s c h t , Haefner, & Drachman, 1979; Best, & Bloch, 1979; K i r s c h t ,  1974;  K i r s c h t , Haefner, Kegeles & Rosenstock, 1966; T a y l o r , 1979; Saucier & Steinberg, Note 3). Rosenstock's i n i t i a l formulation of the Model to e x p l a i n preventive health behavior suggested that there were three major sources of i n f l u e n c e on health behaviors and emphasized the i n d i v i d u a l ' s p o i n t of view. The f i r s t i n f l u e n c e implies a s u b j e c t i v e s t a t e of readiness to take action.  Elements of t h i s i n f l u e n c e are the extent to which the  i n d i v i d u a l perceives he i s s u s c e p t i b l e to a disease and how serious the occurrence of that disease would be.  The second i n f l u e n c e i s how  e f f e c t i v e people b e l i e v e c e r t a i n actions would be and the d i f f i c u l t i e s i n v o l v e d i n c a r r y i n g out such a c t i o n . The t h i r d i n f l u e n c e r e l a t e s to cues which would i n s p i r e one to act (Rosenstock,  1966). The  author  provides a behavioral i n t e r p r e t a t i o n of the i n t e r r e l a t i o n s h i p of these  14 variables.  An i n d i v i d u a l would c a r r y out p r e v e n t i v e behaviors i f i t were  p e r c e i v e d the r i s k s were greater than any personal inconvenience (Rosenstock, 1966).  Haefner and K i r s c h t (1970) confirm that t h i s i s more  l i k e l y to happen when the behaviors are not long e s t a b l i s h e d habits or patterns. While Rosenstock (1966, 1974) i n i t i a l l y suggested m o t i v a t i o n arose out of f e a r of consequences,  the Model has since been r e v i s e d to  suggest t h a t one might a l s o be motivated by the d e s i r e to maintain health (Becker, Maiman, K i r s c h t , Haefner, Drachman, & T a y l o r , 1979).  This  r e v i s i o n would make the Model appropriate f o r the study of n u t r i t i o n as an element of l i f e s t y l e , viewing food behaviors as one category of h e a l t h behaviors.  While several s t u d i e s support the usefulness of the Model i n  p r e d i c t i n g behavior, others have i d e n t i f i e d l i m i t a t i o n s .  The most  important l i m i t a t i o n f o r our purpose r e l a t e s to the e x i s t e n c e of b e l i e f s . The Health B e l i e f Model was developed employing p r i n c i p l e s of f i e l d theory (Rosenstock, 1966).  Lewin's  An assumption of t h i s  theory i s t h a t an i n d i v i d u a l must have an i n i t i a l awareness or concern before material or s t i m u l i w i l l be p e r c e i v e d as r e l e v a n t (Rosenstock, 1966).  This phenomenon may e x p l a i n study r e s u l t s which suggest that the  b e l i e f s being measured as model parameters do not seem to be present i n a l l i n d i v i d u a l s (Rosenstock, 1974; K i r s c h t et a l . , 1966). of t h i s was discussed by Gochman (1972).  The  importance  He suggested t h a t i f health was  not meaningful or s a l i e n t to an i n d i v i d u a l the Model d i d not provide d i r e c t i o n f o r the i n t e r p r e t a t i o n of observed behaviors.  Therefore t h i s  15 w r i t e r questions the value o f employing the Model to study teenagers. Radius  e t a l . , (1980) s t u d i e d health r e l a t e d b e l i e f s and  p r a c t i c e s o f 112 teenagers.  T h e i r f i n d i n g s were c o n s i s t e n t with  Gochman's observations as d e s c r i b e d above.  In a d d i t i o n , they found that  health was not a concern f o r more than 50 per cent of the boys and g i r l s they s t u d i e d . S a u c i e r and S t e i n b e r g (Note 3) i n d i c a t e t h a t teenagers tend to feel s e r i o u s i l l n e s s w i l l not happen to them and as t h e i r age i n c r e a s e s they tend to decrease the number of health o r i e n t e d a c t i v i t i e s they pursue. Subsequent work on the Health B e l i e f Model suggests t h a t there i s a "cue to a c t i o n " phenomenon which a c t i v a t e s or makes s a l i e n t p e r t i n e n t b e l i e f s ( K i r s c h t , 1974).  Such a phenomenon would e x p l a i n changes i n the  presence of b e l i e f s (e.g., an i n d i v i d u a l might experience an event which might change the perceptions o f v u l n e r a b i l i t y or s u s c e p t i b i l i t y ) .  This  suggests t h a t the i d e n t i f i c a t i o n of cues which s t i m u l a t e awareness would be v a l u a b l e and the r e s u l t i n g behaviors would l i k e l y be t e s t a b l e w i t h i n the context of the Model. Although the Health B e l i e f Model focuses on the p e r s p e c t i v e of the i n d i v i d u a l , i t seems to r e q u i r e that i n d i v i d u a l s view t h e i r behaviors in r e l a t i o n to health ( o r i l l n e s s ) .  Observations such as those o f  Gochman (1972), Radius e t a l . (1980), Saucier and Steinberg (Note 3) suggest two t h i n g s . One, health i s not a u n i v e r s a l value o f the adolescent group.  Second, while d i e t a r y b e l i e f s or p r a c t i c e s may be  l i n k e d to health by p r o f e s s i o n a l s , f o r the layman t h i s may not always be so.  Considering t h i s and the observations o f Hinton e t a l . (1963) and  16 Huenemann e t a l . (1966, 1968) t h a t teenagers have a range of reasons (which appear to be c o n c e p t u a l l y unrelated to health) f o r e a t i n g as they do, i t seems i t would be more i n s t r u c t i v e to adopt a d i f f e r e n t focus f o r the study of teenagers' food p r a c t i c e s . One may suggest i t would be valuable to d e s c r i b e not only teenagers' food b e l i e f s , but a l s o the nature of the conceptual l i n k s teenagers make between t h e i r food behaviors and personal goals or  consequences.  The l i t e r a t u r e reviewed thus f a r has examined health behaviors and i d e n t i f i e d f a c t o r s i n f l u e n c i n g the i n i t i a t i o n and maintenance  of  change in health behaviors. The l i t e r a t u r e review that f o l l o w s w i l l d i s c u s s whether s i m i l a r f a c t o r s have been i d e n t i f i e d as i n f l u e n c i n g compliance with n u t r i t i o n i n t e r v e n t i o n programmes.  The d e c i s i o n to  i n c l u d e n u t r i t i o n l i t e r a t u r e (non adolescent) was made because e a r l y s t u d i e s of n u t r i t i o n seemed to address issues s i m i l a r to the concerns of the present study. S t u d i e s of N u t r i t i o n Studies of n u t r i t i o n g e n e r a l l y have as t h e i r focus one of two major purposes. The f i r s t of these i s to understand the n u t r i t i o n a l needs of i n d i v i d u a l s and how they might best be met.  The second i s how to best  address the "human element" in the problem of encouraging i n d i v i d u a l s , o f t e n of d i f f e r i n g c u l t u r e s , to modify t h e i r e a t i n g patterns to support health or to accommodate the a v a i l a b i l i t y of resources ( C u s s l e r & De Give, 1952; Mead, 1964).  T h i s l a t t e r problem, which i s more p e r t i n e n t to  t h i s study, has been addressed d i f f e r e n t l y over time.  Early studies  17 examined d i e t as an element of c u l t u r e and tended to employ q u a l i t a t i v e methods. One might say researchers were attempting a r a t i o n a l approach to the study of what has been r e f e r r e d to as " i r r a t i o n a l " behavior ( C u s s l e r & De Give, 1952).  L a t e r s t u d i e s tended to employ q u a n t i t a t i v e  methods and examined both n u t r i t i o n a l status and behaviors.  Studies of  n u t r i t i o n which i d e n t i f i e d s o c i a l f a c t o r s as i n f l u e n c e s on behavior have considered and s t u d i e d food patterns as an element of c u l t u r e .  Food P a t t e r n s as an Element of C u l t u r e C u s s l e r and De Give (1952) i d e n t i f y numerous examples throughout h i s t o r y which support the view that human behavior i n general, and food behavior i n p a r t i c u l a r , i s i r r a t i o n a l .  The idea that i n d i v i d u a l s do not  always pursue a healthy d i e t even i f they are knowledgeable i s by Bruch  supported  (1973): There i s no human s o c i e t y that deals r a t i o n a l l y with food in i t ' s ( s i c ) environment, that eats according to the a v a i l a b i l i t y , e d i b i l i t y , and n u t r i t i o n a l value alone (p.3). Studies from the s o c i a l science p e r s p e c t i v e have examined the  s o c i a l environment of f a m i l i e s and communities both to assess the nature of f a m i l y i n f l u e n c e on i n d i v i d u a l s and to understand t h e i r apparently i l l o g i c a l behavior.  Anthropological studies have described food patterns  o f p r i m i t i v e and d i f f e r e n t c u l t u r e s (Graubard, 1943; Chang, 1977). Mead (1964) was one of the f i r s t researchers to provide d i r e c t i o n i n the a p p l i c a t i o n of anthropology to the question of d i e t a r y compliance. determination of the s o c i o - c u l t u r a l aspects of food and how they are  The  18 a f f e c t e d by change was her g o a l .  She found that d i e t and d i e t a r y  behaviors were learned as a r e s u l t of s o c i a l i z a t i o n p r a c t i c e s . With knowledge of the perceived importance of foods, Cassel (1953) r e p o r t s that v i s i t i n g health care workers were able to s u c c e s s f u l l y introduce change i n d i e t s . The type of knowledge gained from both the s t u d i e s of Cassel and C u s s l e r and De Give has increased health care workers' understanding of the c u l t u r a l group's p e r s p e c t i v e of i t s food behaviors.  These s t u d i e s exemplify how knowledge of c u l t u r a l  p e r s p e c t i v e s may be a p p l i e d i n p r a c t i c e to promote compliance i n s i t u a t i o n s r e l a t e d to n u t r i t i o n . C u s s l e r and De Give (1952) c a r r i e d out the f i r s t comprehensive study of the s o c i o - c u l t u r a l f a c t o r s a f f e c t i n g food p a t t e r n s , e s p e c i a l l y in the rural south of the United S t a t e s . The purpose of the study, which was q u a l i t a t i v e i n design was to study the "food h a b i t s " and "foodways" of a rural area composed of several communities.  They both interviewed  and acted as p a r t i c i p a n t observers in a range of community meeting and f a m i l i e s ' homes and inter-community  places  comparisons were made.  "Food h a b i t s " were defined as: ...the s p e c i f i c elements connected with the i n d i v i dual's food a c t i v i t i e s . . . i n c l u d i n g in that term not only the d i e t i t s e l f but a l s o i n d i v i d u a l habits of producing, purchasing and preparing food, and a t t i tudes, t a s t e s , and habits of e a t i n g (p.50). "Foodways," on the other hand are more general, i n c l u d i n g " . . . a l l  those  p a r a l l e l elements of the food pattern which have c o n s i d e r a b l y more than i n d i v i d u a l a p p l i c a t i o n " (p.49).  The a p p l i c a t i o n r e f e r r e d to may vary by  19 degrees; examples are s o c i a l c l a s s , community or a r e g i o n .  These  d e f i n i t i o n s continue to be accepted and employed (Lowenberg, Todhunter, Wilson, Savage, & Labawski, 1974). In a d d i t i o n to observations of the impact of values on "foodways," the authors i n d i c a t e that informants' main concerns as they were interviewed were with thoughts and f e e l i n g s about both the food and the s o c i o - c u l t u r a l p a t t e r n s .  This suggests that interviews might e l i c i t  d e s c r i p t i o n s of what i n d i v i d u a l s i n a c u l t u r a l group p e r c e i v e as important or of value.  The researchers comment that information about  p r a c t i c e s was more l i k e l y to be derived from t h e i r observations than from t h e i r i n t e r v i e w s , while interviews produced i n s i g h t i n t o the mechanisms o f t r a n s m i s s i o n of "foodways."  Food b e l i e f s were explored as were  p r a c t i c e s w i t h i n and between s o c i a l groups.  What might be i n f e r r e d from  the d i s c u s s i o n by C u s s l e r and De Give i s t h a t , while knowledge and p r a c t i c e may be r e l a t e d , i n d i v i d u a l s in a community such as the one they s t u d i e d have a p a r t i c u l a r way of formulating knowledge or viewing t h e i r own s i t u a t i o n . An important element i d e n t i f i e d i n the above study was the r o l e of i n d i v i d u a l s i n passing on "foodways."  Women's p o s i t i o n i n the f a m i l y  u n i t and t h e i r r e s p o n s i b i l i t i e s f o r c h i l d s o c i a l i z a t i o n p r a c t i c e s was kind of r o l e i n f l u e n c e . That foods c o u l d be a l l o c a t e d to c l a s s e s o f members (e.g., White landowner versus Black labourer) as well as being a s c r i b e d s p e c i a l s t a t u s (e.g., s p e c i a l occasion foods and d a i l y foods) was a l s o i d e n t i f i e d .  P r i o r to the C u s s l e r and De Give study, lack of  one  20 knowledge of these types of c u l t u r a l values made i t d i f f i c u l t to introduce change or modify food behaviors i n t h i s community.  T h e i r study  provided information which c o n t r i b u t e d to the e f f e c t i v e i n t r o d u c t i o n o f change i n d i e t a r y p a t t e r n s , i d e n t i f i e d c l e a r l y a range o f b e l i e f s about food ( t h a t may stand i n c o n t r a s t to b e l i e f s of other groups or s c i e n t i f i c f i n d i n g s ) and c o n t r i b u t e d to the i n t e r p r e t a t i o n o f q u a n t i t a t i v e , frequency data ( C u s s l e r & De Give, 1952). The study discussed above d i d not focus on teenagers, but i t does support the questions r a i s e d i n the studies c i t e d which addressed  issues  r e l a t e d to the m o d i f i c a t i o n o f health behaviors. The authors sought both to describe the meaning of food w i t h i n the c u l t u r e and to e x p l a i n how personal and community values, i n d i v i d u a l food b e l i e f s and f a m i l y and community members c o n t r i b u t e d to the maintenance and change of food patterns. C u s s l e r and De Give's (1952) work could a c t as a model f o r the design o f a study focusing on teenagers as a s o c i a l group.  Their  methodology would d i r e c t one to examine the food behaviors o f adolescents in the context of t h e i r surroundings.  The format would seek the  teenagers' r a t i o n a l e s f o r t h e i r a c t i o n s i n t h e i r own terms. One may not assume that observations of a p a r t i c u l a r group w i l l be useful f o r a l l other c u l t u r a l groups, but i t does c l e a r l y i n d i c a t e that there are patterns which, when i n t e r p r e t e d from the perspective o f the i n d i v i d u a l s in the community, are c o n s i s t e n t . The l i t e r a t u r e i n the 1960's and 1970's documents a s h i f t i n the  21 methodologies  employed to study food behaviors, in p a r t i c u l a r  teenagers' food behaviors.  As a r e s u l t , there i s a l s o a d i f f e r e n c e in  the type of f i n d i n g s . The next s e c t i o n of the l i t e r a t u r e review examines s t u d i e s of teenagers and t h e i r food behaviors and p a t t e r n s .  Studies of Adolescent N u t r i t i o n and Food Patterns Studies of adolescent n u t r i t i o n were reviewed with the f a c t o r s found to i n f l u e n c e the i n i t i a t i o n and maintenance of health behaviors i n mind.  The review of l i t e r a t u r e r e l a t e d to adolescent n u t r i t i o n a l s o  d e s c r i b e s the s t a t e of knowledge of adolescent n u t r i t i o n and i s organized as f o l l o w s . F i r s t , t h e o r e t i c a l and methodological issues i n f i v e s e l e c t e d s t u d i e s are addressed.  Then, the f i n d i n g s of these f i v e s t u d i e s  are combined with those of other studies of teenage n u t r i t i o n and are presented i n four content areas.  These are: patterns of food consumption  during adolescence, i n f l u e n c e s on teenagers' food behaviors, teenagers' knowledge of n u t r i t i o n , and i n f l u e n c e s of s o c i a l status and f a m i l y .  T h e o r e t i c a l p e r s p e c t i v e s and methodologies.  While teenagers have  o f t e n been included in n u t r i t i o n a l surveys of a l l age groups ( N u t r i t i o n , 1973; N u t r i t i o n Canada, 1975), f i v e s t u d i e s in p a r t i c u l a r have had the adolescent age group as t h e i r focus.  These f i v e s t u d i e s , three c a r r i e d  out i n the United States and two in Canada, have been chosen f o r s p e c i a l d i s c u s s i o n f o r two reasons.  F i r s t , they explored a range of i s s u e s  r e l a t e d to adolescent n u t r i t i o n ; and second, they adopted p e r s p e c t i v e s and methodologies.  differing  While s p e c i f i c f i n d i n g s of the  22 studies are d i s c u s s e d l a t e r i n t h i s chapter, i t i s useful to examine i n more d e t a i l the t h e o r e t i c a l p e r s p e c t i v e s adopted by the researchers and the s i m i l a r i t i e s and d i f f e r e n c e s i n t h e i r f i n d i n g s . The study most e x t e n s i v e l y c i t e d was c a r r i e d out by Huenemann et a l . (1966,1968). p e r i o d o f four y e a r s .  The same group of 1000 teenagers was followed f o r a Each year the Berkeley high school students were  assessed f o r p h y s i c a l growth changes as well as being weighed and measured a n t h r o p o m e t r i c a l l y and c i r c u m f e r e n t i a l l y to determine gross body composition, conformation, and body weight.  Some were given a c l i n i c a l  exam. These p r a c t i c e s f i t with recommendations f o r measurement of body s i z e except t h a t they lack documentation  of m a t u r i t y (McKigney & Munro,  1973). A l s o , once y e a r l y (grades 9-12) the teenagers answered questions on food and meal preferences, reasoning, a c t i v i t y l e v e l , and opinions and knowledge o f food p r a c t i c e s . The t o t a l study group included 10 p e r cent O r i e n t a l and 30 per cent Black teenagers. Hinton e t a l . (1963) s t u d i e d 12 and 14 y e a r o l d middle c l a s s g i r l s p u r p o s e f u l l y chosen to be p r e - and post-puberty.  They employed  food records f o r two periods i n high s c h o o l . They also measured height, weight and bone age by X-ray.  Tools were employed to measure knowledge  of n u t r i t i o n , food enjoyment, food values, and psychologic adjustment of the group.  The bases f o r tool development were not d e s c r i b e d .  In a t h i r d U.S. study, 404 students aged 12 t o 15 y e a r s from three high schools i n Syracuse were s t u d i e d .  The major data sources were  biochemical assays o f blood and urine samples. As w e l l , measurements were  23 recorded of age, height, weight, and t r i c e p s k i n f o l d s . A second data base was interviews which provided researchers with a p r o f i l e of the frequency and types of breakfasts consumed by the teenagers s t u d i e d . data a l s o i n c l u d e d socio-economic  s t a t u s . The sample had  The  approximately  equal d i s t r i b u t i o n of males and females and the r a c i a l d i s t r i b u t i o n was 2/3 White and 1/3 Black ( D i b b l e , B r i n , McMullen, P e e l , & Chen, 1965). Au Coin, Haley, Ray, and Cole (1972) s t u d i e d Nova S c o t i a teenagers aged 10 to 12 y e a r s .  They r e - t e s t e d a d i e t a r y assessment  which had been developed from the Canada Food Guide.  Intake was  tool  assessed  as adequate when teenagers consumed 70 per cent or more of the Canada Food Guide's recommended d a i l y allowances.  Measurements were c a r r i e d out  on one occasion and teenagers recorded what they had eaten that day. Data were analysed f o r v a r i a t i o n s across age and sex. The n u t r i t i o n a l component of the study by Saucier and S t e i n b e r g (Note 3) was only one element i n a more complex design examining a range of health and l i f e s t y l e behaviors.  They surveyed 5000 Quebec students in  f i v e high school grades and two j u n i o r c o l l e g e l e v e l s .  A l l information  was gathered by q u e s t i o n n a i r e . The t h e o r e t i c a l foundation was based on the Health B e l i e f Model (Rosenstock, 1966), value theory, and developmental  t h e o r i e s of adolescence.  In a d d i t i o n to assessing  teenagers' health b e l i e f s and a t t i t u d e s towards prevention, food patterns were a l s o assessed.  To do t h i s , a c h e c k l i s t of foods consumed i n the  previous twenty-four hours was employed.  The purpose was to i d e n t i f y  p a t t e r n s and f r e q u e n c i e s of consumption of key food groups.  Unlike  Dibble et a l . , and Au Coin et a l . , Saucier and Steinberg were not  24 assessing n u t r i t i o n a l s t a t u s . Although d i f f e r e n t methods were employed in these s t u d i e s , trends may be i d e n t i f i e d from the f i n d i n g s .  Four p a r t i c u l a r content areas have  been addressed.  Patterns of food consumption during adolescence. studies c i t e d and others reviewed assessed teenagers'  The f i v e  n u t r i t i o n a l status  and patterns of food intake and document that there i s a wide range in practices.  They also support the f i n d i n g s of studies c i t e d in Chapter I  suggesting that many teenagers do have d e f i c i e n c i e s in t h e i r d i e t s . While some f a c t o r s such as age, sex, and regional d i f f e r e n c e s emerge to d e s c r i b e which teenagers have n u t r i t i o n a l problems, the authors d i f f i c u l t i e s in accounting  report  f o r d i f f e r e n c e s within groups.  One pattern described i s in the d i f f e r e n c e s between boys and girls.  Most studies support the view that males have a more n u t r i t i o u s  d i e t than females ( N u t r i t i o n , 1973; N u t r i t i o n Canada, 1975; Steinberg, Note 3 ) .  Saucier &  In a study which included a d e s c r i p t i o n of  adolescent meal p a t t e r n s , Huenemann et a l . (1968) found that boys g e n e r a l l y ate more than g i r l s , an observation supported by Saucier Steinberg (Note 3 ) .  I t would seem there are i n f l u e n c e s other than those  that can be a t t r i b u t e d to sex d i f f e r e n c e s . of the Quebec and U.S.  and  In c o n t r a s t to the f i n d i n g s  s t u d i e s , the Nova S c o t i a study of 10 to 15 year  olds did not reveal d i f f e r e n c e s between the sexes.  Rather, i t i n d i c a t e d  t h a t few teenagers consumed even 70 per cent of the amounts recommended by the Canada Food Guide (Au Coin et a l . , 1972).  25  Comparison of food intakes between age groups showed a p r o g r e s s i v e d e c l i n e in the adequacy of intake as growth needs increased. One i n t e r p r e t a t i o n f o r the observed d e c l i n e i s that teenagers do not i n c r e a s e consumption of s p e c i f i c food groups to match recommended needs (Au Coin e t a l . , 1972).  Saucier and Steinberg (Note 3) a l s o d e s c r i b e a  lack of change i n amount of food intake with i n c r e a s i n g age. Other examples of ranges of p r a c t i c e s may be c i t e d .  Huenemann e t  a l . , (1966, 1968) d e s c r i b e f i v e c a t e g o r i e s of meal patterns ranging from three r e g u l a r meals with snacks to no r e g u l a r meals and several  snacks.  I t i s documented that teenagers consume "junk foods" two to three times a day on the average (Huenemann et a l . , 1966, 1968; Saucier & S t e i n b e r g , Note 3 ) . Crawford (1977) demonstrated, however, t h a t , although  teenagers  d i d buy junk food from vending machines placed i n high schools, when given the choice of more n u t r i t i o n a l food such as apples and milk, "junk food" purchases not only decreased but vending machine revenue i n c r e a s e d . When made a v a i l a b l e , a l a r g e r number of n u t r i t i o u s snacks were bought by teenagers.  The data were employed to challenge assumptions of school  a d m i n i s t r a t o r s that teenagers w i l l not eat healthy foods. This l a t t e r study i n d i c a t e s the value of e x p l o r i n g the a v a i l a b i l i t y o f n u t r i t i o n a l foods to the teenager.  Lack of a v a i l a b i l i t y  was reported to i n f l u e n c e n u t r i t i o n a l patterns (Huenemann et a l . , 1966; 1968).  I t was a l s o p o s t u l a t e d to c o n t r i b u t e to the poor health of n a t i v e  teenagers on i s o l a t e d reserves (Stepien, 1978). While the c i t e d s t u d i e s document c l e a r l y that teenagers do have a range of food behaviors, only one of the studies even t r i e s to explore  26 t h e i r reasons f o r choosing s p e c i f i c foods.  Some f a c t o r s i n f l u e n c i n g  teenagers' d e c i s i o n making w i l l be discussed i n the next category of 1iterature.  Described i n f l u e n c e s on teenagers' food behaviors.  Besides  having d i f f e r e n t needs than boys, teenage g i r l s are d e s c r i b e d as having d i f f e r e n t concerns about t h e i r body shapes and r a t e s of growth (Dwyer, Feldman & Mayer, 1967; Huenemann et a l . , 1966). to i n f l u e n c e t h e i r d i e t and a c t i v i t y .  These concerns are seen  Teenage boys and g i r l s are  d e s c r i b e d as choosing d i f f e r e n t foods to provide c a l o r i e s ( i . e . , boys eat l a r g e r amounts g e n e r a l l y , g i r l s eat more raw f r u i t s and vegetables, Huenemann et a l . , 1968).  More teenage g i r l s choose to p u r p o s e f u l l y  r e s t r i c t t h e i r intake to minimize growth while boys wish to maximize i t . If weight c o n t r o l i s d e s i r e d , boys tend to e x e r c i s e (Huenemann et a l . , 1966). In t h e i r study of 5000 French Canadian teenagers, Saucier and Steinberg (Note 3) reported t h a t 33 per cent of the females had d i e t e d f o r weight l o s s as compared to only 10 per cent of the males.  Huenemann  et a l . (1966; 1968) r e p o r t s i m i l a r f i n d i n g s . They assessed approximately 25 per cent of the teenage g i r l s to be overweight; however, more than 50 per cent of the g i r l s perceived themselves to be f a t . The boys, however, seemed to hold views of themselves which were c o n s i s t e n t with the researchers' measurements of f a t n e s s . Hinton et a l . , (1963) i n d i c a t e d t h a t e a r l y maturing g i r l s had a tendency to be overweight.  In another  study, Kaufman, Poznanski and Guggenheim (1975) found t h a t 480 grade 8  27  boys' and g i r l s ' perceptions about foods ( i . e . the f a t t e n i n g value of c e r t a i n foods) c o n t r i b u t e d to choices about  consumption.  What begins to emerge from a review of these studies i s the impression t h a t teenagers' perceptions of themselves as they pass through t h i s p e r i o d of a c c e l e r a t e d growth i n f l u e n c e in some way the choice of diet.  Several r e p o r t s i n d i c a t e d t h a t , besides i n f l u e n c i n g c h o i c e , the  s o c i a l aspects of food consumption increase in importance to the teenager (Huenemann et a l . , 1966, 1968). The observation that teenagers who  value  the s o c i a l aspects of e a t i n g tend to have e a t i n g patterns which are l e s s healthy i s a l s o reported (Hinton et a l . , 1963). On the other hand, teenagers who value health are also seen to have more healthy d i e t s (Hinton et a l . , 1963). T h i s view d i f f e r s from comments made by Saucier (Note 1), who i n d i c a t e s that while some teenagers reported that they valued health and i n d i c a t e d readiness to pursue a healthy l i f e s t y l e , i n a c t u a l i t y they d i d not do so. The l i t e r a t u r e reviewed to t h i s p o i n t i n d i c a t e s that teenage e a t i n g patterns may vary by sex, age, perceptions of s e l f , and perceptions of the s o c i a l s i t u a t i o n s r e l a t e d to food a c t i v i t i e s .  Other  f a c t o r s have been examined f o r t h e i r r e l a t i o n to d i e t a r y p a t t e r n s . A t t i t u d e s , knowledge and b e l i e f s about d i e t , socio-economic  status and  family s t r u c t u r e are examples which w i l l be addressed i n the f o l l o w i n g sections.  Teenagers' knowledge of n u t r i t i o n .  Teenagers'  nutritional  knowledge has been assessed i n a v a r i e t y of ways. Two studies of  28 grade 8 students assessed knowledge and found i t to be s a t i s f a c t o r y (Kaufman et a l . , 1975; Thompson & Schwartz, 1977).  Knowledge was not  always found to c o r r e l a t e s i g n i f i c a n t l y with p r a c t i c e ; however, i t was noted that knowledge and a t t i t u d e s were s i g n i f i c a n t l y r e l a t e d as, to a l e s s e r extent, were a t t i t u d e s and p r a c t i c e (Thompson & Schwartz,  1977).  While S a u c i e r and Gauthier (Note 2) found a p o s i t i v e r e l a t i o n s h i p between knowledge of healthy p r a c t i c e s and p o s i t i v e a t t i t u d e s and h e a l t h behaviors, t h i s c o r r e l a t i o n was described as s u r p r i s i n g l y weak. In the study by Huenemann et a l . (1966), assessment of knowledge of 14 to 15 y e a r o l d boys and g i r l s l e d to the c o n c l u s i o n that knowledge was l i m i t e d .  The teenagers were asked to describe foods that should be  eaten d a i l y .  F i f t y per cent of the students d i d not mention any of the  four food groups.  These teenagers, as well as having l i m i t e d knowledge,  a l s o were d e s c r i b e d as holding numerous misconceptions about foods. Examples i n c l u d e b e l i e f s about e f f e c t s of foods on t h e i r bodies, the lack of i n c l u s i o n of milk as a d a i l y d e s i r e d food, and the tendency f o r a l l but Caucasian boys to view o b e s i t y only i n r e l a t i o n to d i e t and not to exercise. F i n a l l y , the study by Hinton et a l . (1963) did not measure knowledge per se, but d i d measure teenagers' a b i l i t y to choose healthy diets.  The teenagers i n t h e i r study who were able to choose healthy  d i e t s also were d e s c r i b e d as having healthy d i e t s .  In t h e i r study,  a b i l i t y to s e l e c t c o r r e l a t e d with d a i l y p r a c t i c e s . In g e n e r a l , adolescents' choices of foods are not seen to be c l e a r l y r e l a t e d to knowledge. These o b s e r v a t i o n s , as well as those which  29 mention that knowledge d i f f e r e d from group to group, suggest that i t would be valuable to explore with teenagers t h e i r processes of d e f i n i n g or using knowledge.  A d i f f i c u l t y in making comparisons between these  s t u d i e s i s that the techniques of measuring knowledge were quite different.  A s i m i l a r problem occurred i n attempting to compare s t u d i e s  examining the i n f l u e n c e of socio-economic  status on teenagers'  dietary  practices.  Influence of s o c i a l status and f a m i l y .  As knowledge and s o c i a l  status were compared, one study demonstrated that knowledge increased with s o c i a l s t a t u s , but the i n f l u e n c e was described to be l e s s than the i n f l u e n c e s of c u l t u r e (Huenemann et a l . 1968).  The observations of  D i b b l e et a l . (1965) stand in c o n t r a s t to those of other i n v e s t i g a t o r s which d i d not f i n d t h a t the behavior of the groups s t u d i e d v a r i e d with t h e i r socio-economic 1975).  status (Thompson & Schwartz, 1977; Kaufman et a l . ,  Au Coin et a l . (1972) noticed a v a r i a t i o n in the h e a l t h i n e s s of  intake which corresponded  to l e v e l of parents' education.  postulated t h i s may p a r a l l e l f i n d i n g s f o r socio-economic  While they s t a t u s , t h i s was  not t e s t e d . Dibble et a l . (1965) document that the q u a l i t y of breakfasts consumed v a r i e s with socio-economic  status.  They also comment on the  f a m i l y s t r u c t u r e of t h e i r study group; 30 per cent of the low socio-economic  school group were from s i n g l e parent f a m i l i e s , compared to  3 per cent s i n g l e parent f a m i l i e s i n the school groups where f a t h e r s were ranked p r o f e s s i o n a l / m a n a g e r i a l .  They i n d i c a t e that many of t h e i r  30 observations c o r r e l a t e with socio-economic s t a t u s and imply c o r r e l a t i o n s with f a m i l y s t r u c t u r e . A t h i r d c h a r a c t e r i s t i c of the group which was not addressed was t h a t 90 per cent of the low socio-economic group was Black while only one per cent of the group in the school of highest socio-economic status was Black. d i f f e r e n c e s were not explored.  These c u l t u r a l and family s t r u c t u r e Such a study, though  documenting  frequencies and trends, a l s o suggests the need to examine how d i f f e r e n t groups account f o r t h e i r behaviors.  Although Huenemann et a l . (1966)  p o s t u l a t e d an impact of c u l t u r e on food behaviors of teenagers in t h e i r study, they a l s o suggested the i n f l u e n c e of c u l t u r e r e q u i r e d f u r t h e r exploration. Family i n f l u e n c e on d i e t a r y p r a c t i c e s i s i m p l i e d , but none of the research c i t e d s t u d i e d teenagers w i t h i n the context of t h e i r f a m i l i e s . F u r t h e r references to the nature of f a m i l y i n f l u e n c e may be noted.  Two  s t u d i e s i n d i c a t e e a t i n g patterns were unrelated to family s i z e (Au Coin e t a l . , 1972; Thompson & Schwartz , 1977). When asked who they considered to be food a u t h o r i t i e s , teenagers named t h e i r parents (Huenemann et a l . , 1966). F a c t o r s such as age, sex, c u l t u r a l background and a v a i l a b i l i t y of foods have been found to i n f l u e n c e the teenager's behavior.  The e f f e c t s  of teenage e a t i n g p r a c t i c e s are confirmed by biochemical analyses. The l i t e r a t u r e reviewed a l s o i n d i c a t e s points needing c l a r i f i c a t i o n .  One  i s the i n c o n s i s t e n c y between teenagers' knowledge and p r a c t i c e . There i s , however, apparent c o n s i s t e n c y between the teenagers' perceptions and t h e i r behaviors.  For example; Huenemann et a l . (1966) described the  31 tendency of females who perceived themselves as f a t to pursue a s e l f s t y l e d weight r e d u c t i o n programme, even when o b j e c t i v e measures d i d not confirm o b e s i t y i n a m a j o r i t y o f the g i r l s .  While teenagers' perceptions  of the adequacy o f t h e i r d i e t were not always confirmed by the r e s e a r c h e r s , they suggest that the d i e t was more l i k e l y c o n s i s t e n t with the c r i t e r i a the adolescent defined to be acceptable. The teenagers' c r i t e r i a i n c l u d e d acceptance of parental guidance, comparison of t h e i r own behaviors with observed a d u l t e a t i n g behaviors and awareness of ideal standards (Huenemann e t a l . , 1966). Three a d d i t i o n a l observations may be made from the l i t e r a t u r e . F i r s t , i n the n u t r i t i o n a l s t u d i e s , l i k e the s t u d i e s o f compliance, the p e r c e p t i o n o f the e f f e c t on other aspects o f the i n d i v i d u a l ' s l i f e s t y l e was seen to i n f l u e n c e the adoption or maintenance  of a behavior p a t t e r n .  A second observation suggesting f u r t h e r e x p l o r a t i o n i s the d i f f e r e n c e between the a t t i t u d e s of male and female teenagers.  Finally, further  e x p l o r a t i o n o f the nature o f f a m i l y i n f l u e n c e i s warranted.  The patterns  observed suggest that motivations to act may be g r e a t l y i n f l u e n c e d by v a l u e s , s o c i a l i z a t i o n , c u l t u r e , p e r c e p t i o n s , and s i t u a t i o n s .  Summary The problem which i s the focus o f t h i s study i s the lack of understanding of how teenagers i n t e r p r e t or make sense of knowledge or f a c t s , how they develop t h e i r a t t i t u d e s , and, i n t u r n , how they make d e c i s i o n s about t h e i r food behaviors.  There i s also a general lack o f  32  knowledge about what adolescents consider to be important regarding foods and food behaviors or what they p e r c e i v e to i n f l u e n c e t h e i r food b e l i e f s or behaviors. T h i s chapter has reviewed studies r e p r e s e n t a t i v e of the c u r r e n t s t a t e of knowledge regarding teenagers' n u t r i t i o n a l behaviors and attitudes.  I t has been argued t h a t addressing the problem of teenage  n u t r i t i o n from the ethnographic p e r s p e c t i v e w i l l c o n t r i b u t e i n f o r m a t i o n needed to remedy the described lack of knowledge. A review of compliance l i t e r a t u r e and c l i n i c a l studies from the ethnographic p e r s p e c t i v e documents t h a t c l i n i c i a n s ' understanding of how i n d i v i d u a l s view a p a r t i c u l a r problem or s i t u a t i o n may c o n t r i b u t e to the p r o v i s i o n of care which i s perceived s a t i s f a c t o r y to the c l i e n t . N u t r i t i o n a l s t u d i e s demonstrate  that the use of ethnographic  methods provides information useful i n the design of n u t r i t i o n i n t e r v e n t i o n programmes.  Other researchers observe that the way  people  c l a s s i f y n u t r i t i o n information and define knowledge i s i n f l u e n c e d by culture.  They a l s o i n d i c a t e that by a c t i n g as a p a r t i c i p a n t observer a  researcher might i d e n t i f y how c u l t u r a l o r i e n t a t i o n s and values i n f l u e n c e food behaviors. not found.  However, ethnographic studies of teenage n u t r i t i o n were  F i n d i n g s of other kinds of s t u d i e s of teenage n u t r i t i o n d i d  not provide answers to questions of how teenagers view t h e i r food behaviors, what i s important to them, or how they a r r i v e at t h e i r food decisions. Although i t i s often assumed that p r a c t i c e w i l l correspond to knowledge, both the compliance l i t e r a t u r e reviewed and studies r e l a t i n g  33  adolescents' n u t r i t i o n a l knowledge to behavior suggest two t h i n g s . I n d i v i d u a l s are more able to comply with p r e s c r i b e d regimens when they have information which w i l l help them cope with the consequences of the regimen on l i f e s t y l e a c t i v i t i e s or i n t e r p e r s o n a l r e l a t i o n s . I t i s l e s s l i k e l y c l i e n t s w i l l comply i f they only have information on, or knowledge o f , t h e i r disease. Recent s t u d i e s of teenage n u t r i t i o n imply that f a m i l y , c u l t u r e and perceptions of s e l f i n f l u e n c e food behaviors.  They also suggest t h a t  teenagers i n t e r p r e t knowledge d i f f e r e n t l y than i s i n d i c a t e d by r e s e a r c h e r s ' o b j e c t i v e measures. I t would seem, then, that there i s a need to describe the f a c t o r s i n f l u e n c i n g teenagers' use of knowledge as they develop the notions which guide t h e i r p a r t i c u l a r food behaviors. Although food behaviors ranging in degrees of h e a l t h i n e s s have been documented, there are no s a t i s f a c t o r y explanations f o r i n d i v i d u a l d i f f e r e n c e s i n observed p r a c t i c e s . Therefore, i t seems to be to seek adolescents' explanations f o r t h e i r food behaviors.  worthwhile  Chapter III METHODOLOGY  T h i s study was guided by the p e r s p e c t i v e derived from the i n t e r p r e t i v e approach.  As teenagers were both interviewed and observed,  data c o l l e c t e d were analysed employing constant comparative a n a l y s i s . This chapter w i l l d e s c r i b e how the i n t e r p r e t i v e method was adapted f o r t h i s study.  To be addressed are:  s e l e c t i o n o f p a r t i c i p a n t s , processes  of data c o l l e c t i o n , e t h i c a l c o n s i d e r a t i o n s and data a n a l y s i s .  S e l e c t i o n o f the Study Group Criteria for Participation As has been d e s c r i b e d , the s e l e c t i o n o f study p a r t i c i p a n t s was based on t h e i r a b i l i t y to address the t o p i c of the study.  As the data  c o l l e c t e d r a i s e d a d d i t i o n a l questions, new candidates o r groups were i n c l u d e d (see G l a s e r & Strauss, 1965; Lindemann, 1974). I n i t i a l c r i t e r i a f o r s e l e c t i o n were: -male and female teenagers o f high school age -healthy and not f o l l o w i n g a t h e r a p e u t i c d i e t -able to converse i n E n g l i s h -from middle c l a s s f a m i l i e s As the study progressed and as i n i t i a l interviews were analysed, i t became a concern that p a r t i c u l a r c h a r a c t e r i s t i c s o f the family might be i n f l u e n c i n g the teenagers' p e r c e p t i o n s . As teenagers described r a t i o n a l e s f o r t h e i r food behaviors they often r e f e r r e d to the mother as 34  35  a r o l e model and some q u a l i f i e d t h i s with "my mother who i s a nurse." Before a l l p a r t i c i p a n t s were chosen, two a d d i t i o n a l s e l e c t i o n c r i t e r i a were added so the researcher could explore more f u l l y the i m p l i c a t i o n s of these f a m i l y c h a r a c t e r i s t i c s .  The researcher a l s o chose to i n c l u d e an  e x t r a p a r t i c i p a n t i n the study. For these reasons, both the eighth and n i n t h study p a r t i c i p a n t s were s e l e c t e d according to the f o l l o w i n g additional c r i t e r i a . -not having a mother who was a nurse -not l i v i n g i n a s i n g l e parent f a m i l y Having i d e n t i f i e d c r i t e r i a f o r the s e l e c t i o n of p a r t i c i p a n t s , procedure f o r s e l e c t i o n and the c h a r a c t e r i s t i c s of the f i n a l group w i l l be d e s c r i b e d .  Procedure f o r P a r t i c i p a n t S e l e c t i o n The study p a r t i c i p a n t s were volunteers from f a m i l i e s recommended by f r i e n d s or acquaintances of the researcher.  The researcher had met  one of the p a r t i c i p a n t s p r i o r to the study. Although the teenagers were l e g a l l y minors and parental consent was r e q u i r e d , i t was considered important t h a t the teenager be involved in the d e c i s i o n making process.  To emphasize t h i s p o i n t , wording of the  consent l e t t e r was d i r e c t e d to the adolescent. A l e t t e r and consent form (Appendices A and B) e x p l a i n i n g the study were given to each p a r t i c i p a n t by a person known to themselves and the researcher.  The l e t t e r , as well as e x p l a i n i n g the study's  purpose,  i n d i c a t e d the researcher's d e s i r e to i n t e r v i e w and observe the teenagers in t h e i r homes.  I f the adolescents and t h e i r parent(s) agreed to  p a r t i c i p a t e , the researcher contacted them by telephone to provide  36 f u r t h e r c l a r i f i c a t i o n of the study's purpose, answer questions and to arrange an i n t e r v i e w time.  Interview times were then scheduled a t the  convenience of the boys or g i r l s and t h e i r f a m i l i e s .  C h a r a c t e r i s t i c s of the P a r t i c i p a n t s F i v e boys and f o u r g i r l s p a r t i c i p a t e d i n two i n t e r v i e w s e s s i o n s . T h e i r ages ranged from 13 years one month to 15 years ten months and they attended seven d i f f e r e n t high schools i n Vancouver and i t s surrounding suburban areas.  Three of the group were i n grade 8, two were  in grade 9, two were i n grade 10, and two were i n grade 11. A l l the teenagers p a r t i c i p a t e d i n a t l e a s t one, and sometimes three to f o u r , e x t r a c u r r i c u l a r i n t e r e s t s depending upon the season. While most were s p o r t s - r e l a t e d , such as hockey, b a s k e t b a l l , v o l l e y b a l l , swimming, c h e e r l e a d i n g , f l o o r hockey, or s k a t i n g , others i n c l u d e d music, dance and Sunday school t e a c h i n g .  Several teenagers had some source o f  revenue such as d e l i v e r i n g papers, b a b y s i t t i n g , mowing lawns, or working at gas s t a t i o n s or r e s t a u r a n t s . Although family s i z e v a r i e d , a l l of the p a r t i c i p a n t s l i v e d a t home with one or both parents and a l l had one or more s i b l i n g s . Two s i n g l e t r i a l i n t e r v i e w s were conducted a t the beginning of the study f o r the purpose of acquainting the researcher with the i n t e r v i e w technique. Two teenagers, aged 15 and 18 y e a r s , each p a r t i c i p a t e d i n one i n t e r v i e w . These two interviews c o n t r i b u t e d data to the study.  In c o n t r a s t to the r e s t of the p a r t i c i p a n t s , these two  teenagers were temporarily away from home. One was on v a c a t i o n with h i s f a m i l y and the other was s t a y i n g with f a m i l y f r i e n d s while attending a course i n Vancouver.  Both of these teenagers normally l i v e d with both  37 parents. One had several s i b l i n g s and one was an only c h i l d .  While some  of the p a r t i c i p a n t s interviewed i d e n t i f i e d with c u l t u r a l groups such as B r i t i s h and I t a l i a n , a l l were White. In the f i n a l a n a l y s i s the researcher came to question the apparent homogeneity of family c h a r a c t e r i s t i c s .  Three q u a l i t i e s were  dominant: the number o f working mothers, 9 out o f 11; the number of s i n g l e parent f a m i l i e s , 5 out o f 11; and the number o f mothers who were nurses, 6 out o f 11. The researcher chose to explore the c u r r e n t f a m i l y trends f o r these three c h a r a c t e r i s t i c s . That more women are working i s c l e a r l y documented ( S t a t i s t i c s Canada, 1976).  I f mothers are working, i t i s more l i k e l y that t h e i r  c h i l d r e n w i l l be o f school age, p a r t i c u l a r l y high school age. On the second p o i n t , Vancouver and i t s surrounding area i s estimated to have approximately 30,000 lone parent f a m i l i e s ( S t a t i s t i c s Canada, 1976).  While the family s i t u a t i o n s o f the study group may not be  considered r e p r e s e n t a t i v e o f a l l teenagers, the i n c l u s i o n of teenagers from s i n g l e and two parent f a m i l i e s i n t h i s study i s not i n c o n s i s t e n t with l o c a l trends. On the t h i r d p o i n t , i t would seem that mothers who were nurses were overrepresented i n the group.  I t was decided that teenagers'  perceptions o f t h e i r parents' r o l e i n t h e i r food behavior would be more c l e a r l y presented i f the researcher could explore whether expressed s i m i l a r i t i e s and d i f f e r e n c e s r e l a t e d to parental r o l e s or professional roles.  Trends i n the data and the need to address the  d e f i n e d purposes o f the study, c l a r i f y i n g with teenagers t h e i r p e r c e p t i o n s , were two more reasons f o r the w r i t e r s ' d e c i s i o n to i n c l u d e the extra p a r t i c i p a n t i n the study group.  38  Data C o l l e c t i o n Ethical Considerations In c a r r y i n g out a study one must ensure the r i g h t s of the i n d i v i d u a l p a r t i c i p a n t s . The p a r t i c u l a r r i g h t s i n question are those of informed consent, c o n f i d e n t i a l i t y and minimization of r i s k s or costs to participants. T h i s study was conducted c o n s i d e r i n g the d i r e c t i v e s of the U n i v e r s i t y of B r i t i s h Columbia E t h i c s Committee.  As has been d e s c r i b e d ,  a l l teenagers were f i r s t contacted by a person known to them.  The  study's purpose and the nature of t h e i r requested involvement was then d e s c r i b e d i n a l e t t e r from the r e s e a r c h e r . Written consent was obtained from the teenager and one parent. When the researcher re-contacted the teenagers f o r the second i n t e r v i e w , a l l teenagers and parents were asked i f they were i n t e r e s t e d in c o n t i n u i n g to p a r t i c i p a t e i n the study.  The researcher i n d i c a t e d they  were not under o b l i g a t i o n to do so. To maintain c o n f i d e n t i a l i t y , t r a n s c r i p t i o n s of tape r e c o r d i n g s d i d not i d e n t i f y the p a r t i c i p a n t s , and i f family names were mentioned on the tapes they were erased p r i o r to the t r a n s c r i p t i o n s .  Although i n the  process of data a n a l y s i s the researcher c o n s u l t e d with committee members and other graduate students f a m i l i a r with the method, i d e n t i t y of i n d i v i d u a l teenagers was not r e v e a l e d . The method of s e l e c t i o n of p a r t i c i p a n t s and the concern to maintain c o n f i d e n t i a l i t y presented some d i f f i c u l t y to the r e s e a r c h e r . Those who r e f e r r e d teengers were often i n t e r e s t e d i n e n q u i r i n g how the interview went.  Such s i t u a t i o n s were managed best by i n d i c a t i n g the  39 researcher's concern to not breach the c o n t r a c t e s t a b l i s h e d with the adolescents and t h e i r f a m i l i e s .  I t was u s u a l l y i n d i c a t e d that the  teenager had been a h e l p f u l p a r t i c i p a n t . In the process of the study the teenagers and t h e i r f a m i l i e s c o n t r i b u t e d a great deal by g i v i n g up t h e i r time and accommodating the researcher in t h e i r homes. While the b e n e f i t s to i n d i v i d u a l  teenagers  were not assessed, i t was of i n t e r e s t to note that comments made to r e f e r r i n g i n d i v i d u a l s i n c l u d e d several which i n d i c a t e d such made the teenagers feel "quite s p e c i a l . "  involvements  Thus, the researcher might  assume that the experience f o r the m a j o r i t y was perceived to have had some p o s i t i v e outcomes.  Data C o l l e c t i o n Procedure The teenagers were interviewed i n t h e i r homes on two occasions during the l a t e summer and e a r l y f a l l , 1981. collected.  Two forms of data were  Audiotapes of i n t e r v i e w s formed one category of data and hand  recorded notes of the i n t e r v i e w e r ' s observations formed the second. The data c o l l e c t e d during interviews and observations were guided by the three study purposes.  An i n t e r v i e w schedule was not employed.  The study purpose was d e s c r i b e d to the teenagers and i t was suggested to them they might begin by d e s c r i b i n g what they d i d i n a t y p i c a l  day.  Combined i n t e r v i e w - o b s e r v a t i o n times ranged from one to three hours.  Tapes of the i n t e r v i e w p e r i o d alone ranged from 30 to 60 minutes.  Each i n t e r v i e w was t r a n s c r i b e d and a n a l y s i s of i t d i r e c t e d the researcher in seeking c l a r i f i c a t i o n or i n t e r p r e t a t i o n of accounts in subsequent interviews.  Spradley (1979) c o n s i d e r s the best source of data f o r  ethnographic d e s c r i p t i o n s to be f u l l y t r a n s c r i b e d tape recorded  40 interviews. The interview process as i t has been i n i t i a l l y described has  two  boundaries or dimensions.  One i s i t s focus, that i s , on food  behaviors  and b e l i e f s of teenagers.  The second i s i t s p e r s p e c t i v e , that i s , a goal  of the interview i s f o r the researcher to i d e n t i f y teenagers' points o f view or s u b j e c t i v e impressions of events or t o p i c s r e l a t e d to t h e i r food patterns. Although the interviews had these boundaries,  i t was  the  i n t e n t i o n of the interviewer to allow the teenager to provide the d i r e c t i o n and the s t r u c t u r e .  I t i s an assumption of the method that each  p a r t i c i p a n t w i l l have d e f i n i t i o n s or impressions that d i f f e r from those of the researcher.  Allowing the teenager to define the p e r t i n e n t  thoughts and issues f a c i l i t a t e d t h i s task of d e s c r i b i n g the perspectives.  teenagers'  The r o l e of the researcher in the interview has been  described as an a c t i v e one.  The researcher, once given a general view,  seeks c l a r i f i c a t i o n by r e f l e c t i n g upon i t , c o n t r a s t i n g i t with her  own  view, or asking the teenager to make comparisons with other views presented.  Thus, the interview process i s one i n which the researcher  participates.  She follows the lead taken by the subject,  as well as  r e f l e c t i n g upon the subject's comments and her own i n t e r p r e t a t i o n s of those comments. Observations c o n t r i b u t e d to the enrichment of data c o l l e c t e d in two ways. The f i r s t c o n t r i b u t e d to the researcher's understanding teenagers'  "taken f o r granted" knowledge or f u n c t i o n i n g .  of  The second was  the researcher's need f o r knowledge of what Schutz (.1970) describes as the o v e r a l l plan. Observations were made in the time spent with the teenager and d i f f e r e n t family or household members p r i o r to, during  41 and a f t e r the i n t e r v i e w s took p l a c e .  Although on occasion o b s e r v a t i o n s  were recorded simultaneously, most recordings were made immediately a f t e r the i n t e r v i e w . These observations c o n t r i b u t e d awareness o f both unspoken r o u t i n e s and those that had been more r e a d i l y d e s c r i b e d .  The study  method i s dependent upon both the teenager's a b i l i t y to describe and the researcher's a b i l i t y to achieve understanding of the intended meaning. Some teenagers r e l a t e d d a i l y experiences with greater f a c i l i t y than others.  Observations c o n t r i b u t e d to the researcher's a b i l i t y to  formulate questions which were more r e l e v a n t to each s i t u a t i o n . T h i s might include asking teenagers to rank i n t e r e s t s or place them i n t o the context of their larger social l i f e .  The o b s e r v a t i o n p e r i o d on occasion  provided the opportunity f o r the researcher to compare statements made by the teenager with r e s p e c t to behaviors and actual behaviors  observed.  In order to meet the second g o a l , t h a t of c o n t r i b u t i n g to the researcher's understanding of the o v e r a l l p i c t u r e , the researcher spent time varying from 30 minutes t o 3 hours with the teenagers and others present i n the household.  On o c c a s i o n , a t t e n t i o n was focused on  p a r t i c u l a r meal behavior.  At other times, the researcher p a r t i c i p a t e d i n  d i s c u s s i o n s o f the adolescents' i n t e r e s t s and a c t i v i t i e s a t home and school, family p r o j e c t s and understanding how the teenagers spent t h e i r time. Data A n a l y s i s Data a n a l y s i s was based on the p r i n c i p l e s of constant analysis.  comparative  This technique d i r e c t s the researcher to examine data  c o l l e c t e d f o r basic patterns and to v a l i d a t e patterns or  42  c o n c e p t u a l i z a t i o n s by seeking c l a r i f i c a t i o n from the study group or i n the research s e t t i n g . As such, the processes of data c o l l e c t i o n and a n a l y s i s are i n t e r t w i n e d . In t h i s study, the researcher was guided by the i n i t i a l three purposes, that i s , the d e s c r i p t i o n of teenagers' perceptions of food and the value placed upon food.  As each i n t e r v i e w was conducted, the data  were examined f o r themes and patterns and these d i r e c t e d subsequent i n t e r v i e w i n g and a n a l y s i s . Several emerging themes may be remarked upon. A f i r s t i s r e l a t e d to t e r m i n o l o g i e s .  Terms such as "junk food," "good  food," "normal food," "healthy food," and "balanced meal" a l l held s p e c i a l meaning f o r each teenager.  The e x p l o r a t i o n of these concepts  allowed the researcher access to the teenagers' reasoning and i t was by e x p l o r i n g these patterns t h a t new i n t e r p r e t a t i o n s of data emerged.  Both  in a n a l y s i n g c o l l e c t e d data and during the interviews the researcher explored the nature of apparent i n c o n s i s t e n c i e s and c o n t r a d i c t i o n s i n accounts to make sense of them. Themes which began to develop and c o n t r i b u t e d to f u r t h e r development of the c o n c e p t u a l i z a t i o n of the meaning of food behaviors r e l a t e d to the e x p l o r a t i o n of f a m i l y patterns for transmission of "food ways," the expectations of teenagers i n f a m i l i e s , the r o l e of s i g n i f i c a n t others in the formation of b e l i e f s , and the r e l a t i o n s h i p of knowledge and b e l i e f s to p r a c t i c e . In presenting the data, the goal was to organize the teenagers' accounts in a way t h a t would be c o n s i s t e n t with how the teenagers  viewed  t h e i r s i t u a t i o n s , as well as in a form that might be useful to health professionals.  Despite t h i s i n t e n t i o n , one must note t h a t the  p r e s e n t a t i o n of accounts represents the w r i t e r ' s i n t e r p r e t a t i o n s of the teenagers'  accounts.  43  Summary The method used to address the study problem i s derived from the interpretive school.  Three c h a r a c t e r i s t i c s of the study method make i t  p a r t i c u l a r l y appropriate.  These are; s e l e c t i o n o f p a r t i c i p a n t s , the  processes o f data c o l l e c t i o n and the r e l a t i o n s h i p between data c o l l e c t i o n and data a n a l y s i s . S e l e c t i o n c r i t e r i a were e s t a b l i s h e d i n order to i d e n t i f y a group of teenage subjects with c e r t a i n common c h a r a c t e r i s t i c s .  In t h i s study  method data a n a l y s i s i s ongoing and may d i r e c t the researcher to i n c l u d e extra p a r t i c i p a n t s exemplifying d i f f e r i n g c h a r a c t e r i s t i c s .  Based on data  analysed e a r l y i n t h i s study, the researcher chose to r e f i n e the c r i t e r i a and augment the group s i z e . Data were c o l l e c t e d employing both interviews and o b s e r v a t i o n s . The interviews had as t h e i r focus the i d e n t i f i c a t i o n of each i n d i v i d u a l ' s way o f t h i n k i n g about the t o p i c o f food r a t h e r than the c a t e g o r i z a t i o n o f h i s or her knowledge about food. s u b s t a n t i a l l y from others.  In t h i s way, the method d i f f e r s  The interviews were d i r e c t e d by what the  adolescent p a r t i c i p a n t s perceived was important to share.  This type o f  data c o l l e c t i o n process allowed the teenagers to i d e n t i f y issues or ideas they perceived to be r e l e v a n t to t h e i r food behaviors.  In t h i s way, they  c o n t r i b u t e d the type o f information sought by the researcher as defined by the study's purposes.  The observations and second interviews allowed  the w r i t e r to i d e n t i f y c o n s i s t e n c y i n behaviors and accounts and provided the opportunity to c l a r i f y i n t e r p r e t a t i o n s . In the study method used, data c o l l e c t i o n and a n a l y s i s occurred concurrently.  The a c t i v i t i e s o f l i s t e n i n g , r e f l e c t i n g upon comments,  44  a s s e s s i n g the nature of s i m i l a r i t i e s and d i f f e r e n c e s , i n t e r p r e t i n g accounts, and then r e t u r n i n g to the teenagers f o r f u r t h e r c l a r i f i c a t i o n represent the major elements of the combined processes of data c o l l e c t i o n and a n a l y s i s .  T h i s aspect of the study method d i f f e r s s u b s t a n t i a l l y from  other methods but i t i s t h i s process which i s seen to be most a p p r o p r i a t e in c o l l e c t i n g the type of information necessary to address the purposes of t h i s study.  Chapter IV PRESENTATION AND DISCUSSION OF ACCOUNTS  T h i s chapter d e s c r i b e s the processes i n v o l v e d as the researcher moved through the research process from the f i r s t stage of data c o l l e c t i o n to the l a t t e r stages o f c o n c e p t u a l i z a t i o n . The process of data c o l l e c t i o n and a n a l y s i s i n i n t e r p r e t i v e s t u d i e s such as t h i s one a r e intertwined.  The f i r s t t o p i c addressed i s the c o n s t r u c t i o n of accounts.  Included i n t h i s d e s c r i p t i o n are examples o f how i n i t i a l data, once analysed, c o n t r i b u t e d to f u r t h e r data c o l l e c t i o n .  The r e l a t i o n s h i p  between t h i s data c o l l e c t i o n process and the i d e n t i f i e d study purposes i s the second t o p i c addressed. accounts.  The t h i r d t o p i c i s the p r e s e n t a t i o n of  In p r e s e n t i n g accounts the researcher attempts to make  e x p l i c i t how the teenagers made sense of information presented to them. How the a c t i v i t i e s i n which the adolescents were i n v o l v e d c o n t r i b u t e d to the development of t h e i r p a r t i c u l a r frameworks or plans of a c t i o n f o r t h e i r food behaviors i s also d i s c u s s e d . As a r e s u l t of d e s c r i b i n g how teenagers were seen to develop t h e i r frameworks, the researcher describes c h a r a c t e r i s t i c s of two d i f f e r e n t patterns of food behaviors.  C o n s t r u c t i o n o f Accounts It has been described t h a t the i n t e r v i e w process c o n t r i b u t e d to the researcher's understanding o f the p a r t i c i p a n t s ' perceptions and 45  46  points of view.  This process i n v o l v e d both members of the i n t e r a c t i o n .  Preconceptions of nurses and nurses' knowledge of food seemed to l e a d some subjects to expect that the researcher might in some way be e v a l u a t i n g t h e i r d i e t s or a s s e s s i n g t h e i r knowledge.  In the second  s e r i e s of i n t e r v i e w s the researcher chose to explore questions p e r t a i n i n g to these e x p e c t a t i o n s . While the teenager might have ideas of what to expect of nurses or guests, researchers were another matter.  Several teenagers were  i n t e r e s t e d to know what kinds of i n f o r m a t i o n would be u s e f u l , how the information gathered might be used and i f they had answered the questions thoroughly enough. eager to be h e l p f u l .  In e f f e c t , most teenagers and t h e i r f a m i l i e s were As such, one might assume that at times they were  attempting to provide what they p e r c e i v e d the researcher to be l o o k i n g for. As the study evolved, the a n a l y s i s of the data d i r e c t e d the researcher to seek c l a r i f i c a t i o n and e v a l u a t i o n of her i n t e r p r e t a t i o n s . I n t e r a c t i o n s between the researcher and p a r t i c i p a n t s then changed somewhat because of the researcher's developing way of l o o k i n g at the situations. As i t has been i n d i c a t e d , the goal of the i n t e r v i e w was to allow the teenagers to present t h e i r perceptions without undue i n t e r f e r e n c e . While t h i s was e a s i l y accomplished in most i n t e r v i e w s , i t presented d i f f i c u l t i e s i n two types of s i t u a t i o n s .  As the researcher summarized or  made i n f e r e n c e s from the data, these had to be v a l i d a t e d with i n d i v i d u a l teenagers.  Spradley (1979) cautions that one must guard a g a i n s t  47  transforming the p a r t i c i p a n t s ' meanings to the language of the researcher.  T h i s might occur n a t u r a l l y when the researcher f a i l s to  recognize the d i f f e r e n c e s in meaning between the teenagers' use of a term and her own.  The i n t e r v i e w process, then, included the researcher's  developing awareness of her own assumptions situations.  or expectations i n d i f f e r e n t  Mutual e x p l o r a t i o n was an important part of the  " C o n s t r u c t i o n of Accounts." For example, in the i n i t i a l interviews teenagers often employed the term "junk food" as they described what they or others might eat. I n i t i a l assumptions  of the researcher about what t h i s food category might  be were r e l a t e d to preconceived notions and how°"junk food" had been d e f i n e d i n n u t r i t i o n s t u d i e s . I t became c l e a r that the teenagers had d i f f e r i n g perceptions of t h i s type of food.  As the inteviews progressed,  i f the teenager introduced the term, the researcher asked f o r an elaboration.  If the teenager d i d not introduce the word then the  researcher asked the teenager to comment on the "junk food" concept or enquired i f i t might be f a i r to include foods that had already been described as "unhealthy" or "bad" i n such a category. A second s i t u a t i o n where i t was d i f f i c u l t not to d i r e c t responses occurred when the teenager had d i f f i c u l t y e x p l a i n i n g what was meant by an expression, or d i f f i c u l t y in i d e n t i f y i n g patterns that were so much a part of the everyday experience they were not considered remarkable to note.  The researcher managed t h i s s i t u a t i o n in two ways.  One technique was to ask the teenagers to make comparisons  between t h e i r  behaviors and those of other groups such as same and opposite sex  48  f r i e n d s , s i b l i n g s , or adults or t h e i r behaviors at d i f f e r e n t times and i n d i f f e r e n t s e t t i n g s . Such c o n t r a s t s e l i c i t e d perceptions o f elements which were important, d i f f e r e n t , or the same. Another technique f o r understanding what the teenagers might have meant was to explore why a p a r t i c u l a r word was used and i n what context, an approach recommended by Spradley (1979).  The researcher's  observations also c o n t r i b u t e d to the u n r a v e l l i n g of meaning i n these situations.  At d i f f e r e n t points i n the i n t e r v i e w , the researcher might  comment on or seek i n t e r p r e t a t i o n s of the teenager's a f f e c t .  This o f t e n  introduced new dimensions to the d i s c u s s i o n . As well as p r o v i d i n g the researcher with the opportunity to observe food behaviors, f e e l i n g s about the t o p i c o f food might be voiced or personal concerns introduced.  R e l a t i o n s h i p o f "Accounts" to the Study's  Purposes  Accounts were constructed i n order to c o n t r i b u t e to an understanding o f teenagers' r a t i o n a l e s f o r t h e i r food behaviors. order to do t h i s , three study purposes were i d e n t i f i e d .  Each  In  purpose  d i r e c t e d the researcher to seek p a r t i c u l a r kinds of information with respect to teenagers' b e l i e f s and food behaviors.  As a r e s u l t of the  information gained by i n t e r v i e w i n g teenagers about t h e i r perceptions o f food and by observing them i n s e l e c t e d s i t u a t i o n s at s e l e c t e d times, the researcher developed an understanding of teenagers' perceptions o f t h e i r food behaviors.  The accounts were i n t e r p r e t e d and organized to i d e n t i f y  processes i n v o l v e d i n d e c i s i o n making and to describe two conceptual categories.  49 I n t e r p r e t a t i o n s of Accounts An important observation i n t h i s study was that there were i m p l i c i t frameworks guiding the teenagers' reasoning processes concerning t h e i r food behaviors.  A f i r s t goal i n presenting the accounts i s to  d e s c r i b e how the teenagers used t h e i r frameworks i n making sense of their daily situations.  I t has already been noted that Kleinman  (1978a)  d e s c r i b e s i n d i v i d u a l s or c l i e n t s i n the health care system as having "explanatory models" which help them to understand t h e i r i l l n e s s experience.  One might c o n s i d e r the frameworks being d e s c r i b e d i n t h i s  study to be comparable to these "explanatory models." Three p a r t i c u l a r a c t i v i t i e s which c o n t r i b u t e d to the development o f the frameworks are described.. These i n c l u d e d the teenagers' i n t e r p r e t a t i o n s of cues and the use of knowledge, the comparison  of  themselves with others and the conceptual l i n k s seen between i s s u e s of personal concern and food behaviors.  There were s i m i l a r i t i e s i n how  several teenagers thought about foods or the e f f e c t s of foods on themselves or o t h e r s .  Observations of such s i m i l a r i t i e s and d i f f e r e n c e s  l e d to the e l a b o r a t i o n of c a t e g o r i e s . Two c a t e g o r i e s or patterns of t h i n k i n g about food behaviors with d e s c r i p t i o n s of how they were seen to i n f l u e n c e r e s u l t i n g behaviors were formulated.  The patterns which have been l a b e l l e d " c o n v i c t i o n s " and  "convenience" w i l l be presented and t h e i r i m p l i c a t i o n s d i s c u s s e d . p r e s e n t a t i o n of accounts w i l l flow from general observations to the development of these s p e c i f i c c a t e g o r i e s .  The  50  I n t e r p r e t i n g Cues and Applying Knowledge A general and, indeed, u n i v e r s a l view held by the teenagers p a r t i c i p a t i n g i n the study was t h a t they a l l viewed t h e i r food behaviors positively.  They employed terms l i k e "good," "healthy," or "average" to  d e s c r i b e t h e i r own s i t u a t i o n s .  That i s , although some teenagers might  r e p o r t they had some p a r t i c u l a r l y "good" or p a r t i c u l a r l y "bad" behaviors, t h e i r o v e r a l l assessment was t h e i r food behaviors were "okay." How d i d the teenagers develop t h i s view?  As the i n t e r v i e w s  progressed the researcher became aware of the v a r i e t y and types of cues and events c i t e d by the teenagers to support the development of t h e i r r a t i o n a l e s f o r a c t i n g . An example of cues to which the adolescents might attend was the response of t h e i r bodies to p a r t i c u l a r foods or activities.  In essence, the researcher became aware of some of the  processes i n v o l v e d as the teenagers came to t h e i r d e f i n i t i o n s of "normal," "healthy" or "good." I t has been suggested that i n d i v i d u a l s respond to or i d e n t i f y cues i n making food d e c i s i o n s or l o o k i n g f o r consequences behaviours.  to food  The kinds of cues and meanings a t t r i b u t e d to the cues were  many and v a r i e d . During an i n t e r v i e w , one adolescent both described a p a r t i c u l a r p a t t e r n of food behaviors and discussed the reasoning behind it.  The f o l l o w i n g account i s a comment on information that had been  shared which apparently suggested that some patterns of e a t i n g were more healthy than others and might make one feel b e t t e r . How t h i s teenager responded to behavioral d e s c r i p t i o n s may be noted: T:  I t doesn't seem to make any d i f f e r e n c e  51 so why bother with i t anyways? how most people f e e l .  It's j u s t  R:  L i k e what kind of d i f f e r e n c e s would you look for?  T:  Well I mean, the way people describe junk food compared to normal food?  R: Yes T:  Somebody who eats a l o t o f junk food would be walking around, you know, eyes a l l j e r k y , and kinda, sagging along, and somebody who eats r e g u l a r food w i l l be running along. You know, that's the kind o f d i f f e r e n c e you'd expect i f you l i s t e n e d to a l o t o f people ( l a u g h s ) .  Discussion such as t h i s suggested  to the w r i t e r that i n t h i s  instance the teenager was operating from a framework which questioned the v a l i d i t y and c r e d i b i l i t y of conveyed knowledge.  His i n t e r p r e t a t i o n s i n  t h i s instance suggested the consequences o f e a t i n g some foods were exaggerated.  The i n t a n g i b l e nature of some of the c r i t e r i a measuring  h e a l t h i n e s s might be considered one source o f the problem.  Another  teenager seems to have examined her own s i t u a t i o n quite c l o s e l y l o o k i n g f o r cues r e l a t e d to healthy and unhealthy eating patterns: T:  ...when I went dancing there was a l o t o f e x e r c i s e i n v o l v e d . . . i t was more l i k e t i g h t e n i n g and toning o f muscles, not so much i n l o s i n g weight ...So when I d i d dance according to the foods that I a t e I c o u l d r e a l l y feel the d i f f e r e n c e . You know, i f I went out and ate a l o t o f p i z z a or, uh, pies and s t u f f l i k e t h a t , I could r e a l l y t e l l by the way my body reacted a f t e r I had e x e r c i s e d .  R:  L i k e what?  52  T:  Well I'd r e a l l y f e e l , uhm, b l a h , you know more pep more energy things l i k e t h a t . ( I f we ate p i z z a f i r s t ) . . . b y the time we were ready to go home i t was l i k e , ohh, I need some water, I need a glass of coke, I need t h i s . Other times I'd j u s t have a nice q u i e t dinner at home with r e g u l a r , meat, vegetables, potatoes and by the time we were f i n i s h e d , an apple would s a t i s f y my t h i r s t .  This second account, l i k e the f i r s t , suggests that the teenagers examine and present reasons f o r a c t i n g as they do.  Both of these  accounts, l i k e o t h e r s , present views of what i s "normal" or " r e g u l a r " food.  Both of these teenagers i d e n t i f i e d cues which would be d i f f i c u l t  to measure but nonetheless c o n t r i b u t e d to t h e i r developing c o n v i c t i o n s about food. Both of the teenagers looked f o r cues i n terms of t h e i r body's response.  I t would seem t h e i r i n t e r p r e t a t i o n s were l i m i t e d e i t h e r  by the extensiveness of t h e i r knowledge or by a c c e p t i n g l i t e r a l  meanings  which were presented to them. The process of developing a r a t i o n a l e f o r a c t i n g was an a c t i v e one.  The teenagers were seen to be t e s t i n g a c t i o n s , consequences and  weighing a l t e r n a t i v e s . feedback was  Sometimes, as i n the f o l l o w i n g i n s t a n c e , the  immediate:  T:  i f you have to have energy, l i k e i n b a s k e t b a l l , I get cramps i f I don't eat.  R:  Stomach  T:  Yes, I get r e a l l y bad cramps but l i k e that's what happens so I can't skip i t (lunch) 'cause I feel r e a l l y bad.  cramps?  The three previous accounts suggest that the teenager's body might a c t as a moderator f o r i n f o r m a t i o n or knowledge he or she might  53  have r e c e i v e d . As such, the boys and g i r l s i n t e r p r e t e d t h e i r bodies' responses to foods w i t h i n the context of t h e i r knowledge about food. Some teenagers a c t i v e l y sought d i e t a r y information or advice from sources such as t h e i r mother, p h y s i c a l education teacher or l i b r a r y books.  Their  purposes appeared to be the d e s i r e to gain knowledge of how they might modify food behaviors.  Some reasons presented f o r doing t h i s were to  increase r a t e s o f growth, decrease weight or achieve a higher l e v e l o f f i t n e s s . Despite the teenagers' choices to seek information they s t i l l described that they " t e s t e d " i t out.  As a r e s u l t of such t e s t i n g , some  adopted new food behaviors as suggested and others s e l e c t e d some elements of the change which they viewed to be most h e l p f u l or e a s i e s t to maintain. In the next account a boy i s commenting on how he a r r i v e d a t the d e c i s i o n to i n s t i t u t e changes i n h i s food behaviors: T:  urn, How d i d I g e t there? Probably because one day I j u s t decided and I asked my mom. S t a r t e d asking my mom, since she's a nurse, what would be good f o r me and how I could g e t slimmer and what foods you should s t i c k with and she gave me some answers and I kept asking her and asking her.  Other teengers s e l e c t e d elements o f advice or information viewed to be most h e l p f u l or perhaps e a s i e s t to maintain: T:  I t r y r e a l l y hard, I was on a, well not r e a l l y a doctor's d i e t , but t h i s d i e t out of a book. And I d i d n ' t f o l l o w i t e x a c t l y or anything, but i t was more or l e s s . I t r i e d to have meats and vegetables and a l o t of s a l a d and water. And a l o t of f r u i t s in between i f I was hungry f o r my between meal snacks. And my energy l e v e l was r e a l l y good and I was f e e l i n g r e a l l y good, about i t .  54  R:  uh  hum  T:  And then something would change, you know change my, r o u t i n e , you know l i k e I would go away l i k e f o r a weeks v a c a t i o n , somewhere ...things l i k e that and then I s t a r t e d e a t i n g differently.  The t e s t i n g of knowledge was something a l l of the teenagers d i d . It appeared that on occasion information acted to r e i n f o r c e the maintenance of food behaviors or provided teenagers with a new awareness of reasons behind recommended or family p a t t e r n s . Some teenagers described that they sought new i n f o r m a t i o n , and as such might be described as being more open to i n c l u d i n g information from other sources.  The way they discussed t h e i r behaviors included  references to these d i f f e r e n t sources of i n f o r m a t i o n .  Several  adolescents had problems with acne; such problems might prompt them to seek help: T:  Well e a t i n g too much sugar gives me ' z i t s . And so now I'm t r y i n g to cut down on sugar and eat more things that w i l l help. L i k e , the head guy at the gym t o l d me there's l o t s of s t u f f that I can eat i n s t e a d of sugar, l i k e natural sugar. Oranges and apples and s t u f f i n s t e a d of man made sugar. He says those work j u s t as well except you have to eat more. 1  This l a t t e r account demonstrates an instance where the teenager expanded information on which d e c i s i o n s to act were based and information from an outside source.  has sought  Rationales f o r a c t i n g i n c l u d e t h i s  information. On the other hand, there were adolescents who seemed to place l e s s value on knowledge from other sources and r e l i e d more on t h e i r own  55  measurements of success as they decided they had "good," "normal" or "healthy" food behaviors.  Despite d i f f e r e n c e s i n the number of  information sources s e l e c t e d , a l l set l i m i t s on the nature of the information they would c o n s i d e r .  Such l i m i t s might be based e i t h e r on  the teenagers' d e c i s i o n s that t h e i r behaviors were "okay," or t h e i r perceptions of the c r e d i b i l i t y of the information source. To t h i s p o i n t , the d i s c u s s i o n suggests the p a r t i c i p a n t s i n the study had p a r t i c u l a r ways of employing about t h e i r food behaviors.  knowledge as they made d e c i s i o n s  They had varying amounts of knowledge and  some were seen to be seeking out or using t h i s knowledge more than others. In d i s c u s s i n g the C o n s t r u c t i o n of Accounts i t was suggested  that  one type of food which held d i f f e r i n g meanings f o r each p a r t i c i p a n t i n the study was "junk food."  An examination of some of the teengers'  d e f i n i t i o n s of t h i s concept supports the view that the developed  teenagers  t h e i r notions not only from information from others, but also  from t h e i r own T:  experiences: I t ' s not good f o r you, i t hasn't got the p r o t e i n and a l l t h a t . That's c a l l e d junk food, that's why i t t a s t e s good. ...No junk food doesn't r e a l l y hurt me 'cause I guess I eat what I'm supposed to a l s o . I t gives me the c a l o r i e s . I f I d i d n ' t eat junk food with a l l those c a l o r i e s , I'd j u s t be a toothpick, worse than I am r i g h t now.  The idea that teenagers s e l e c t e d out knowledge which was useful or a p p l i c a b l e to them i s portrayed in the l a t t e r account.  Not only did t h i s  adolescent have a d e t a i l e d view of "junk food" but the account a l s o  56  suggested why, d e s p i t e information to the c o n t r a r y , the adolescent f e l t the food was a l r i g h t to eat.  I t becomes c l e a r from t h e i r d e f i n i t i o n s  t h a t they a l l have some ideas about foods which r e a l l y are not healthy and should be avoided.  An account which presents foods i d e n t i f i e d as  "okay" or "good" and "bad" f o l l o w s . The teenager was prepared to l i m i t intake of sugar, but considered i t l u d i c r o u s that popcorn might be considered "junk food" by o t h e r s . One argument presented i s based on absence o f media support. The strength o f the p o s i t i o n taken i s supported by suggesting the u n l i k e l y but grave consequences of cancer o r death: T:  Well popcorn's never done anything to me, so. I've never heard...you see headlines saying sugar i s b l a , b l a , b l a , but then you don't see popcorn k i l l s you or popcorn causes cancer i n the head o r anything l i k e t h a t , so.(laughs)  As one examines accounts of the teenagers' reasoning p a r t i c u l a r l y when viewed out o f context, one might question i f indeed any notions or a c t i o n s are based on knowledge or l o g i c .  One would think i f a l l i s  l o g i c a l t h a t everyone would agree on what are "good" or "bad" foods or food behaviors.  Instead, i t appears that when i n d i v i d u a l s are faced with  ambiguous cues or are r e q u i r e d to o v e r g e n e r a l i z e knowledge, plans of a c t i o n are developed which decrease ambiguity and d i r e c t d a i l y decision-making. Two sources which c o n t r i b u t e to the development of reasoning have been i d e n t i f i e d .  They are the i n t e r p r e t a t i o n of cues and the use o f  knowledge. Other a c t i v i t i e s were seen to c o n t r i b u t e to the development of the teenagers' r a t i o n a l e s f o r a c t i n g . These w i l l be addressed i n the s e c t i o n s which f o l l o w .  57  The Process o f Comparing Oneself to Others The second s e t of a c t i v i t i e s which provided teenagers with r a t i o n a l e s f o r concluding t h e i r food behaviors were "good" r e l a t e s to t h e i r comparison of themselves with o t h e r s .  As the adolescents defended  t h e i r stance they d e s c r i b e d t h a t they compared t h e i r food behaviors with those of others such as f a m i l y members, a d u l t s , peers and perhaps athletes.  As they compared themselves, they might choose a  c h a r a c t e r i s t i c of the other they would l i k e to emulate or avoid, and hence commented on the d i e t : T:  Well they (food habits) aren't t h a t good, they're j u s t average. But I don't think they're any worse than most other people's. W e l l , even my own parents. L i k e I don't eat t h a t much d i f f e r e n t . I have the same lunches p r a c t i c a l l y , I have the same dinners, the same b r e a k f a s t s .  One can see from t h i s account t h a t c h a r a c t e r i s t i c s are not always c l e a r l y r e l a t e d to consequences  of diet.  In t h i s i n s t a n c e , the f a c t the  behaviors are as good as those of the a d u l t s provides support f o r the teenager's argument t h a t i t i s i n a p p r o p r i a t e f o r adults to c r i t i c i z e teenagers' food behaviors. In other i n s t a n c e s , d i f f e r e n c e s between the teenager's own response to foods and the responses of others c o n t r i b u t e d to the development o f notions concerning concepts such as varying metabolic r a t e s , or p r e d i s p o s i t i o n to c e r t a i n c h a r a c t e r i s t i c s such as " f a t n e s s " o r " t h i n n e s s , " through h e r e d i t y . While some teenagers might accept a  58  p r e d i s p o s i t i o n to being t a l l or f a t , they also compared t h e i r behaviors to those of others i n the hopes of achieving in a fashion s i m i l a r to that of t h e i r r o l e model: T:  When you become a teenager, you kind of want to be as t a l l as everybody or as strong as everybody and you t r y and f i g u r e out what would be the best foods that you could eat to get you to be l i k e the person you'd want to be. Let's see, the guy that won the decatholon, in the United S t a t e s , i n the Olympics, Bruce Jenner. Well, he had his name on Weetabix, Wheaties, you know the s t u f f , and everybody j u s t went out and bought Wheaties, 'cause they thought oh wow, l e t ' s eat cereal and be j u s t l i k e Bruce Jenner.  Although a l l the teenagers i n the study possessed information and compared themselves  to others, i t would seem that they did so f o r varying  purposes and from d i f f e r i n g p e r s p e c t i v e s . a t h e l e t e f o r h i s success i n s p o r t s .  This teenager admired the  I t i s a l s o evident in the account  that the boy was a c t i v e l y t r y i n g to f i g u r e out what would make him at l e a s t as t a l l or strong as o t h e r s .  Food presents i t s e l f as something  which can c o n t r i b u t e to the d e s i r e d goals. Another dimension or boundary in the information s i f t i n g process p e r t a i n s to what the w r i t e r has l a b e l l e d issues of personal  concern.  Information s i f t i n g p e r t a i n s to the teenagers' c o n s i d e r a t i o n of information i n l i g h t of such things as b o d i l y responses or habits of themselves  and o t h e r s .  Conceptual Links between Behaviors and Issues of Personal Concern Not only d i d the teenagers seek out or l i m i t the types of knowledge they perceived to be useful and base on them some assessments  59  of t h e i r own behaviors or the behaviors of o t h e r s , but they also d e f i n e d areas o f focus depending upon issues seen to be o f personal  importance.  Issues o f personal concern helped the teenagers to d e f i n e what food behaviors were most important to maintain or modify. A l l the teenagers c i t e d at l e a s t one, and most teenagers c i t e d more than one, o f three personal i s s u e s which they considered to i n f l u e n c e t h e i r food d e c i s i o n s . These were body image, f r i e n d s and sports.  While one may not assume that these were the only i s s u e s of  concern to the teenagers i n the study, they d i d c o n t r i b u t e i n important ways to the p a r t i c u l a r food behaviors of the teenagers s t u d i e d . For example, body image concerns were almost u n i v e r s a l although they v a r i e d . Most teenagers wished to lose weight or maintain t h e i r weight.  Some teenagers wished to b u i l d c e r t a i n muscles and others had  concerns about t h e i r s k i n , teeth or height. Why these i s s u e s were of concern was q u i t e u n r e l a t e d to food. however, was c l e a r .  T h e i r importance to the teenagers,  They perceived t h a t how one looked i n f l u e n c e d one's  r e l a t i o n s h i p s with f r i e n d s and one's f e e l i n g s about o n e s e l f . Food or p a r t i c u l a r food behaviors were seen as instrumental i n r e s o l v i n g these i s s u e s . As teenagers described how they made d e c i s i o n s about what they ate they employed v a r y i n g c r i t e r i a .  The p a r t i c i p a n t s  described t r i a l periods of t e s t i n g p a r t i c u l a r foods, e l i m i n a t i n g foods, or adopting meal p a t t e r n s and a s s e s s i n g the e f f e c t s i n terms of the d e s i r e d outcome. When the outcome was not e a s i l y or r e a d i l y achieved, the teenagers sometimes d e s c r i b e d that they weren't convinced the p a r t i c u l a r food was c o n t r i b u t i n g to the problem or that they had sought  60  a d d i t i o n a l s o l u t i o n s . Such s o l u t i o n s might include e x e r c i s i n g , or the a d d i t i o n o f s p e c i a l foods or vitamins to the d i e t . Teenagers had more or l e s s comprehensive problems o r addressing issues o f concern.  approaches to s o l v i n g  Some focussed on the a d d i t i o n  or e l i m i n a t i o n of a p a r t i c u l a r food, while others emphasized versus food,  activity  and s t i l l others s t r o v e more c o n s c i o u s l y to achieve some  type o f o v e r a l l balance.  As such, the observed behaviors and expressed  r a t i o n a l e s ranged i n complexity. A second personal i s s u e o f concern to teenagers i n the group s e l e c t e d was the need to have f r i e n d s . To have f r i e n d s was most f r e q u e n t l y c i t e d as the most important or most valued thing f o r the boys and g i r l s i n the study.  The idea that not having f r i e n d s r e f l e c t e d on  the i n d i v i d u a l i n a negative way was introduced as w e l l . The d e s i r e to have f r i e n d s was seen to i n f l u e n c e the teenagers' food behaviors and perceptions o f food.  As they contemplated what would  c o n t r i b u t e to the development of f r i e n d s h i p s , the adolescents considered f a c t o r s such as body s i z e or weight, a t h l e t i c a b i l i t y , academic looks, and common i n t e r e s t s .  ability,  One may note that while f r i e n d s h i p s were  most valued, food behaviors were only one aspect of what teenagers described they would modify, change or think about to ensure or maintain them. The f o l l o w i n g accounts d e s c r i b e some of the ways teenagers c o n c e p t u a l i z e d the r e l a t i o n s h i p between t h e i r food behaviors and friendships: T: Everybody wants to be popular. So I guess one way to be popular, or to be l i k e d i s to look good. And so I guess that's one of the  61 reasons t h a t I changed, so I could look b e t t e r . R: Do you think that a f f e c t s the way people r e l a t e to him, that he's so big? T: Yes, he, no one wants to be seen with him! R: Why i s that? T: 'Cause he's so grotesque, kind of bad f o r your image too 'cause he's such a j e r k . L i k e i f he was nice i t would be d i f f e r e n t but, he's not. Some teenagers i n d i c a t e d t h e i r food behaviors were modified to achieve goals with respect to body image changes, which they perceived would c o n t r i b u t e to t h e i r a t t r a c t i v e n e s s and hence f r i e n d s h i p s . Other teenagers thought about food or food a c t i v i t i e s w i t h i n the context o f friendship activities.  These teenagers i n d i c a t e d they consumed d i f f e r e n t  foods when a t home or when with f r i e n d s . For some adolescents "going to the s t o r e " was an outing with f r i e n d s , and meal times a t school f o r h a l f of the teenagers provided o p p o r t u n i t i e s to s o c i a l i z e and v i s i t with friends. Doing well i n sports or a p a r t i c u l a r sport was a t h i r d issue seen to be important f o r many of the teenagers s t u d i e d .  Again, the value o f  p a r t i c i p a t i n g i n a p a r t i c u l a r s p o r t was independent o f food per se. Some teenagers enjoyed the competition, the development of s k i l l s , the p h y s i c a l e x e r t i o n and the idea that they might become a s t a r . As with the two personal issues of body image and f r i e n d s , food b e l i e f s and behaviors o f teenagers were c o n c e p t u a l i z e d and t e s t e d according to t h e i r notions about what would best support or c o n t r i b u t e to p a r t i c i p a t i o n i n a sport.  62  There are many instances which demonstrate how the teenagers might have a r r i v e d a t , or reasoned out, what impact p a r t i c u l a r food behaviors might have on t h e i r performance.  The c r i t e r i a f o r  decision-making employed by the teenagers r e l i e d predominantly on "how they f e l t " .  They a t t r i b u t e d causes o f " f a t i g u e , " "cramps" or "energy  l e v e l " to v a r i o u s foods or the l a c k t h e r e o f : T: Well, I guess s i n c e I'm i n sports and s t u f f , I don't eat a l o t , l i k e maybe before a game o r something I don't l i k e to go out and eat a l o t . 'Cause i t ' s about the only thing t h a t concerns me. I j u s t l i k e to get a good meal, a balanced meal, or something before a game. I j u s t don't l i k e to carry a l o t o f weight around when I p l a y . The e f f e c t t h i s personal i s s u e had on the p a r t i c i p a n t ' s d e s c r i b e d food behaviors was not constant. That i s , the teenager also s t a t e d that what was eaten was not o f p a r t i c u l a r concern except i n the i n s t a n c e s where i t might i n t e r f e r e with p a r t i c i p a t i o n i n s p o r t s . As such, while personal i s s u e s might c o n t r i b u t e to the development of notions about what was "good" to eat, t h i s notion f o r some could be seen to change.  An  important o b s e r v a t i o n i n both the previous and the f o l l o w i n g account i s the i d e n t i f i c a t i o n o f what i s r e a l l y important to the teenager. One element seen to be i n v o l v e d i n the decision-making process was the weighing o f r i s k s .  When i t was r e a l l y important to do w e l l ,  d e s p i t e perceived l a c k s o f p o s i t i v e e f f e c t , the teenager c a r r i e d out a plan t h a t would not harm, but might not help: T: L i k e i t doesn't have any e f f e c t on me no matter what I e a t . R: Okay.  63  T: I can e a t steak or something l i k e t h a t , i t ' s supposed to be f u l l of i r o n or whatever, i t doesn't make any d i f f e r e n c e to me. I j u s t don't even seem to n o t i c e i t so, I f i n d i t hard to b e l i e v e t h a t , you know what most people would...The only t h i n g I've ever thought about i s having steaks before the game. You know the o l d thing that you have to have a steak before a game. T h i s account again demonstrates that some of the teenagers question the knowledge statements given to them.  In t h i s i n s t a n c e , the  teenager appeared t o be expecting a change i n f e e l i n g with the i n t a k e of iron.  Another element present i n t h i s account i s the idea that there are  p a t t e r n s or t r a d i t i o n s that c o n t r i b u t e to d e c i s i o n s i n d i f f e r e n t s i t u a t i o n s . In t h i s instance i t was "the o l d t h i n g , " a t other times i t was d e s c r i b e d to be "we always do i t t h i s way," or "we always, eat f i s h on F r i d a y , . . . I think i t has something to do with the r e l i g i o n or something." As with the r e s o l u t i o n o f concerns r e l a t e d to body image, the complexity o f approaches employed by the boys and g i r l s as they assessed the u s e f u l n e s s or e f f e c t i v e n e s s o f d i e t a r y change to r e s o l v e concerns about t h e i r a t h l e t i c a b i l i t y v a r i e d . The s i g n i f i c a n c e of the three i d e n t i f i e d personal i s s u e s to the d i s c u s s i o n of how the teenagers i n the study employed t h e i r frameworks i n a s s e s s i n g food behaviors, l i e s i n how personal i s s u e s guided the teenagers' d e c i s i o n s about what information was r e l e v a n t or the p r i o r i t i z a t i o n of i t s relevance.  In a sense, then,  the personal i s s u e s were seen by the w r i t e r to provide the teenagers with a context f o r i n t e r p r e t i n g knowledge, cues and behaviors of themselves and o t h e r s .  64  To t h i s p o i n t in presenting the accounts the w r i t e r has argued t h a t each teenger has notions concerning food.  The notions have  developed from i n t e r p r e t a t i o n s of experiences and knowledge and c o n t r i b u t e to the development of what has been c a l l e d a framework.  This  framework, i n t u r n , guides d e c i s i o n making about food and hence i n f l u e n c e s food behaviors.  Despite the i n d i v i d u a l ways information was  assessed and the v a r i a t i o n i n concerns or p r a c t i c e s , there were s i m i l a r i t i e s i n teenagers' e v a l u a t i o n s of t h e i r food behaviors and i n t h e i r patterns of assessing the usefulness of i n f o r m a t i o n . Having made the processes of developing and employing  these  described frameworks more e x p l i c i t , i t w i l l now be argued t h a t , depending on the teenagers' r a t i o n a l e s , two p a r t i c u l a r food behavior patterns can be d e s c r i b e d .  These have been l a b e l l e d " c o n v i c t i o n s " and  "convenience."  Food Patterns A s s o c i a t e d With C o n v i c t i o n s Teenagers whose food patterns were c o n s i s t e n t with what the w r i t e r has defined as the " c o n v i c t i o n s " category were seen to have developed a r a t i o n a l e f o r a c t i n g which was a r t i c u l a t e d in terms of b e l i e f s and s p e c i f i c a c t i o n s , and  which was a p p l i e d across most  situations. As these teenagers discussed t h e i r r a t i o n a l e s they tended to employ terms l i k e "We should do i t t h i s way," e f f e c t y" and "I b e l i e v e i t i s good f o r x."  "I b e l i e v e doing x has the The teenagers who  thought  t h i s way seemed to be more l i k e l y to plan t h e i r meals i n advance. i n a r e s t a u r a n t or c a f e t e r i a , they t r i e d to make choices that were  Or, i f  65  c o n s i s t e n t with t h e i r b e l i e f s .  There seemed to be a c e r t a i n  p r e d i c t a b i l i t y i n the food behaviors of t h i s group. The d e s c r i b e d b e l i e f s seemed to be based on or at l e a s t were c o n s i s t e n t with knowledge, but as well might have emotional, c u l t u r a l or p a r t i a l knowledge o r i g i n s . Teenagers d e s c r i b e d c e r t a i n b e l i e f s as having evolved from t a k i n g a stand on a moral i s s u e or being p a r t of t h e i r family or c u l t u r a l p a t t e r n . As was s t a t e d e a r l i e r , the process of c o n s i d e r i n g i n f o r m a t i o n and making d e c i s i o n s about a c t i o n s was an a c t i v e one.  These teenagers' c o n c l u s i o n s appeared to be that c e r t a i n foods and  food patterns are "good f o r you" or p r e f e r r e d over o t h e r s . The f o l l o w i n g account describes how one teenager reasoned out the d i f f e r e n c e between "junky" foods and the "good" foods t h a t were seen to be b e t t e r to eat: T: ...hamburgers, i t depends what you r e a l l y mix with hamburgers, whether they're junky or bad. I f you eat hamburgers and potato chips and a pop or something, that would be junky...But i f you had a g l a s s of milk, a hamburger, a couple of c h i p s , and c a r r o t s , and l e t t u c e i n your hamburger and s t u f f t h a t would make i t a b i t b e t t e r . An important element to behaviors of teenagers whose food d e c i s i o n were guided by " c o n v i c t i o n s " was the element of c o n s i s t e n c y . One reason c i t e d by a teenager was dependent upon the strength of one's beliefs: R: What do you suppose i s the d i f f e r e n c e between s t i c k i n g with i t or not s t i c k i n g with i t ? T: Well i t depends how s t r o n g l y you feel about i t , i f you do i t j u s t f o r the sake of doing i t or i f you do i t because you b e l i e v e in i t .  66  What comes across i n the l a t t e r two accounts, as i n others, i s t h a t there i s a value or merit attached to behaving i n a c e r t a i n way. In a d d i t i o n , most o f these teenagers took a c t i o n s to ensure "good" meals by taking t h e i r own lunches.  I t was reported e a r l i e r that the teenagers  made d e c i s i o n s about the relevancy o f information and were seen t o compare themselves with o t h e r s . Some of the teenagers i t would seem, were committed to seeking out new knowledge and were w i l l i n g to change t h e i r behaviors a c c o r d i n g l y . T h e i r r e s u l t i n g behaviors were c o n s i s t e n t with t h e i r b e l i e f s . One teenager commented on how a teacher modified an approach to be c o n s i s t e n t with d e s c r i b e d b e l i e f s : T: L i k e l a s t week we made c h i l i , we work i n partners and we j u s t made ours without meat. (We) made the meat i n a separate f r y i n g pan and my partner j u s t put the hamburger i n . We never thought o f doing that a t home. While i n t h i s instance the teenager i n c o r p o r a t e d the information and considered using the information i n l a t e r p r a c t i c e , other teenagers had d i f f e r e n t a t t i t u d e s . Some seemed to present the view that t h e i r knowledge and behaviors were adequate and the maintenance m o d i f i c a t i o n o f them was what was important.  r a t h e r than  T h i s appeared to be the  case i n two c l a s s room i n s t a n c e s . One was a s i t u a t i o n where the p a r t i c i p a n t f e l t t h a t a teacher u n j u s t i f i a b l y assumed that the students were l a c k i n g knowledge and s k i l l s .  The teenager's impression was t h a t  the students would be prepared to p a r t i c i p a t e i f they f e l t they were going to gain knowledge they perceived to be r e l e v a n t . In a second instance the teenager was w i l l i n g to "make i t " but  67  not "eat i t . " Lessons were not perceived valuable because the foods prepared were outside of the adolescent's "normal" d i e t .  In one  the p r e f e r r e d d i e t would not have been assessed as adequate. of the i n s t a n c e s , the emotional  instance  In several  element to t h e i r arguments provided  reasons f o r c h a l l e n g i n g knowledge.  One sensed from several of the  accounts t h a t there was commitment to the o r i g i n of the b e l i e f s and the m o d i f i c a t i o n of such b e l i e f s might be a form of b e t r a y a l .  Examples of  t h i s i n c l u d e teenagers' accounts which i n d i c a t e d t h e i r behaviors were part of a family pattern and they i d e n t i f i e d with t h e i r f a m i l y . Those adolescents whose food behavior pattern might correspond with t h e i r " c o n v i c t i o n s " are seen to have p a r t i c u l a r sets of food b e l i e f s t h a t d i r e c t them to ensure t h e i r food behaviors are c o n s i s t e n t across situations.  These b e l i e f s also i n f l u e n c e d t h e i r use of i n f o r m a t i o n .  The second pattern i n t e r p r e t e d from the teengers' accounts observations of t h e i r behaviors i s r e l a t e d to issues of  and "convenience."  Food P a t t e r n s A s s o c i a t e d With Convenience The teenagers who have been included in t h i s category i n t e r p r e t e d information given to them and responded to cues, but were seen to come to the d e c i s i o n that i t was not p a r t i c u l a r l y important to ensure that c e r t a i n foods were eaten d a i l y .  I t would seem the g r e a t e s t tendency was  to make d e c i s i o n s based on a v a i l a b i l i t y . The teenagers reported they d i d n ' t think much about what they ate or tended to choose foods based on t h e i r preferences.  T h e i r experiences suggested to them that there was  u s u a l l y no harm in e a t i n g whatever was there.  I t would appear some  68  adolescents had behaviors which were more s i t u a t i o n a l l y  dependent.  The f o l l o w i n g accounts suggest that o f t e n the adolescents were concerned about things other than food per se. T: I f you're hungry, you j u s t grab something, whatever there i s to eat in the c a f ' . Most of the times i t ' s u s u a l l y what you have enough money f o r .  T: Well, . . . i t depends on when you wake up. Depends how you f e e l . I f you feel l i k e you want to eat junk food or, i f you want to eat somethin t h a t ' s good f o r you, healthy f o r y o u . . . . I t depends what you do with your f r i e n d s . I f your f r i e n d s say, 'Let's go f o r a hamburger.' You can't r e a l l y t e l l what you w i l l do. L i k e say today I'm going to do t h i s and tomorrow I'm going to eat t h a t . More than having decided p a r t i c u l a r foods were important or p r e f e r r e d , these teenagers reported that the consumption of p r e f e r r e d foods was l i k e l y to be l i m i t e d by i s s u e s r e l a t e d to a v a i l a b i l i t y .  Such f a c t o r s  might i n c l u d e what was a v a i l a b l e at home or s c h o o l , what they could a f f o r d or what they had time f o r . As the teenagers supported t h e i r view that t h e i r food behaviors were "normal," "healthy" or "good," they p a r t i c i p a t e d i n s i m i l a r processes as those who were guided by c o n v i c t i o n s .  They attended to cues  examined t h e i r own bodies' responses to foods, queried the a p p l i c a b i l i t y o f knowledge to t h e i r own s i t u a t i o n and compared themselves to o t h e r s . The c o n c l u s i o n s or thoughts of those concerned about "convenience" were often q u i t e d i f f e r e n t from those who were " c o n v i c t i o n s " o r i e n t e d . T h i s might i n f l u e n c e how ready they were to i n c o r p o r a t e new information or  69  change t h e i r behaviors. Those who were concerned about i s s u e s o f "convenience" have been d e s c r i b e d as having behaviors which were s i t u a t i o n a l l y dependent or changing.  Another reason f o r changing  behavior was sometimes a t t r i b u t e d to g a i n i n g new knowledge. sense, new information provided a new s i t u a t i o n .  In t h i s  Some teenagers were  q u i t e i n t e r e s t e d i n adopting new behaviors or t r y i n g new "programmes." However, some o f them i n d i c a t e d changes might only be maintained u n t i l new information provided another a l t e r n a t i v e . I t might seem they were not committed to, or perhaps convinced of, the idea that one pattern o f a c t i n g i s p r e f e r a b l e to another and might be s u s c e p t i b l e to f a d s . As opposed to those who were guided by " c o n v i c t i o n s , " these teenagers were l e s s l i k e l y to think o f foods i n e v a l u a t i v e terms. "I don't l i k e to think o f i t as junk food, j u s t food." t h e i r preferences or challenged recommendations, terms of what was " e a s i e r " or "more economical."  As they d i s c u s s e d  they d e s c r i b e d t h i n g s i n They supported t h e i r  arguments by suggesting there was not r e a l l y any documentable d i f f e r e n c e in how they f e l t or how well they performed.  I t i s i n t e r e s t i n g to note  t h a t while those who wished to a c t i n accordance with " c o n v i c t i o n s " evaluated courses such as home economics i n terms of the type o f knowledge t h a t was shared, those who were "convenience" o r i e n t e d assessed courses more i n terms o f i n c r e a s i n g personal autonomy. As a r e s u l t of examining accounts and e x p l o r i n g with the adolescents the e v o l u t i o n of t h e i r reasoning, the researcher was made aware t h a t , although they behaved i n ways t h a t were very i n d i v i d u a l , t h e i r own p a t t e r n was c o n s i s t e n t with t h e i r developed b e l i e f s and  70  notions.  Such behaviors when observed or measured outside of the  i n d i v i d u a l ' s framework might appear to be i n c o n s i s t e n t , i l l o g i c a l or irrational.  When viewed i n the context of his or her explanations or  accounts one has a b e t t e r understanding of the i n d i v i d u a l ' s view of the situation.  D i s c u s s i o n of Accounts Having presented the accounts, the w r i t e r w i l l discuss how t h i s study adds to an understanding of teenagers' food behaviors. L i t e r a t u r e reviewed i n Chapter II i d e n t i f i e d the merits of studying n u t r i t i o n from an ethnographic p e r s p e c t i v e and discussed how information from such s t u d i e s might be employed to increase the e f f e c t i v e n e s s of n u t r i t i o n i n t e r v e n t i o n programmes.  Reviews of studies of adolescent n u t r i t i o n  i d e n t i f i e d a decided lack of information of adolescents' p e r s p e c t i v e s of nutrition.  This was the general problem i d e n t i f i e d f o r t h i s study.  The  d i s c u s s i o n w i l l review accounts in r e l a t i o n to c i t e d l i t e r a t u r e and w i l l describe how the study problem has been addressed.  I n i t i a t i o n and Maintenance of Change i n Health Behaviors I t was assumed food behaviors are a category of health behaviors. For t h i s reason l i t e r a t u r e was reviewed to i d e n t i f y issues r e l a t e d to the i n i t i a t i o n and maintenance of change i n health and l i f e s t y l e behaviors. Findings of these s t u d i e s i n d i c a t e i n d i v i d u a l s ' perceptions of the value of a treatment regimen, how they perceive i t to i n f l u e n c e other aspects of t h e i r l i f e s t y l e s , how i n d i v i d u a l s define t h e i r s i t u a t i o n ,  71 and t h e i r commitment to the change a l l i n f l u e n c e the l i k e l i h o o d they w i l l comply with p r e s c r i b e d regimens. T h i s l i t e r a t u r e , as was suggested e a r l i e r , a l s o i n d i c a t e s t h a t modifying or maintaining change i n health o r l i f e s t y l e behaviors requires the use o f approaches d i f f e r e n t from those successful i n achieving adherence to p r e s c r i b e d i l l n e s s o r i e n t e d interventions.  Some reasons f o r t h i s are that the p r e s c r i b e d regimens  can be more complex and can a f f e c t more aspects o f the i n d i v i d u a l ' s l i f e . Furthermore, negative consequences o f non-compliance with health o r l i f e s t y l e regimens, i f perceived at a l l , may be l e s s meaningful to i n d i v i d u a l s than consequences o f non-compliance with i l l n e s s regimens. These f i n d i n g s merit d i s c u s s i o n i n l i g h t of the observations made i n the present  study. In t h i s study teenagers made d e c i s i o n s about the v a l i d i t y of  recommended eating p r a c t i c e s .  They assessed the e f f e c t s of consuming  c e r t a i n foods through b o d i l y changes and how they f e l t .  This practice  s e n s i t i z e s one to the perceived ambiguity of messages which suggest e a t i n g w i l l make you "feel b e t t e r " or make you " h e a l t h i e r . " teenagers concluded  Several  non-compliance with recommended eating p r a c t i c e s  would have negative consequences. T h i s study demonstrated that adolescents' perceptions i n f l u e n c e d food behaviors. d e f i n i t i o n s o f what was important  The teenagers'  such as issues r e l a t e d to " c o n v i c t i o n s "  or "convenience" c o n t r i b u t e d to the adoption o f d i f f e r e n t food patterns.  behavior  Consuming c e r t a i n foods was perceived as c o n t r i b u t i n g to the  r e s o l u t i o n o f issues o f personal concern. the food behaviors adopted.  These issues also i n f l u e n c e d  Three issues of personal concern were body .  72 image, to succeed in sports or to have f r i e n d s . Reasons f o r non-compliance  with a recommended food pattern could  be r e l a t e d to teenagers' perceptions that the recommended patterns were not r e l e v a n t to t h e i r own s i t u a t i o n or recommendations based on concepts such as " y o u ' l l feel b e t t e r " may be too broadly i n t e r p r e t e d . I t has already been mentioned that food and food behaviors were p e r c e i v e d by the teenagers as instrumental i n the r e s o l u t i o n of three personal i s s u e s . On f i r s t examination the meaning of these observations i s not at a l l c l e a r . The l i t e r a t u r e does not present such problems or concerns as r a t i o n a l e s f o r encouraging the m o d i f i c a t i o n of food behaviors.  However, re-examination of the works of Becker and Maiman  (1975) and T a y l o r (1979) provide one b a s i s f o r i n t e r p r e t a t i o n .  The  authors d e s c r i b e an i n d i v i d u a l ' s perception of the e f f e c t s of e i t h e r a p r e s c r i b e d regimen or i l l n e s s on other a c t i v i t i e s as f a c t o r s i n f l u e n c i n g compliance.  A c o n t r i b u t i o n of t h i s present study i d e n t i f i e s some f a c t o r s  the adolescents would consider in making d e c i s i o n s to modify t h e i r food behaviors, what they perceive to be important i n r e l a t i o n to foods and how such perceptions can i n f l u e n c e subsequent food behaviors. As the w r i t e r described the patterns of behavior a s s o c i a t e d with c a t e g o r i e s of " c o n v i c t i o n " and "convenience," major behavioral d i f f e r e n c e s were noted.  The behavior patterns a s s o c i a t e d with  " c o n v i c t i o n s " were c h a r a c t e r i z e d by consistency across s i t u a t i o n s and the adolescents described s p e c i f i c b e l i e f s which guided t h e i r food d e c i s i o n making. Food behavior patterns were described as "valued" or "important."  something  Commitment was also i d e n t i f i e d by both Becker,  73 Maiman, K i r s c h t , Haefner, & Drachman (1979) and T a y l o r (1979) as a f a c t o r which p r e d i c t s sustained behavioral change or long term  compliance.  Perhaps teenagers whose food patterns were c o n s i s t e n t with t h e i r " c o n v i c t i o n s " could be described as committed to t h e i r p a r t i c u l a r food behaviors. Several comments may be made as one examines the w r i t e r ' s i n t e r p r e t a t i o n of accounts in the l i g h t of the Health B e l i e f Model. Rosenstock (1966) described four sources of i n f l u e n c e on an i n d i v i d u a l ' s health behaviors; one of these was the d e s i r e to maintain h e a l t h .  A  c o - r e q u i s i t e to the Model's usefulness as a health behavior p r e d i c t o r was that the concept of health be meaningful  or s a l i e n t to the i n d i v i d u a l .  This study did not examine health b e l i e f s i n general, but i t d i d assume food behaviors to be a category of health behaviors.  While some  of the study p a r t i c i p a n t s would have been described as v a l u i n g h e a l t h , i t seemed that most teenagers d i d not view t h e i r food behaviors i n r e l a t i o n to h e a l t h .  They considered food in r e l a t i o n to more general i s s u e s , f o r  example, what was important to the teenagers was how t h e i r perceptions o f how food a f f e c t e d t h e i r d a i l y f u n c t i o n i n g or t h e i r i n t e r a c t i o n s with peers.  As such, d e s c r i p t i o n s i n t h i s study would be c o n s i s t e n t with  those of Radius et a l . (1980) who concluded that many teenagers do not value h e a l t h .  The conceptual c a t e g o r i e s and processes described in the  present study provide an a l t e r n a t i v e way of looking at teenagers'  food  behaviors which i s not n e c e s s a r i l y dependent upon v a l u i n g h e a l t h . In d e s c r i b i n g health behaviors using the Health B e l i e f Model, Rosenstock (1966) i n d i c a t e d that i n d i v i d u a l s would carry out  preventive  74  actions i f they perceived the r i s k s of i l l n e s s to be greater than personal inconvenience. That i s , i n d i v i d u a l s would c o n s i d e r the l i k e l i h o o d they would develop an i l l n e s s , what they would have to do to decrease t h e i r chance of c o n t r a c t i n g i t , and the degree of behavioral change such p r e v e n t i v e a c t i o n s would r e q u i r e . The present f i n d i n g s suggest convenience i s not the only c o n s i d e r a t i o n . The c a t e g o r i e s , as they have been d e s c r i b e d , suggest that f a c t o r s r e l a t e d to convenience such as a v a i l a b i l i t y or c o s t are p r e d i c t o r s of food behaviors only f o r some i n d i v i d u a l s .  Those whose food behaviors are c o n s i s t e n t with the  d e s c r i p t i o n s of the "convenience" pattern might be the i n d i v i d u a l s whom Rosenstock (1966) d e s c r i b e s as weighing r i s k s of i l l n e s s and basing d e c i s i o n s on what i s e a s i e r or more convenient.  Those i n d i v i d u a l s whose  food d e c i s i o n s are guided by t h e i r c o n v i c t i o n s might be prepared to work around inconveniences i n order to ensure compliance with the p r e s c r i b e d regimen.  S t u d i e s of N u t r i t i o n Food P a t t e r n s as an Element of C u l t u r e The problem of encouraging i n d i v i d u a l s to modify t h e i r e a t i n g patterns to support h e a l t h or to accommodate the a v a i l a b i l i t y o f resources has been addressed d i f f e r e n t l y over time.  Research which has  been instrumental i n the design of n u t r i t i o n i n t e r v e n t i o n programmes i s t h a t which has i n c r e a s e d health care workers' understanding of the c u l t u r a l group's p e r s p e c t i v e of i t s food b e h a v i o r s . Studies which have examined food patterns as an element of  75 c u l t u r e c o n t r i b u t e two types o f i n f o r m a t i o n .  They describe food b e l i e f s  held by the groups s t u d i e d and provide i n s i g h t i n t o how b e l i e f s were developed.  Researchers who studied food behaviors from the c u l t u r a l  p e r s p e c t i v e r e p o r t t h a t i n d i v i d u a l s have a need to communicate both thoughts and f e e l i n g s about food.  They also suggest that food i s more  c l e a r l y understood when examined i n the context of other l i f e events. While l i f e events may account f o r v a r i a t i o n s i n food behaviors there i s a group i n f l u e n c e which c o n t r i b u t e s to s i m i l a r i t i e s i n food behaviors. D i f f e r e n t groups of people are described as c o n c e p t u a l i z i n g or developing t h e i r notions d i f f e r e n t l y .  C u s s l e r and De Give (1952) i d e n t i f i e d  v a r i a t i o n s between community members and p r o f e s s i o n a l groups or between community members of d i f f e r i n g s o c i a l standing.  They label the food  patterns a s s o c i a t e d with groups as "food ways." C u s s l e r and De Give (1952) a l s o d e s c r i b e how i n d i v i d u a l s are i n v o l v e d i n the transmission of "food ways." The authors described the meaning of food w i t h i n the c u l t u r e and explained how personal and community values, i n d i v i d u a l food b e l i e f s and family and community members c o n t r i b u t e d to the maintenance and change of food behaviors. T h i s study of teenagers perceptions o f t h e i r food behaviors demonstrated  i t was important f o r adolescents to communicate t h e i r ideas  and concerns about foods.  I t a l s o supports the view t h a t food behaviors  are more c l e a r l y understood when examined i n the context of other l i f e events.  As has been mentioned e a r l i e r i n t h i s d i s c u s s i o n , understanding  the development of r a t i o n a l e s f o r a c t i n g r e q u i r e s one to explore food i n  76  r e l a t i o n to family and l i f e s t y l e .  The p a r t i c i p a n t s ' accounts only began  to make sense t o the w r i t e r when she broadened her d e f i n i t i o n s o f the d e s i r a b i l i t y o f c e r t a i n food behaviors and the negative consequences o f others.  Instead, an e f f o r t was made to understand the boys' and g i r l s '  ideas o f these same i s s u e s . I t has been proposed that d i f f e r e n t groups o f people c o n c e p t u a l i z e or develop t h e i r notions d i f f e r e n t l y .  The researcher  discovered that adolescents perceive t h e i r behaviors to be s i m i l a r to those o f some groups and d i f f e r e n t from those o f o t h e r s .  Most often t h e  p e r c e i v e d or d e s i r e d s i m i l a r i t i e s were with groups with whom the teenager identified.  Such groups might be family or f r i e n d s .  The w r i t e r ' s study i d e n t i f i e d the i n d i v i d u a l s teenagers  perceived  as i n f l u e n c i n g the development of t h e i r food b e l i e f s . In t h i s study parents and f r i e n d s were i n d i v i d u a l s with whom teenagers compared t h e i r food behaviors.  One reason comparisons were made was to j u s t i f y food  p a t t e r n s adopted. The teenagers a l s o sought information from o t h e r s . Most frequent information sources were parents, p r o f e s s i o n a l s or on occasion people with d e s i r e d c h a r a c t e r i s t i c s such as a t h l e t e s . By p r o v i d i n g information and a c t i n g as r o l e models these i n d i v i d u a l s c o n t r i b u t e d to the development o f teenagers' d e f i n i t i o n s o f what were appropriate or "good" food behaviors.  These observations are s i m i l a r t o  those o f C u s s l e r and De Give (1952) who i d e n t i f i e d mechanisms o f t r a n s m i t t i n g "food ways" which included input from family and community members. Awareness o f food b e l i e f s i s important i n planning to change  77  behaviors.  The patterns of food behaviors a s s o c i a t e d with " c o n v i c t i o n s "  and "convenience" could be considered as r e p r e s e n t i n g two d i f f e r i n g value sets.  The teenagers considered both information and recommended a c t i o n s  in l i g h t of t h e i r frameworks. Those guided by issues of  "convenience"  had d i f f e r e n t food b e l i e f s and behaviors than those who considered food i n r e l a t i o n to " c o n v i c t i o n s . " The c o n c e p t u a l i z e d food patterns a s s o c i a t e d with " c o n v i c t i o n s " and "convenience" might be seen as r e p r e s e n t i n g the value sets o f d i f f e r i n g c l a s s e s or groups of community members and r e p r e s e n t i n g two d i f f e r i n g points of view.  If i n d i v i d u a l s  i n t e r p r e t information or formulate knowledge i n l i g h t of t h e i r own s i t u a t i o n and b e l i e f s and values then those with d i f f e r e n t values would p e r c e i v e d i f f e r e n t types of information important.  Clearly intervention  s t r a t e g i e s that would appeal to one set of values would not n e c e s s a r i l y appeal to the other. The w r i t e r d i d not c o n t r a s t teenagers' perceptions of t h e i r food behaviors with those of other groups, but the c o n c e p t u a l i z a t i o n s developed i n t h i s study may c o n t r i b u t e to the e x p l o r a t i o n of p o t e n t i a l d i f f e r e n c e s between groups in several ways. The c o n c e p t u a l i z a t i o n of teenagers' perceptions of t h e i r food behaviors which has been proposed i s a c l e a r example t h a t teenagers have t h e i r own ways of viewing t h e i r food behaviors and that t h e i r views may d i f f e r from those of others.  Also,  c o n t r a s t i n g one's own c o n c e p t u a l i z a t i o n with that of another implies t h a t i n d i v i d u a l s must begin to c l a r i f y t h e i r own b e l i e f s about food behaviors. Such notions might be personal and based on knowledge and experiences or they might r e f l e c t defined p r o f e s s i o n a l o r i e n t a t i o n s . Making e x p l i c i t  78 one's own framework i s important i f a p r o f e s s i o n a l i s going to enter i n t o n e g o t i a t i o n of t h e r a p e u t i c i n t e r v e n t i o n s .  Studies of Adolescent N u t r i t i o n and Food Patterns Patterns of food consumption  during adolescence.  The review o f  t h i s category of l i t e r a t u r e i n d i c a t e s t h a t , while researchers document a range of adolescent food behaviors, the patterns are not e a s i l y explained.  Two s t u d i e s suggest that food consumption  i s r e l a t e d i n some  way to the a v a i l a b i l i t y of foods (Crawford, 1977; S t e p i e n , 1978).  Other  s t u d i e s suggest a lack of responsiveness to increased energy and n u t r i t i o n a l requirements of the age group.  Reasons proposed to e x p l a i n  the d e s c r i b e d patterns i n c l u d e lack of awareness of the nature of i n c r e a s e d needs and lack of knowledge. The behavior patterns a s s o c i a t e d with " c o n v i c t i o n s " and "convenience," and the c h a r a c t e r i s t i c s of s i t u a t i o n a l independency  and  dependency, c o n t r i b u t e to an explanation of how or why teenagers' food behaviors might a l t e r with changing c o n d i t i o n s . Changing the a v a i l a b i l i t y of foods might change the kinds of foods consumed by teenagers whose food behaviors were guided by f a c t o r s r e l a t e d to "convenience."  Changing the a v a i l a b i l i t y of foods would l i k e l y r e s u l t i n  a change i n food behaviors, but not n e c e s s a r i l y foods consumed, i f teenagers were operating under the o r i e n t a t i o n s r e l a t e d to the " c o n v i c t i o n s " category.  In t h i s l a t t e r instance food behaviors would  i n c l u d e e a t i n g as well as planning, purchasing or preparing meals or snacks.  79 Another explanation f o r the range of food behaviors reported i n the l i t e r a t u r e can be a t t r i b u t e d to the b e l i e f s teenagers hold about p a r t i c u l a r foods.  As the adolescents a r t i c u l a t e d t h e i r notions about why  they might e a t c e r t a i n foods and avoid others, they included the c h a r a c t e r i s t i c s a s c r i b e d to foods as reasons.  The q u a l i t i e s such as  " l i g h t , " "quick," "greasy," or " f a t t e n i n g " were named, as were the d e s i r e s to include " l i g h t " foods when one was concerned about one's weight or to exclude "greasy" foods i f one was concerned complexion.  about  Foods were also discussed i n terms of being "healthy,"  "junky" or " n u t r i t i o u s . " An i n t e r e s t i n g part o f these observations was that although the adolescents might use the same terms, they were not always d e s c r i b i n g the same foods or the same food q u a l i t i e s .  Similar  observations were reported by Kaufman e t a l . (1975).  Described i n f l u e n c e s on teenagers' food behaviors.  When Kaufman  et a l . (1975) reported t h a t adolescents a t t r i b u t e d q u a l i t i e s to d i f f e r e n t foods and food types, they i n d i c a t e d t h i s i n f l u e n c e d the teenagers' d e c i s i o n s about food consumption.  The present study suggests food  d e c i s i o n s are a l s o i n f l u e n c e d by the p a r t i c i p a n t s ' perceptions of t h e i r bodies' responses to food and how they perceive foods to a f f e c t t h e i r personal development or f u n c t i o n i n g . The p r e s e n t a t i o n o f accounts described processes which i n v o l v e d the teenagers' attendance to cues and t h e i r use o f knowledge. Cues which were described as c o n t r i b u t i n g to the development of the teenagers' r a t i o n a l e s included food q u a l i t i e s l i k e " l i g h t n e s s " or "greasiness" and corresponding b o d i l y responses  80  such as "strength," "energy" or " h e a l t h i n e s s . " A d d i t i o n a l i n f l u e n c e s on food behaviors may also be considered. Three issues of personal concern have been discussed i n r e l a t i o n to how perceptions i n f l u e n c e behaviors.  As the patterns of e a t i n g a s s o c i a t e d  with " c o n v i c t i o n s " and "convenience"  were described, the w r i t e r  i d e n t i f i e d f a c t o r s i n f l u e n c i n g not only food behaviors but adolescents' r a t i o n a l e s f o r seeking n u t r i t i o n information.  One f a c t o r i s the d e s i r e  to acquire s k i l l s i n food preparation or purchase i n order to increase personal autonomy. A second i s that f o r those who are guided by i s s u e s of "convenience"  new information can induce changes i n food behavior  patterns but these behavioral changes may not n e c e s s a r i l y be  maintained.  Deciding to maintain "healthy" or recommended food behavior patterns depends upon the teenagers' i n t e r p r e t a t i o n s of t h e i r bodies' responses  to  foods as well as t h e i r a b i l i t i e s to c r i t i c a l l y examine i n f o r m a t i o n . Perhaps f o r some teenagers the source of information and i t s mode of p r e s e n t a t i o n are more important reasons to modify behaviors than the nature of the information i t s e l f . Teenagers'  knowledge of n u t r i t i o n .  Several studies i n the  l i t e r a t u r e report varying l e v e l s of knowledge among d i f f e r i n g groups of teenagers.  An assumption i n assessing knowledge i s that i t i s a pre- or  c o - r e q u i s i t e to healthy p r a c t i c e . Studies such as those by Thompson and Schwartz (1977) and S a u c i e r and Gauthier (Note 2) suggest that knowledge of n u t r i t i o n does not c o r r e l a t e with recommended p r a c t i c e s .  One  explanation f o r t h i s observation may be found i n the r e s u l t s of t h i s  81 study. As accounts were presented the researcher decribed how  teenagers  used t h e i r experiences and perceptions i n d e f i n i n g how " f a c t s " were incorporated i n t o r a t i o n a l e s f o r a c t i n g . In a s s e s s i n g the usefulness of information given to them by teachers, nurses or others, the teenagers v a l i d a t e d i t by examining i t s relevancy to t h e i r own s i t u a t i o n , i t s c o m p a t i b i l i t y with personal b e l i e f s or notions, and i t s consistency with messages from other sources i d e n t i f i e d as c r e d i b l e . Such c r e d i b l e sources might include parents, teachers or nurses. The teenagers sought information f o r the purposes of s o l v i n g problems or to expand the amount of information used i n making d e c i s i o n s . Learning new s k i l l s was also described as being motivated by the d e s i r e to increase choices and to increase personal autonomy.  A l l of the  adolescents d e s c r i b e d t h a t on r e c e i v i n g information they " t e s t e d " i t out. In making sense of information presented to them, the teenagers i n t e r p r e t e d i t in l i g h t of t h e i r perceptions of what was  important,  valued, or l i k e l y to c o n t r i b u t e to the r e s o l u t i o n of issues of personal concern. These observations emphasize that information or a d i e t a r y routine recommended by a p r o f e s s i o n a l w i l l l i k e l y be pondered, examined, t e s t e d , and p r i o r i t i z e d f o r i t s perceived relevance to the i n d i v i d u a l ' s situation.  Information may be challenged not only by the teenagers but  a l s o by t h e i r e s t a b l i s h e d r o u t i n e s , p r a c t i c e s or preferences as well as t h e i r observations of general trends. T h i s process of i n t e r p r e t i n g information i n context of the  82  i n d i v i d u a l ' s experiences c o n t r i b u t e s one explanation of why recommendations may not always r e s u l t i n the d e s i r e d behavioral change. It a l s o has i m p l i c a t i o n s f o r how health care workers might assess an i n d i v i d u a l ' s understanding of conveyed i n f o r m a t i o n . The measurement of knowledge by a b i l i t y to r e c a l l " f a c t s " does not assess how teenagers have i n t e r p r e t e d information i n l i g h t of t h e i r everyday experiences.  Everyday  knowledge i s more l i k e l y to be assessed i f one explores what i s understood or how information i s i n c o r p o r a t e d i n t o an e x i s t i n g knowledge base or framework.  One type of knowledge assessment r e v e a l s " f a c t s " and  the other, the framework which i s guiding d a i l y d e c i s i o n making.  Influence of s o c i a l status and f a m i l y . The p a r t i c i p a n t s in t h i s study were a l l from middle c l a s s f a m i l i e s .  I t i s worthy of note that as  well as having a range of food behaviors, the teenagers w i t h i n the study group held d i f f e r i n g views of what was important or valued as f a r as t h e i r food behaviors were concerned.  Studies such as that by Dwyer et al  (1967) suggest that c u l t u r a l and f a m i l i a l f a c t o r s i n some way i n f l u e n c e d adolescents' food p r a c t i c e s . In the process of developing t h e i r perceptions of food, the teenagers in the study d e s c r i b e d here c i t e d t h e i r parents as sources of knowledge. They also v a l i d a t e d t h e i r food behaviors by comparing them with those of t h e i r parents or peers.  Many  teenagers, as well as i d e n t i f y i n g f a m i l y members as sources of i n f o r m a t i o n , i n d i c a t e d that some food behaviors or b e l i e f s derived from f a m i l y p a t t e r n s or t r a d i t i o n s .  Some teenagers perceived i t more  important to maintain these t r a d i t i o n s than others. The importance of  83  maintaining t r a d i t i o n s could be seen to correspond with the types o f behaviors and b e l i e f s c h a r a c t e r i z e d by the " c o n v i c t i o n s " category. The idea t h a t knowledge i s s o c i a l l y constructed and t h a t i n f o r m a t i o n i s i n t e r p r e t e d i n l i g h t o f b e l i e f s and experiences r e i n f o r c e s the need f o r health care workers to assess i n d i v i d u a l s ' food behaviors and r a t i o n a l e s f o r t h e i r behaviors i n the context of the f a m i l y .  Family  environments c o n t r i b u t e to the i n d i v i d u a l ' s assessments of what i s meaningful and what types o f information or behaviors are perceived by the teenagers as important to c o n s i d e r .  Summary The p r e s e n t a t i o n o f accounts described processes i n v o l v e d i n the development o f teenagers' r a t i o n a l e s f o r t h e i r food behaviors.  The  d i s c u s s i o n addressed how t h i s study adds to an understanding of why teenagers have the food behaviors they do, how they make food d e c i s i o n s , how they make sense of information and how they develop t h e i r a t t i t u d e s towards food. In c o n s t r u c t i n g accounts the w r i t e r was guided by the three purposes o f the study.  One purpose was to explore with the teenagers  t h e i r perceptions o f t h e i r food behaviors.  A second was to understand  the p o s i t i o n food and food behaviors have w i t h i n the values of the adolescent group. The t h i r d was to describe v a r i a t i o n s or changes i n adolescents' food r e l a t e d a c t i v i t i e s by observing them. Data c o l l e c t i o n was guided by the study purposes and data a n a l y s i s organized accounts i n t o conceptual c a t e g o r i e s .  84  This chapter described that teenagers have frameworks which guide t h e i r food d e c i s i o n making.  Processes which c o n t r i b u t e d to the  development of the frameworks were the i n t e r p r e t a t i o n of cues and knowledge, the comparison of themselves with others and the d e s i r e to resolve issues of personal concern.  The teenagers were also described as  having food behaviors d i r e c t e d by issues r e l a t e d to e i t h e r " c o n v i c t i o n s " or  "convenience." The p r e s e n t a t i o n of accounts i s unique in comparison  to reviewed  l i t e r a t u r e i n that i t represents the teenagers' points of view and i d e n t i f i e s , f o r example, who they view as information resources, t h e i r i n t e r p r e t a t i o n s of the e f f e c t s of recommended e a t i n g patterns on t h e i r bodies or sense of well being and t h e i r perceptions of both the p o s i t i v e and negative outcomes of adopting p a r t i c u l a r food behavior p a t t e r n s .  The  w r i t e r ' s d e s c r i p t i o n of both the processes which c o n t r i b u t e d to the development of the adolescents' frameworks and the two behavioral p a t t e r n s a s s o c i a t e d with " c o n v i c t i o n s " and "convenience"  conceptualizes  the adolescents' p e r s p e c t i v e s d i f f e r e n t l y than what i s presented i n reviewed l i t e r a t u r e .  In d i s c u s s i n g t h i s study in r e l a t i o n to the  l i t e r a t u r e i t was also proposed that presented accounts can both provide explanations f o r patterns of food intake which were described i n s t u d i e s c i t e d and i d e n t i f y f a c t o r s which i n f l u e n c e teenagers' food behaviors. T h i s study demonstrated  that food behaviors are most often  perceived in r e l a t i o n to issues of l i f e s t y l e such as a c t i v i t i e s or f r i e n d s h i p s and not n e c e s s a r i l y i n r e l a t i o n to concerns of health or illness.  In d e s c r i b i n g the patterns of food behaviors a s s o c i a t e d with  85  " c o n v i c t i o n s " and "convenience," the w r i t e r proposes a way of e x p l a i n i n g teenagers' food behaviors in a way that i s not n e c e s s a r i l y dependent upon v a l u i n g health.  Chapter V SUMMARY, CONCLUSIONS, IMPLICATIONS AND RECOMMENDATIONS FOR FURTHER STUDY  Summary Both the w r i t e r ' s observations o f teenagers i n c l i n i c a l s e t t i n g s and a review of r e l e v a n t l i t e r a t u r e i d e n t i f i e d that we know l i t t l e adolescents' food behaviors.  about  T h i s presents a problem to nurses and other  health care workers as they i d e n t i f y the need to design or implement n u t r i t i o n i n t e r v e n t i o n programmes.  Understanding why people behave as  they do can help health care p r o f e s s i o n a l s provide care i n terms meaningful  to the c l i e n t s and i n a way which i s c o n s i s t e n t with c l i e n t s '  expectations.  Studies which examined issues r e l a t e d to the i n i t i a t i o n  and maintenance o f change i n health behaviors were reviewed.  They  addressed questions r e l a t e d to when and why i n d i v i d u a l s c a r r y out p r e s c r i b e d behaviors.  Reviewed s t u d i e s o f health behaviors i n d i c a t e d  t h a t , while some aspects o f "preventive" a c t i o n s are viewed s i m i l a r l y t o " c u r a t i v e " ones, there are a l s o d i f f e r e n c e s . Examples of c i t e d d i f f e r e n c e s are c l i e n t s ' perceptions of the value of the p r e s c r i b e d behaviors, perceptions o f the p r e s c r i b e d regimen's impact on other aspects of t h e i r l i f e s t y l e and the complexity of the p r e s c r i b e d r o u t i n e . E a r l y n u t r i t i o n researchers s t u d i e d problems r e l a t e d to the i n i t i a t i o n and maintenance of change i n food behaviors. They employed ethnographic methods and s t u d i e d food as part o f a c u l t u r e . The 86  87 understanding gained by t h e i r research c o n t r i b u t e d to the design of more e f f e c t i v e n u t r i t i o n i n t e r v e n t i o n programmes.  S i m i l a r research methods  and a p p l i c a t i o n s of f i n d i n g s have been described more r e c e n t l y i n understanding how d i f f e r e n t c u l t u r a l groups perceive and r e s o l v e i l l n e s s concerns. I t i s important to describe and i d e n t i f y patterns of what i t i s people eat to assess the incidence and type of n u t r i t i o n a l problems. Several researchers have done t h i s f o r the adolescent p o p u l a t i o n .  Recent  s t u d i e s also suggest that f a m i l y , c u l t u r e and perception of s e l f i n f l u e n c e food behaviors.  Although adolescent food behaviors ranging in  degrees of h e a l t h i n e s s are documented i n l i t e r a t u r e reviewed, there are not s a t i s f a c t o r y explanations of i n d i v i d u a l d i f f e r e n c e s in observed practices.  What has not been responded to are the questions r e l a t e d to  why teenagers a c t as they do. Such information has been described as c r i t i c a l to the e f f e c t i v e p r o v i s i o n of care.  P r o v i s i o n of care in the context of t h i s study would  mean communicating n u t r i t i o n information i n a manner that would be acceptable to teenagers and r e s u l t i n t h e i r adoption of recommended eating patterns. I t was proposed that p r o v i d i n g a d e s c r i p t i o n of how  teenagers  e x p l a i n t h e i r food behaviors would help to increase understanding of how adolescents i n t e r p r e t or make sense of knowledge or f a c t s , how they develop t h e i r a t t i t u d e s and i n turn how they make d e c i s i o n s about t h e i r food behaviors.  I t could a l s o provide information about what teenagers  consider to be important or what they perceive to i n f l u e n c e t h e i r food  88  b e l i e f s or behaviors. The i n t e r p r e t i v e method was chosen to address the study  problem.  C h a r a c t e r i s t i c s of the method i n c l u d e researcher involvement i n the research process of understanding how i n d i v i d u a l s develop t h e i r views. The researcher both interviewed and observed teenagers to i d e n t i f y f a c t o r s which were meaningful meaningful.  to them and to understand why they were  This enabled the researcher to respond to the study's  purposes which were; to d e s c r i b e adolescents' perceptions of t h e i r food r e l a t e d behaviors, to develop an understanding of the p o s i t i o n food and food r e l a t e d behaviors have w i t h i n the values of the adolescent group and to d e s c r i b e v a r i a t i o n s or changes in food r e l a t e d a c t i v i t i e s as adolescents were observed in s e l e c t e d s i t u a t i o n s at s e l e c t e d times. In t h i s study method, data a n a l y s i s i s ongoing and may d i r e c t the researcher to i n c l u d e e x t r a p a r t i c i p a n t s exemplifying d i f f e r i n g characteristics.  Based on i n i t i a l data a n a l y s i s the researcher chose to  augment the sample s i z e and to r e f i n e the s e l e c t i o n c r i t e r i a of age, sex and a b i l i t y to speak E n g l i s h . Nine teenagers were interviewed and observed on two occasions and two teenagers were interviewed and observed on one o c c a s i o n .  The t r a n s c r i b e d interviews and recorded observations  formed the data f o r the study. P r e s e n t a t i o n of an i n t e r p r e t i v e study does not i n v o l v e the measurement of the incidence of p a r t i c u l a r behaviors or statements,  but  d e s c r i b e s how f a c t o r s such as events, a c t i v i t i e s or knowledge become meaningful  to i n d i v i d u a l s . A goal was to i d e n t i f y each i n d i v i d u a l ' s way  of t h i n k i n g about the t o p i c of food.  T h i s method was p a r t i c u l a r l y  89  appropriate to study the described problem because observations and second interviews allowed the researcher to i d e n t i f y c o n s i s t e n c y i n behaviors and accounts and provided the opportunity to c l a r i f y interpretations.  In t h i s way, the researcher constructed accounts of  food behaviors with the teenage p a r t i c i p a n t s . The p r e s e n t a t i o n of accounts demonstrated  that teenagers have  frameworks which guide t h e i r d e c i s i o n making about food.  Processes which  c o n t r i b u t e d to the development of the frameworks were the i n t e r p r e t a t i o n of cues and knowledge, the comparison of themselves with others and the d e s i r e to r e s o l v e issues of personal concern.  The adolescents were a l s o  described as having food behaviors d i r e c t e d by issues r e l a t e d e i t h e r to " c o n v i c t i o n s " or "convenience."  An example of cues to which they might  attend was the response of t h e i r bodies to p a r t i c u l a r foods or activities.  In t h e i r use of knowledge, the teenagers were described to  both assess the usefulness of shared f a c t s and to a c t i v e l y seek s o l u t i o n s to p a r t i c u l a r problems i d e n t i f i e d .  The teenagers defined the relevancy  of such cues or knowledge in terms of how they might c o n t r i b u t e to reaching i d e n t i f i e d personal goals. The reasoning processes used by the boys and g i r l s provide i n s i g h t i n t o how b e l i e f s about foods and food behaviors are developed how teenagers use i n f o r m a t i o n .  and  The p r e s e n t a t i o n of accounts c o n t r i b u t e s  to an understanding of teenagers' food behaviors by i d e n t i f y i n g not only what the teenagers' perceptions are, but a l s o what f a c t o r s c o n t r i b u t e to t h e i r development. In d i s c u s s i n g t h i s study in r e l a t i o n to the l i t e r a t u r e , the  90  w r i t e r i d e n t i f i e d t h a t making e x p l i c i t the frameworks guiding teenagers' food d e c i s i o n s c o n t r i b u t e s to an understanding of what i s s u e s are perceived as important by teenagers and how the issues i n f l u e n c e food d e c i s i o n s made. In c o n c e p t u a l i z i n g food patterns a s s o c i a t e d with " c o n v i c t i o n s " and "convenience," the w r i t e r presents ways of e x p l a i n i n g teenagers' food behaviors which r e f l e c t t h e i r p e r c e p t i o n s , a t t i t u d e s and values.  Understanding how adolescents develop t h e i r points of view, the  nature and types of cues to which they attend, the r o l e models they choose, and the way they i n t e r p r e t information in l i g h t of t h e i r b e l i e f s can provide d i r e c t i o n to health care p r o f e s s i o n a l s as they develop i n t e r v e n t i o n programmes.  There i s a need to present n u t r i t i o n  information i n r e l a t i o n to issues of importance to teenagers and in terms understood by them.  Conclusions The observations and conceptual c a t e g o r i e s developed in t h i s study represent how teenagers view t h e i r food behaviors.  As such, t h i s  study c o n t r i b u t e s one explanation of adolescents' everyday food d e c i s i o n making. T h i s study, l i k e others, r e i n f o r c e s the notion that i n d i v i d u a l s develop ways of viewing t h e i r own s i t u a t i o n s that may d i f f e r from those of o t h e r s .  Health care workers most f r e q u e n t l y c o n c e p t u a l i z e and present  n u t r i t i o n information w i t h i n the context of health r e l a t e d i s s u e s .  While  some teenagers i n t h i s study were concerned about h e a l t h , most were more concerned about the impact food behaviors had on other parts of t h e i r  91 life.  As such, health care workers and teenagers might be seen to have  d i f f e r i n g "explanatory models," (Kleinman, 1975) or i n the context of t h i s study,  frameworks.  That teenagers p e r c e i v e t h e i r food behaviors to be "normal" or "good" i s an important observation which c o n t r a s t s with r e p o r t s o f n u t r i t i o n r e s e a r c h e r s . This b e l i e f was c i t e d as a r a t i o n a l e by the adolescents as they j u s t i f i e d d e c i s i o n s made, considered how they would use knowledge and chose t h e i r food behavior r o l e models.  Nutrition  research, however, r e p o r t s t h a t many teenagers have "bad" or "unhealthy" diets. The conceptual c a t e g o r i e s o f " c o n v i c t i o n s " and "convenience" and the d e s c r i b e d processes o f d e c i s i o n making suggest the adolescents' r a t i o n a l e s f o r a c t i n g are more c l e a r l y r e l a t e d to i s s u e s of personal concern, e s t a b l i s h e d patterns or r o u t i n e s , and i n t e r p r e t a t i o n s o f information communicated than they are to i s s u e s of h e a l t h . D e s c r i p t i o n s of the processes i n v o l v e d as teenagers develop t h e i r p a r t i c u l a r food b e l i e f s s t r o n g l y suggest t h a t , although one may c o n t r o l the content and types of information shared (such as i n n u t r i t i o n teaching or i n t e r v e n t i o n programmes), how the i n d i v i d u a l teenager might use i t or make sense of i t i s l e s s p r e d i c t a b l e . Imp!ications T h i s study assumed that i n d i v i d u a l respondents spoke as competent members of the adolescent group.  The w r i t e r through the use o f  i n t e r v i e w s and observations sought to c l a r i f y with the teenagers t h e i r  0  92 perceptions of t h e i r food behaviors.  The importance of the d e s c r i p t i o n ,  then, l i e s in the c l a r i t y of p r e s e n t a t i o n , allowing others to develop, question and r e f i n e the observations and c o n c e p t u a l i z a t i o n s i n i n t e r a c t i o n with teenagers or groups.  The accounts presented show that  i n d i v i d u a l teenagers think about t h e i r food behaviors in ways that d i f f e r from health or p r o f e s s i o n a l models. Kleinman (1978a) s t a t e s the i m p l i c a t i o n s of d i f f e r i n g points of view on the e f f e c t i v e p r o v i s i o n of care.  In order to increase s a t i s f a c t i o n with care and f o r p r o f e s s i o n a l s  to be able to achieve higher l e v e l s of compliance with regimens they p r e s c r i b e , awareness of how i n d i v i d u a l s a r r i v e at d e c i s i o n s or view t h e i r situations i s required.  Inherent i n such a statement i s the i m p l i c a t i o n  f o r p r o f e s s i o n a l s to a r t i c u l a t e t h e i r models or ways of viewing a t o p i c such as food. T h i s study supports the view that in order to increase the e f f e c t i v e n e s s of teaching i n t e r v e n t i o n s the teaching s i t u a t i o n should provide o p p o r t u n i t i e s f o r e x p l o r a t i o n of preconceived notions concerning the t o p i c of food.  Such a process would f a c i l i t a t e assessment of what  teenagers would perceive as necessary information as well as a i d i n g the i n t e r v e n i n g nurse i n presenting information in a manner the adolescent would perceive to be r e l e v a n t . The process o r i e n t e d approach would also encourage the nurse to seek the i n d i v i d u a l ' s perceptions of what had been "taught."  In t h i s way  the i n t e r v e n i n g nurse would have the opportunity to c l a r i f y misconceptions, add more information, or i d e n t i f y conceptual b a r r i e r s i n h i b i t i n g the c l i e n t ' s a b i l i t y to incorporate new i n f o r m a t i o n .  93  People i n f l u e n c e the types of b e l i e f s developed or food behaviors adopted because, through a process of v a l i d a t i o n , the teenagers compare t h e i r food behaviors and seek information or advice.  This implies health  care workers should i d e n t i f y the teenagers' p r e f e r r e d r o l e models and t h e i r sources f o r information. L i t e r a t u r e , observations and t h i s study reported that most teenagers have reasons f o r t h e i r food behaviors which were not r e l a t e d to health and t h i s could account f o r an observed lack of r e c e p t i v i t y to i n t e r v e n t i o n programmes.  A v a r i e t y of d i f f e r e n t views were d e s c r i b e d .  For example, food behaviors were i n f l u e n c e d by b e l i e f s and the teenagers' perceptions t h a t p a r t i c u l a r foods would c o n t r i b u t e to the r e s o l u t i o n o f i s s u e s of personal concern.  The behavioral patterns a s s o c i a t e d with  " c o n v i c t i o n s " and "convenience" are examples of how d i f f e r e n t o r i e n t a t i o n s or value sets may i n f l u e n c e food d e c i s i o n s and food behaviors.  These observations and the adolescents' perceptions t h a t  t h e i r food behaviors are "good" or "healthy" suggest some reasons  why  teenagers might consider they do not need n u t r i t i o n i n t e r v e n t i o n programmes or t h a t n u t r i t i o n information i s not useful to them.  This  study can provide d i r e c t i o n to health care workers i n t e r e s t e d i n encouraging teenagers to p a r t i c i p a t e i n n u t r i t i o n i n t e r v e n t i o n programmes by presenting information i n a manner which would be meaningful  to them.  Recommendations For Further Study As the teenagers recounted experiences and t h e i r reasons f o r f o r adopting new food behaviors, they o f t e n i n d i c a t e d something  had  94  happened to change the way they p r i o r i t i z e d the importance of some food r e l a t e d i s s u e s . Developing an awareness of new food ideas was one reason c i t e d ; others were o f t e n r e l a t e d to changing perceptions of themselves. F u r t h e r research might u s e f u l l y explore the process of s e n s i t i z a t i o n of teenagers to food r e l a t e d i s s u e s , what might be an optimum time f o r teaching or i n t e r v e n t i o n programmes, i . e . p r i o r to or post puberty, and the  i d e n t i f i c a t i o n of s t r a t e g i e s of i n t e r v e n t i o n which would support the  i n t r o d u c t i o n of change in teenagers' d i e t s .  While t h i s study focused on  healthy teenagers, a s i m i l a r study of teenagers on t h e r a p e u t i c d i e t s would c o n t r i b u t e to an understanding of how they develop views of t h e i r food behaviors and in what ways, i f any, they may d i f f e r from teenagers such as those i n c l u d e d i n t h i s study. The notion t h a t some persons were i d e n t i f i e d by the teenagers as more " r e l i a b l e " or c r e d i b l e information sources than others r a i s e s questions r e q u i r i n g f u r t h e r e x p l o r a t i o n . How might nurses enhance t h e i r c r e d i b i l i t y as informants?  Or, how might one intervene to change a  s i t u a t i o n where e s t a b l i s h e d r o u t i n e s are supported by persons i d e n t i f i e d as " c r e d i b l e ? " The boys and g i r l s i n the study a l l p a r t i c i p a t e d , in a c t i v i t i e s o u t s i d e of s c h o o l . One had the sense that most of them were very busy. Some teenagers would say t h a t , d e s p i t e being busy, planning a "good" lunch was important so "you make time."  Several of the adolescents who  were more s i t u a t i o n a l l y dependent valued o p p o r t u n i t i e s which would i n c r e a s e t h e i r range of c h o i c e s . These might i n c l u d e having i n c r e a s e d  95  spending money, d e s i r i n g greater v a r i e t y i n c a f e t e r i a s , or l e a r n i n g s k i l l s r e l a t e d to food p r e p a r a t i o n .  Such observations make one question  whether the described tendencies are only r e l a t e d to food behaviors or i f they represent two d i f f e r i n g ways o f coping with a busy l i f e s t y l e , by planning or by responding. The two d i f f e r i n g value sets a l s o suggest t h a t , although a l l of the adolescents may have known what they "should" e a t , t h e i r perceptions of t h e i r own a b i l i t i e s to provide the foods e i t h e r through preparation or purchase i n f l u e n c e d t h e i r food behaviors.  I t would be worthwhile to  f u r t h e r explore t h i s n o t i o n . F i n a l l y , although t h i s study focused on adolescents' p e r c e p t i o n s , understanding the extent to which such perceptions might be shared by those of d i f f e r e n t age groups and with d i f f e r e n t c u l t u r a l o r i e n t a t i o n s would a l s o be useful to explore.  96  REFERENCE NOTES 1 - S a u c i e r , J e a n - F r a n c o i s . R e s p o n s i b i l i t y f o r own health and prevention among teenagers. Paper presented a t the Canadian P u b l i c Health A s s o c i a t i o n Annual Conference June 26, 1980. Ottawa, Ontario. 2 -  , & Gauthier, Marie Chantal. Le degree des connaissances en r e l a t i o n avec l e s a t t i t u d e s e t l e s comportements, eh p r e v e n t i o n , chex l e s adolescents M o n t r e a l a i s . 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Adolescent n u t r i t i o n as i t r e l a t e s to c a r d i o v a s c u l a r disease and reproductive c a p a c i t y l a t e r i n l i f e . N u t r i t i o n Reviews, 1981, 39, 107-11. Wilson, H o l l y Skodol. L i m i t i n g i n t r u s i o n - s o c i a l control of o u t s i d e r s i n a healing community, ah i l l u s t r a t i o n of q u a l i t a t i v e comparative a n a l y s i s . Nursing Reseach, 1977, 26_, 103-11.  106  APPENDIX A  0  108  APPENDIX B  109 J u l y 31, 1981. Consent Form  I am i n t e r e s t e d i n spending some time t a l k i n g with Judy Lynam about my e a t i n g p a t t e r n s . I understand that she i s i n t e r e s t e d i n knowing more about how teenagers made d e c i s i o n s about t h e i r d i e t . I understand that we w i l l get together twice i n my home where Judy w i l l ask me some questions and observe me. An example of a question I might be asked would be to d e s c r i b e a t y p i c a l day's e a t i n g p a t t e r n . Observations made might i n c l u d e ; time, place and composition of meal and type o f i n t e r a c t i o n s between those present. As we t a l k the d i s c u s s i o n w i l l be tape recorded. w i l l be kept c o n f i d e n t i a l .  These tapes  I am aware t h a t I may refuse to answer any s p e c i f i c question(s) or completely withdraw from the study, without p r e j u d i c e , at any time. I have discussed t h i s with my parents.  Teenager  Date  I (agree/do not agree) to allow my son/daughter * to p a r t i c i p a t e i n the study as i t has been d e s c r i b e d .  Parent  Date  

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