Provided for non-commercial research and education use. Not for reproduction, distribution or commercial use.

Volume 42 Number 4 , July/Auiust 201 0

Journal of Nutrition Education

and Behavior

In This Issue:

Leamtt·centettd Eduauion to Improve Fruit & Veget• ble lnl• k• in WK

F• mlly Membtt>' Influence on F• mlfy Meal Vqetable Choicu

Gender Ptt>pectives on Adolescent Eoting Behaviors in Hong Kong

Feedln1 Proctic .. & Styles Uoed by Low-income hrenb

This article appeared in a journal published by Elsevier. The attached copy is furnished to the author for internal non-commercial research and education use, including for instruction at the authors institution

and sharing with colleagues.

Other uses, including reproduction and distribution, or selling or licensing copies, or posting to personal, institutional or third party

websites are prohibited.

In most cases authors are permitted to post their version of the article (e.g. in Word or Tex form) to their personal website or institutional repository. Authors requiring further information

regarding Elsevier's archiving and manuscript policies are encouraged to visit:

http://www.elsevier.com/copyright

Research Article Gender Perspectives on Adolescent Eating Behaviors: A Study on the Eating Attitudes and Behaviors of Junior Secondary Students in Hong Kong Wai-ling Theresa Lai Yeung, PhD

ABSTRACT

Objective: This research aimed to investigate the eating attitudes and behaviors of junior secondary students in Hong Kong, with a specific focus on possible gender differences . Design: A survey was conducted in 2005 to solicit data about participants' food knowledge, eating atti­tudes and behavior, perceptions of cooking skills and body weight, and related factors influencing food choice. Setting: Twenty-three secondary schools located in different district areas of Hong Kong. Participants: The sample was composed of 836 students (41 % male, 59% female) aged 11-18 years selected by random sampling. Analysis: Cross-tabulation analyses were used to compare the responses by gender. Results: Regardless of gender, less than half of the sample ate breakfast every day, and their consumption of fruits and vegetables was below recommended daily intakes. No significant differences were observed between respondents' eating habits and levels of food knowledge.Female students were more weight con­scious than male students. Dissatisfaction about body weight was common among normal and under­weight students. Cooking skills were generally valued as important life skills by both genders, though cooking skills were seen to be more relevant for girls. Conclusions and Implications: School nutrition education in Hong Kong should be designed to appeal to boys as well as girls, and effective implementation of nutrition education programs should inculcate healthful eating habits and sound cooking skills and address the needs of students with reference to gender differences. A more diversified approach could be employed through formal and informal curricula, prioritizing cooking skills and food advertising literacy in the curriculum. Key Words: gender, adolescent, eating, cooking skills, food advertising literacy U Nutr Educ Behav. 2010;42:250-258.)

INTRODUCTION are a variety of factors that influence young people1s food choices. For ex­ample, taste and flavor have consis­tently been reported as major influences on food choice. 1

•3

•4 Other

factors include cost and accessibility of the food, and the perceived health­fulness or energy density characteris­tics of the food. 1'

5 Environmental concern appears to influence food choice.6

•7 Recent studies have re-

vealed relationships between body image and adolescent eating behav­ior.8-10 Young peoples1 eating habits also appear to be influenced by the family, peers, and the social eating culture, as well as mass media mes­sages. 4,5, 11, 12

Adolescence is characterized by rapid growth and maturation. Healthful eating helps young people to achieve their full growth potential, promotes their health and well-being, and re­duces their risk of chronic diseases in adulthood. 1 Food choice patterns es­tablished during youth will likely in­fluence long-term behaviors.2 There

Research was conducted while the author was a doctoral student at Deakin University, Aus­tralia; Dr. Lai-Yeung is currently at the Department of Health and Physical Education, Technology and Living Division, The Hong Kong Institute of Education, Hong Kong, PRC. Address for correspondence: Wai-ling Theresa Lai Yeung, PhD, Department of Mathemat­ics, Science, Social Sciences and Technology, Technology and Living Division, The Hong Kong Institute of Education, 10 Lo Ping Road, Tai Po, N .T. Hong Kong, PRC; Telephone; +852 29487641; Fax : +852 29487848; E-mail: tlai@ied.edu.hk ©2010 SOCIETY FOR NUTRITION EDUCATION doi: 10.1016/j.jneb.2009 .05 .008

International studies have indi­cated that despite possessing consider­able food knowledge, many adolescents find it difficult to follow healthful eating recommendations and often consume food that they think is unhealthful. 11

•13 Similar find­

ings have been found among Hong Kong students, which indicated that many students are not able to put the theory they learn in the classroom into practice.14 Understanding young people1s beliefs and attitudes about food will help practitioners design and implement effective interven­tions to help adolescents develop lifelong healthful eating habits.

250 Journal of Nutrition Education and Behavior • Volume 42, Number 4, 2010

Journal of Nutrition Education and Behavior • Volume 42, Number 4, 2010

Therefore, the present study was con­ducted in 2005 and 2006 to investigate the eating attitudes and behaviors of junior secondary students.

The theoretical basis of this study was the Food-related Lifestyle model. 15

•16 In this model, variables

that make up consumers' lifestyles in­clude usage situations (social situa­tions in which people eat and buy food, eg, home, cafeteria, restaurant); concrete food product attributes (per­ceived sensory properties such as taste, smell, texture, and appearance of the food item); shopping scripts (the knowledge that enables people to shop for food products, eg, do they read food labels?); meal prepara­tion scripts (the knowledge that en­ables people to transform food into meals, eg, how much time is used for preparation? Is it certain family mem­bers' responsibility? Is it by family division of labor?); higher order attri­butes (attributes such as healthful, nutritious, natural, trendy, conve­nience properties); expected conse­quences after consumption of the food (eg, acceptance by members of the family, feeling sick after eating raw food, and increasing body weight after eating food high in fat); and per­sonal values (eg, peer acceptance, taste enjoyment, healthful food choice for long-term health conse­quences) .

This study was broadly based on the ways in which factors such as shopping and food preparation scripts, cost, habitual usage, and atti­tudes and beliefs about nutrition influence food choice behaviors. Al­though gender differences in several components of the Food-Related Life­style model have been described among adults in several studies, 1•

17-19

they have not been widely examined in relation to adolescents' food choice behaviors, particularly those of Chi­nese adolescents.

Generally, females make more healthful food choices than males.20

They are more likely to avoid high­fat food, eat fruit and food with high dietary fiber, and limit salt intakes. 19

Women also appear to be more reflec­tive about food and health issues and express more ethical concerns in rela­tion to food. 17 For example, American women appear to favor more health­ful meals than men, and they rate such meals higher on dimensions of

pleasure, convenience, and health.2 1

Similarly, Norwegian women appear to have higher levels of health knowl­edge than men, and they are more in­clined to make dietary changes in line with official recommendations.22

Women's beliefs and practices are im­portant because they often control family food consumption. In this study, it was expected that girls would exhibit more healthful eating habits and be more concerned than boys about healthful eating. It was also ex­pected that girls would demonstrate greater food knowledge than boys.

Generally, the main responsibility for food preparation in the household lies with women. For example, women prepared the evening meal in 70% of households in the United Kingdom in 1992.23 In the eyes of children, the prominent person in the household for the transmission of cooking skills is still "Mom" and older sisters24

; many still believe that cooking skills are more important for girls than boys. 25

•26 Indeed, men are

more likely to have first learned cook­ing skills from their wives or partners than from school or books. 27 There­fore, it is hypothesized that more boys than girls are likely to believe cooking skills are "women's business." Lack of food preparation skills is found to be one of the barriers to the consumption of a healthful diet.24

•2

•28 In that case, men may be

more vulnerable to unhealthful eating if they are unable to cook.

Women are more likely than men to report that weight concerns influ­ence their food choices, and that healthful eating is important to them. For example, more female than male students used food label in­formation about fat content and low­fat food. 1 Women are more likely than men to be dieting; to deliberately alter their diet so as to lose weight; to report eating in response to stress or boredom; and to report guilt in rela­tion to eating.17

•19 Further, the use of

weight loss diets is more a characteris­tic of females than males. 17

•29

•30 These

general findings also appear to apply to the young people in Hong Kong.8

•10 Therefore, in this study, it

was expected that girls would be more weight conscious than boys.

From an extensive review of previ­ous literature, it was expected that there would be gender differences

Lai Yeung 251

demonstrated in Hong Kong adoles­cents' beliefs about and use of food. Therefore, this paper aims to investi­gate the eating attitudes and behav­iors of junior secondary students (those studying at secondary level 1, 2, and 3, aged between 11 and 16 years), and examine possible gender differences among Hong Kong sec­ondary students. The following hy­potheses were made:

1. Girls will have more healthful eat­ing habits and will be more con­cerned about healthful eating.

2. Girls are more competent in food knowledge than boys.

3. More boys than girls are likely to believe cooking skills are girls' business.

4. Girls will be more weight conscious than boys.

METHODS Questionnaire

A questionnaire was constructed to as­sess eating attitudes and behaviors with reference to the factors included in the Food-Related Lifestyle model. 15

•16 There were 56 questions

about the subjects' food use situations (social settings such as the home, schools, and restaurants); how they shop for and prepare food (such as types of food purchased and prepared at home); concrete attributes (such as taste and cost) and higher attributes ("credence variables" such as percep­tions of healthfulness and conve­nience); as well as the consequences they may associate with eating (such as the risk of chronic diseases) . Some of the questionnaire items were based on those used in earlier studies in Hong Kong.31

•32 Attitudes about food

choice, concerns about healthful eat­ing, cooking skills, perceived peer health, and weight concerns were generally assessed by closed questions using 5-point response scales (strongly agree, agree, disagree, strongly disagree, and not sure), in which respondents were requested to specify their level of agreement with a statement or a question. Open­ended options were also used to en­able respondents to provide their own answers to certain questions and to provide reasons and examples (see Appendix 1 in the Supplementary

252 Lai Yeung

Data for examples of questionnaire items). A pilot-test with 8 academics and 20 students was conducted to identify confusing and ambiguous language and to obtain information about possible patterns of results.3 3

Survey Administration

Fifty-eight schools were invited to par­ticipate in the survey, of which 23 agreed to take part. These schools were scrutinized to ensure representa­tion of different school types and lo­cations in the various districts that serve diverse socioeconomic commu­nities within Hong Kong. The home economics teacher at each participant school was requested to administer questionnaires to 40 students study­ing at Secondary 1 to Secondary 3 se­lected by random sampling. For example, the teachers drew lots to pick 2 classes (of 40 students each) from the junior forms and then ran­domly selected students by picking odd or even numbers on the class list. Informed consent was obtained from all the respondents and their parents, and they were assured their responses would be kept in confi­dence. Ethics permission for this study was granted by the Deakin Uni­versity Human Ethics Committee. Nine hundred twenty questionnaires were disseminated and 836 completed questionnaires were returned for data analysis, making up a response rate of 90%.

Data Analysis

Returned questionnaires were scanned using the Teleform Software Package, and the data were analyzed using SPSS (version 12.0, SPSS, Inc., Chicago, IL, 2003). Although 836 questionnaires were used for analyses, there were occasional missing counts in some of them. Therefore, the max­imum number of responses available was analyzed. Body mass index (BMI) was calculated using the for­mula BMI = weight (kg)/ height (m)2

from self-reported heights and weights, and was categorized accord­ing to the standard for children and adolescents recommended by the Tai­wan Department of Health.34 Self-re­ported height and weight data from teenage populations provide valid in-

journal of Nutrition Education and Beh avior • Volume 42, Number 4, 2010

dices of true height and weight, though they should be used with cau­tion, as subjects may underestimate their weight.35

-37

Prior to cross-tabulation analyses, the 5-point response scales were ag­gregated into 3 groups (for example, "strongly agree" and "agree" were col­lapsed into "agree"; "strongly dis­agree" and "disagree" were collapsed into "disagree"; and "not sure" re­mained unchanged) . This step was performed to increase the expected cell frequencies. Cross-tabulation analyses were used to compare the re­sponses of the students by gender and BMI category. Chi-square tests were used to assess the statistical signifi­cance of the comparisons. An a level of P < .01 was set to determine statisti­cal significance. Results relevant to the gender issues are reported here; other findings are reported else­where. 14

RESULTS Demographic Characteristics

Most of the 836 respondents were in the 11-14 age group (82%), and only a minority (18%) was in the 15-18 age group. There were more female students than male students in the sample (Table 1). Fourteen percent of the males were overweight, slightly less than two-thirds were in the "nor­mal" range, and a quarter was under­weight. The distribution of male students across this variable was simi­lar to that of the female students (Table 1).

Students' Perceptions of Body Weight and Image

More female students reported they would feel upset if they discovered they were overweight, and the major­ity of the female respondents watched their weight (20% always; 65% some­times). Most of them would be likely to go on a slimming diet if their weight increased, and some of them would eat less food to compensate if they had eaten a lot of high-energy food. Overall, female students were more conscious than male students about their body weight (Table 2) . De­spite the fact that only about 14% of the sample was overweight, one-third of the respondents were not satisfied

with their weight. Among this group of 252 students (students not satisfied with their weight), only a quarter was from the overweight group, and three-quarters were from the normal (57%) and underweight (17%) cate­gories (Table 3).

Students' Eating Attitudes and Behaviors

Flavor (38%) and cost (23%) were found to be the main concerns of the students regarding food choice; hygiene (22%) and nutritive value (13%) were relatively less important influences. Very few respondents (3%) rated body image as important; peer food choice and environmental concern were of least importance (1 % and 1 %, respectively) .

About half of the students (49%) reported that they were concerned whether the food they ate was health­ful or not, but only about one-third (35%) would choose healthful food for snacks. Slightly less than half (43%) of the students reported that when eating tasty food, they could not stop themselves from eating even though they were no longer hungry. The majority (87%) was con­cerned that bad eating habits may lead to eating-related diseases in the long run, such as heart disease, cancer, osteoporosis, diabetes, and hyperten­sion. Most of the respondents (80%) believed that the tuck shops in their schools provide healthful options for snacks and drinks. More than half (60%) of them thought it was okay for the school snack bar to sell junk food. No significant differences by gender were observed in these regards. More female students believed that their friends care about eating health­ful food (62% vs 53%), and more male students believed that their friends care very much about staying fit and exercising than the female students (66% VS 58%).

Students' Eating Habits

Slightly less than half (46%) of the students in the sample ate breakfast everyday. The percentages who con­sumed bread, vegetables, and fruit are shown in Table 4 by gender. Four­teen percent of the group never in­cluded milk in their diet, and milk

Journal of Nutrition Education and Behavior • Volume 42, Number 4, 2010 Lai Yeung 253

Table 1. Breakdown of BMI Categories and Standards of Weight Status by Gender (n = 778)

BMI (kg/m2) category breakdown

Male (n) % Female (n) Underweight 78 25 11 3 Normal weight 188 61 293 Overweight 43 14 63 Total 309 100 469

BMI (kgl m2) standard used to define weight status of adolescentsa

Male 11 -14 Age(y)

Underweight Normal weight Overweight

(:::: 16.7) (16.8-21 .9) (~22 . 0)

15-18 (::::18.8) (18.9-23.5) (~23.6)

BMI indicates body mass index; y, years. 8 Source: Taiwan Department of Health, 2007.

consumption by the majority (81 %) of the sample was below recommen­ded portion of 2 glasses a day. The consumption of vegetables by each gender was similar, but more boys drank milk at least once a day. As for bread, most of the students pre­ferred white bread to brown bread, and the percentage for each gender was similar. One-third of the sample avoided visible fat when eating meat, whereas 12% said they ate all the visible fat. In this regard, more male students ate all the visible fat, whereas more female students re­moved all the visible fat. On the other hand, the majority (72%) of the sample usually chose low-fat milk, but more female students than male students preferred low-fat milk to whole milk.

Students' Food Knowledge

The majority of the sample (94%) had studied food and nutrition in their school curriculum through their home economics course (currently re­named "Technology and Living"), and most of them also learned cook­ing (86%), shopping (78%), and food label-reading skills (75%) from this course. However, fewer than half of them (41%) had learned how to cope with food advertising and marketing. In general, more than two-thirds of the respondents gave correct answers to the questions in the food knowl­edge quiz (no significant differences were observed between male and fe­male students). The majority (92%) of the students knew that exercising every day helps prevent heart disease.

% 24 63 13

100

11-14 (:::: 16.7) (16.8-21 .9) (~22.0)

Total (n) 191 481 106 778

Female

% 24 62 14

100

15-18 (::::18.2) (18.3-22.7) (~22.8)

About two-thirds (67%) of the respon­dents believed that they had acquired sufficient food knowledge from school and were competent to make healthful food choices.

Perceptions and Mastery of Cooking Skills

Cooking skills were taught in all 23 sur­veyed schools. Most of the respondents considered cooking skills important and believed that everyone should learn how to cook. However, 10% of the sample thought that cooking was not the boys' business, and more male students thought that only girls should learn cooking. Slightly less than half of the male students ( 4 7%) re­ported they always or sometimes learn

Table 2. Hong Kong Adolescent Students' Consciousness About Body Weight by Gendrn

Items

I am satisfied with my weight (n = 836). I will feel upset when I find myself overweight (n = 81 O). If I have eaten a lot of high-energy food which

I know is unhealthful , I eat less of other food to make up for it (n = 789).

I keep watching my weight (n = 780). I will go on a slimming diet if my weight goes up (n = 815).

All Male (n = 328)

Female (n = 478) (n = 806) Chi-square P value

67 40 35

% agree (% disagree) (24) 55 (37) 60 (43) 66 (25) 55 (49) 37 (44) 36

(32) (32) (46)

% always or sometimes (% never) 67 (33) 85 (15) 77 (23) 50 (50) 63 (37) 58 (42)

16.5 51.1

6.7

49 15

< .001 < .001

'15

<.001 <.001

254 Lai Yeung Journal of Nutrition Education and Behavior • Volume 42, Number 4, 2010

Table 3. Hong Kong Adolescent Students' Consciousness About Body Weight by BMI Category

Items

I am satisfied with my weight (n = 788). % within those not satisfied with their

weight (n = 252).

I keep watching my weight (n = 780).

BMI indicates body mass index.

cooking skills from their parents, but more than half of the female stu­dents (57%) did so (Table 5).

DISCUSSION Students' Eating Attitudes

Flavor and cost were the main con­cerns of the students, and hygiene and nutritive value were considered secondary preferences. This finding agrees with those from both interna­tional and local studies. 1•

3•4

•3 1

•38 Con­

temporary decision-making theories suggest that sensory appeal is one of the most important factors in food choice. 6 Taste and appearance of food are primary factors in adoles­cents' food selection, 1 and it has been argued that adolescents who ranked snack taste as the most impor­tant factor were less likely to report intended low-fat snack choice. 5

The majority of this sample was con­cerned that bad eating habits may lead to nutrition-related diseases in the long run, yet only 1 in 3 of them would choose healthful food for snacks. Many also reported that they could not stop themselves from eating when eating tasty food even though they were no longer hungry. This finding suggests that adolescents, regardless of gender, may not practice healthful eating habits even if they possess food knowl­edge, which agrees with similar find­ings from both local and international studies. 11

•13

• 14 For example, an Ameri­

can study indicated that adolescents found it difficult to follow healthful eat-

Underweight Normal Overweight All (n = 358) (n = 396) (n = 34) (n = 788) Chi-square Pvalue

% agree (% disagree) 67 (23) 65 (29) 18 (79) 60 (32) 86.3 <.001

17 57 26 100

Underweight Normal Overweight All (n = 355) (n = 391) (n = 34) (n = 780) Chi-square Pvalue

% always or sometimes (% never) 72 (28) 79 (21) 83 (17)

ing recommendations despite having sound food knowledge.13 A local teacher survey also revealed that most students prefer immediate food enjoy­ment to long-term health. Cravings were identified by the teachers as one of the barriers to healthful eating, apart from other barriers such as insufficient school support and influences brought about by peers, family, the media, and the social eating culture.14 Food crav­ings are significant psychological phe­nomena that may be triggered by exposure to the sensory properties of food. They may have adverse nutri­tional effects such as unhealthful snacking behavior.39 Contrary to the author's expectations, the findings did not support the hypothesis that girls would be more concerned than boys about healthful eating.

The present survey indicated that peer choice was seen to be of minor im­portance by most of the respondents. This finding contradicts those from the study by Story et al, 4° which sug­gests that peers help to create the norms concerning behavior and exert a major influence on overall adoles­cent behavior. Chapman and Maclean indicate that junk food was associated with friends and pleasure, whereas lik­ing healthful food was perceived as an oddity.4 1 Likely reasons for this dis­crepancy could be either that students' perceptions may not reflect their ac­tual behavior, or that not enough questions about peer influence were included in the questionnaire.

The female students were more con­cerned about removing fat from meat

78 (22) 20 .04

and choosing low-fat milk, thus sup­porting hypothesis 1, which expects that girls would have more healthful eating habits and would be more con­cerned about healthful eating. Some research suggests that healthful eating among adolescents may be more a re­sult of wanting a slender body shape than the pursuit of health.9 There was a statistically significant difference between female and male students re­garding consciousness of fat intake, however, whether the respondents ' choices reflected health consciousness or weight consciousness is uncertain. Such a difference may be owing to girls' greater interests in slim fashion and boys' interests in fitness and mas­culinity. In that case, the finding may support hypothesis 4, which predicted that girls would be more weight con­scious than boys.

Students' Food Knowledge and Eating Habits

Males and females exhibited similar levels of nutrition knowledge and similar consumption of vegetables, fruit, milk, and bread. This finding runs counter to the hypothesis that girls would have more healthful eat­ing habits and exhibit greater nutri­tion knowledge than boys. Although the students generally believed that they had acquired sufficient food knowledge from school and were competent to make healthful food choices, data about their eating habits did not support their claims. More

Journal of Nutrition Education and Behavior • Volume 42, Number 4, 2010 Lai Yeung 255

Table 4. Hong Kong Adolescent Students' Eating Habits Regarding H1gh-f1ber Food and Fat Intake by Gende1

Male Female Items (n = 328) (n = 476)

% white bread (% brown bread) Which one do you choose among the 73 (27) 76 (24)

2 types of bread (n = 806)? % consumption Amount of vegetables eaten everyday (n = 819)

None at all 1 2 Very little 20 15 Half bowl 36 34 1 bowl 35 41 2 bowls 9 8

Frequency of eating fruit (n = 822) Twice a day 8 13 Once a day 52 49 5-6 times a week 26 25 2-4 times a week 11 12 Once a week 2 2

% remove all the fat (% eat all the fat) Do you avoid visible fat, such as chicken skin , 24 (20) 42 (7)

when eating meat (n = 821)? % whole milk (% low-fat milk) Which type of milk do you usually drink (n = 820)? 34 (66) 25 (75)

than half of them (54%) did not eat breakfast every day, and only about one-tenth of them met the fruit and vegetable guidelines of the Hong Kong Department of Health (2 bowls of vegetables and 2 portions of fruit per day; see Table 4).42 This finding is consistent with those from other in­ternational and local studies.42

•43

Family eating habits may partly ex­plain this finding, as there appears to be an association between parental eating habits and fruit and vegetable consumption of children.44 Studies have also found that adolescent fruit and vegetable consumption is related to socioeconomic status.45

Consumption of brown bread by participants was low. This observation also agrees with other research, con­ducted locally, which revealed low awareness of the value of whole-meal bread and vegetables.46

-48 Further­

more, only 5% of the subjects met the recommended daily intake of 2 servings of milk. This finding may be because milk is not a traditional food item in the Chinese diet , yet there may be factors such as lactose intoler­ance in addition to cultural reasons. Local studies revealed that the Hong Kong population has a low mean cal­cium intake,4 7

•49 below the recom-

mendations of the World Health Organization/Food and Agriculture Organization (WHO/FA0).48

The present findings indicate that food and nutrition were generally taught as part of the home economics curriculum in most of the schools. Al­though cooking skills, shopping, and food label-reading skills were often included in the curriculum, food ad­vertising and marketing are often not included. Students and teachers may be unaware of the adverse effects of food advertising and marketing on eating habits. In Hong Kong, food and nutrition topics may not be ade­quately covered in home economics owing to a shared timetable with design and technology and content selection at the teachers' discretion.

Students' Food Preparation Skills and Attitudes toward Cooking

Consistent with international and local studies,23

-26 the differences between

the views of male and female students reflect a gender-stereotyped, traditional view that cooking is women's responsi­bility. Men (and women) who are un­able to cook are likely to be more

All (n = 804) Chi-square Pvalue

75 (25) 1.3 .25

1 5.4 .25 17 35 38

9

11 4 .5 .34 50 26 12

2

35 (12) 50.0 <.001

28 (72) 7.3 .01

vulnerable to unhealthful eating.27

The present findings show that al­though cooking skills are valued as im­portant life skills by young people of both sexes, not all of them have the op­portunity to learn cooking skills from their parents and from school.

Students' Perceptions of Their Own Body Weight

Many students, especially female stu­dents, in this study were conscious of their body weight. The willingness of female students to change their food consumption to stay at a fashion­able weight suggests that eating behavior is associated with their per­ceptions of body image. This finding reflects those from international and local studies.8•

9

Physical definitions of overweight with reference to BMI did not equate with personal perceptions of body weight. The majority of respondents who were not satisfied with their weight were from the normal and un­derweight categories. This finding agrees with findings from recent stud­ies in Hong Kong.10

•50 Reasons given

by those respondents in the normal BMI category who were dissatisfied

256 Lai Yeung Journal of Nutrition Education and Behavior • Volume 42, Number 4, 2010

Table 5. Hong Kong Adolescent Students' Attitude About Cooking Skills by Gender

Male Female All Items (n = 329) (n = 476) (n = 805) Chi-square Pvalue

% agree (% disagree) Everyone should learn how to cook (n = 818). Only girls should learn how to cook;

73 (17) 16 (75)

82 (11) 5 (93)

cooking is none of boys' business (n = 818). Cooking skills are important life skills (n = 811). At home, my parents teach me how

70 (7) 47 (53)

80 (3) 57 (43)

to cook food (n = 805).

with their weight generally reflected their desire to look slim. Attitudes to­ward dieting have changed dramati­cally over the past few years. People no longer diet exclusively for health reasons. It has become increasingly common for non-obese people in Hong Kong, particularly women, to diet so as to look thinner. 8 This may be an effect of the "tyranny of slender­ness" associated with food advertis­ing.50-52 This is an important area for school nutrition education, as recent studies have indicated that adoles­cents' anxiety about body weight and their interest in dieting will influ­ence their everyday food choice and sometimes may lead to eating disor­ders.9, J0,53,54

Limitations

The questionnaire elicited self­reported weight and height. Although it is argued that self-reported height and weight data from teenage popula­tions provides valid indices of true height and weight,36-38 some subjects may have reported inaccurate infor­mation, underestimated their weight, or responded in socially desirable ways. Self-reported behavior such as the frequency of vegetable consump­tion may be subject to recall error. Therefore, the generalization should be made with caution. Furthermore, the study employed a cross-sectional design, which prevents the making of causal attributions. In addition, the di­etary intakes of the subjects were not measured in detail. Further validation and replication of the study findings in subsequent studies is required.

With a view to enhancing validity and reliability of the survey, some items that had been used in other validated

studies were included in this explor­atory survey.31·32 To provide evidence of reliability, responses of various cate­gories of subjects (eg, sex and BMI) were compared to check whether known differences from previous stud­ies were also present in the data of this study. As discussed in the foregoing sec­tion, results of this preliminary study were also compared with those from other international and local studies.

IMPLICATIONS FOR RESEARCH AND PRACTICE

Home economics classes were found to be a major channel for students to learn food and nutrition as well as cooking skills. Gewirtz and Ball have argued that principals are increasingly driven by market principles and pa­rental choice55; such attitudes may negatively affect the survival of home economics in the curriculum in Hong Kong. In recent years, there has been an increase in the number of secondary schools discontinuing home economics, indicating that some principals are not supportive of including home economics in the curriculum because of other compet­ing demands. In a 2001 home eco­nomics teacher survey in Hong Kong, 22% of the respondents indi­cated that the subject faces a crisis in that its value is becoming trivialized in the teaching environment.56 In the Hong Kong education reforms, the subject's status is uncertain. The profile of secondary schools in 2006 (Committee on School Home Cooper­ation) revealed a low percentage (6%) of schools intending to allow home economics as an elective for their se­nior levels in 2009.57 Since food and

78 (13) 10.6 .01 10 (86) 50.8 < .001

76 (4) 16.9 <.001 53 (47) 11.5 .01

nutrition and healthful eating topics are taught mainly through home eco­nomics at schools, the survival of the subject in secondary schools is impor­tant for a continuing place for nutri­tion education in the school curriculum. On the other hand, fe­male students in this study appear to be more weight conscious; however, advertising literacy in nutrition edu­cation was not commonly taught in the schools. In view of the adverse ef­fects in food choice brought about by the "tyranny of slenderness," high­lighting the problems of food adver­tising should be an important starting point to raise awareness of the issue.

This study confirms the existence of gender differences in weight consciousness and in perceptions of cooking skills. However, the over­whelming finding was that regardless of sex, most adolescents exhibited poor eating habits. Further research is needed to identify barriers that pre­vent adolescents from consuming healthful diets. A holistic food and nutrition curriculum that supports the development of healthful eating habits and sound cooking skills is needed to help young women and men translate food knowledge into daily practice.

To help students develop lifelong healthful eating habits, a more holis­tic food and nutrition curriculum is needed, not only to teach students food knowledge at the cognitive level. A more diversified approach could be employed through formal and infor­mal curricula to expose students to various influences over food choices. For example, students might be given opportunities to evaluate food issues not only from a scientific perspective, but also from humanistic (including

Journal of Nutrition Education and B eh avior • Volume 42 , Number 4 , 2010

emotional, psychological and envi­ronmental) and socially critical per­spectives. Advertising literacy should be included as part of the nutrition or consumer education curriculum at schools, with more attention being given to female students. Education practitioners in Hong Kong should help young people to acquire positive attitudes toward body weight through implementing relevant value educa­tion and media literacy education pro­grams.

There is a need to examine the rea­sons for low milk consumption and to encourage eating of more fruits and vegetables. Incorporation of milk, fruit, and vegetables, as well as whole-meal cereals such as brown rice, should be encouraged in family diets and lunches provided at schools. School canteens should provide healthful options and make healthful food more appealing to teenagers.

School nutrition education in Hong Kong should be designed to ap­peal to boys as well as girls, and cook­ing should form a "core" component of the nutrition curriculum. To pro­vide opportunities for students to put theory into practice, nutrition educa­tion should go beyond the classroom. Therefore, schools and families should work together to provide a favorable environment for inculcating good eat­ing habits.

Further research is required to ex­plore the ways in which schools and families can collaborate to encourage cooking at home, that is, to make the home a context where theories from school nutrition education can be put into practice. The influence of the mass media and food marketing should also be examined in further re­search, so as to provide a holistic food and nutrition education for young people. More focused research to ex­amine the effects of peer influence on eating habits is also needed.

ACKNOWLEDGMENTS

The author would like to acknowledge her advisor Professor Tony Worsley who was her supervisor and head of the school of Exercise and Nutrition Sciences during her studies (2003 -2007). He is now Professor of Public Health of the School of Health Sci­ences at University of Wollongong.

SUPPLEMENTARY DAT A

Supplementary data associated with this article can be found, in the online version, at doi: 10.1016/j . jneb.2009. 05.008

REFERENCES

1. Shannon C , Story M, Fulkerson JA , French SA. Factors in the school cafete­ria influencing food choices by high school students. J Sch H ealth .

2002;72:229-235. 2. Kelder SH , Perry CL, Klepp KI,

Lytle LL. Longitudinal tracking of ado­lescent sm oking, physical activity, and food choice behaviors. A m J Public

H ealth. 1994;84:1121-1126. 3. Clarke JE. T aste and flavour: their im­

portance in food choice and acceptance. Proc N utr Soc. 1998;57:639-643 .

4. Giskes K, Patterson C , T urrell G, N ewman B. Health and nu trition be­liefs and perceptions of Brisbane adoles­cents. N utr Diet. 2005;62:69-75.

5. Story M , N eumark-Sztainer D , French SA. Individual and environmen­tal influences on adolescent eating be­haviors. j Am D iet A ssoc. 2002; 102(suppl 3):S40-S51.

6. Steptoe A, Pollard TM, W ardle J. De­velopment of a measure of the motives underlying the selection of food : the food choice questionnaire. Appetite.

1995;25:267-284. 7. Worsley A. Food and consumers:

where are w e heading? Asia Pac J C/in

N utr. 2000;9(suppl):S1 03-S107. 8. Cheung PCH , Ip PLS, Lam ST,

Bibby H . A study on body weight per­ception and w eight control behaviours among adolescents in Hong Kong. H ong K ong M ed). 2007;13:1 6-21.

9. Contento IR , Michela JL, Williams SS . Adolescent food choice criteria: role of weight and dieting status. A ppetite.

1995;25:51-76. 10. Lee S, Leung T , Lee AM, Yu H ,

Leung CM . Body dissa tisfaction among Chinese undergraduates and its implica­tions for eating disorders in Hong Kong. Int j Eat Disord. 1996;20:77-84.

11 . Birch LL, Fisher JO . D evelopment of eating behaviors among children and ad­olescen ts. Pediatrics. 1998;101 :539-549.

12. Wilson N , Quigley R , Mansoor 0 . Food ads on TV: a health hazard for children? A ust N Z J Public Health.

1999;23:647-650. 13. Croll JK , Neumark-Sztainer D ,

Story M. H ealthy ea ting: what does it

Lai Y eung 257

mean to adolescents? j N utr Edi1c.

2001;33:193-1 98. 14. Lai T . Th e Eating Habits of H ong Kong

Adolescents and Their Families [PhD thesis]. Australia: Deakin University; 2007.

15. Grunert KG. T owards a concept of fo od-rela ted life style. A ppetite.

1993;21 :151-1 55. 16. Grunert KG, Brunso K, Bisp S. Food

related lifes tyle: development of a cross-culturally valid instrument for market surveillance. MA PP; 1993. Working paper no . 12.

17. Beardsworth A, Bryman A, Keil T , Goode J , Haslam C , Lancashire E. Women, men and food : the signifi cance of gender fo r nutritional attitudes and choices. Br Food). 2002;104:470-491.

18. Terre L, Ghiselli W , T aloney L, DeSouza E. Demographics, affect, and adolescents' health behaviors. A doles­

cence . 1992;27:13-24. 19. Wardle J , Haase AM, Steptoe A,

Nillapun M , Jonwutiwes K, Bellisle F. Gender differences in food choice: the contribution of health beliefs and diet­ing. Ann Behav M ed. 2004;27:107-11 6.

20. Perry C , Griffin G, Murray DM. As­sessing needs fo r youth health promo­tion. Prev M ed. 1985; 14:379-393.

21. R appoport L, Peters GR, Downey R , McCann T, Huff-Corzine L. Gender and age differences in foo d cognition. A ppetite. 1993;20:33-52.

22. Fagerli RA, W andel M . Gender differ­ences in opinions and practices with regard to a healthy diet. Appetite.

1999;32:171-1 90. 23. Dixey R . Gender perspectives on fo od

and cooking skills. Br Food). 1996; 98:35. 24. Caraher M , Baker H , Burns M . C hil­

dren's views of cooking and foo d prep­aration. Br Food). 2004; 106:255-273.

25 . Caraher M , Dixon P, Lang T , Carr-Hill R . The state of cooking in England: the relationship of cooking skills to food choice. Br Food ).

1999; 101 :590-609 . 26. Lai T . A study of perceptions of food

preparation skills in H ong Kong adoles­cents. H EIA J. 2007;14:16-24.

27. Lang T , Caraher M . Is there a culinary skills transition? D ata and debate from the UK about changes in cooking cul­ture. HEIAJ. 2001;8:2-14.

28. Short F. D omestic cooking practices and cooking skills: findin gs fro m an English study. Food Service T echnology.

2003;3:177-1 85. 29. Champion H , Furnham A. The effect

of the m edia on body dissatisfac tion in

258 Lai Yeung

adolescent girls. E11r Eat Disord Re11. 1999; 1 :213-228.

30. Pingitore R , Spring B, Garfield D. Gender differences in body satisfaction. Obes R cs.1997;5:402-409.

31. Small Campus, Produce Green Foun­dation , The Boys and Girls Club Asso­ciation of Hong Kong, the Hong Kong Vegetarian Society. Survey on lunch habits of primary school students [in Chinese]. http: //www.vegsochk.org/ Health yDiet/index.htm . Accessed De­cember 7, 2009.

32. Hong Kong Department of Health. Healthy Living St1rt1ey 1999 R eport. H ong Kong Government Department of Health; 1999.

33. Wiersma W. R esearch Methods in Ed11ca­tion: An Introduction. 7th ed . Boston, MA: Allyn and Bacon; 2000.

34. Taiwan D epartment ofHealth. The Def­inition of Obesity and Principles oflnter­vention (in Chinese). http: //food.doh. gov . tw /foodnew /heal th/Child .aspx . Accessed December 7, 2009.

35. Crawley HF, Portides G. Self-reported versus measured height , weight and body mass index amongst 16-17 year old British teenagers. Int) Obes R e/at Metab Disord. 1995;19:579-584.

36. Roberts RJ. Can self-reported data accurately describe the prevalence of overweight? P11blic Health. 1995;109: 275-284.

37. Giacchi M , Mattei R , Rossi S. Correc­tion of the self-reported BM! in a teen­age population. Int) Obes Re/at M etab Disord. 1998;22:673-677.

38. Hong Kong Department of Health. Base­line Assessment of Promoting Hea lthy Eating in Primary Schools-Report S11111111ary. Hong Kong Department of Health, Cen­tre for Health Protection; 2006.

39. Pelchat ML. Food cravings in young and elderly adults. Appetite. 1997;28:103-1 13.

Journal of Nutrition Education and Behavior • Volume 42, Number 4, 2010

40. Story M, Lytle LA, Birnbaum AS, Perry CL. Peer-led, school-based nutri­tion education for young adolescents: feasibility and process evaluation of the T eens study. ) Sch Health . 2002;72:121-127.

41. Chapman G, Maclean ]. "Junk food" and "healthy food": meanings of food in adolescent women's culture. J N 11tr Ed11c. 1993;25:108-113 .

42. Hong Kong Dept of Health. Behaviomal Risk Factor S11r11ey (Apri l 2006)-Main Report . Hong Kong: The University ofHong Kong Social Sciences Research Centre; 2006 .

43. Smithers G, Gregory JR, Bates CJ, Prentice A, Jackson L V, W enlock R . The National Diet and Nutrition Survey: young people aged 4-18 years. N11tr B111l. 2001;25:105-111.

44. Wardle J , Carnell S, Cooke L. Parental control over feeding and children's fruit and vegetable intake: how are they re­lated? ) Am Diet Assoc. 2005;105: 227-232.

45. Neumark-Sztainer D , Story M, Resnick MD, Blum R W . Correlates of inadequate fruit and vegetables con­sumption among adolescents. Prev Med. 1996;25:497-505.

46. Leung SSF, Ho S, Lam TH, Janus ED. Hong Kong Adult Dietary S11rvey 1995. Hong Kong: Department of Paediat­rics , Chinese University of Hong Kong; 1997.

47. Leung SSF, Woo J, Ho S, Lam TH, Janus ED. Hong Kong Adult Dietary Survey 1997. A11st J N11tr Diet. 1998;55(suppl 1):S11-S13.

48. Woo J , Leung SS, Ho SC, Lam TH, Janus ED. Dietary intake and prac tices in the Hong Kong Chinese population. J Epidemiol Co111m11nity H ealth. 1998;52:631-637.

49. W oo J. Nutrition and health issues in the general Hong Kong popula­tion. Hong Kong Med). 1998;4:383-388.

50. W ong JP, Ho SY, Lai MK , Leung GM , Stewart SM, Lam TH. Overweight , obesity, weight-related concerns and behaviours in Hong Kong Chinese chil­dren and adolescents. Acta Paediatr . 2005;94:595-601.

51. Fung MS , Yuen M . Body image and eating attitudes among adolescent Chi­nese girls in Hong Kong. Percept Mot Skills. 2003;96:57-66.

52. Lai T. Combating deceptive advertise­ments and labelling on food products -An exploratory study on the perceptions of teachers. Int ) Cons Stud. 2004;28: 117-126.

53. Hong Kong D epartment of Health . Heal th Status of Women in Hong Kong Qanuary 2002). http://www. women.gov.hk/download/health_status_ of_ women.pdf. Accessed December 7, 2009 .

54. Mooney E, Farley H, Strugnell C. Diet­ing among adolescent females: som e emerging trends. Int J Cons St11d. 2004;28:347- 354.

55. Gewirtz S, Ball S. From "W elfarism" to "New managerialism ": Shifting dis­courses of school headship in the educa­tion marketplace. Discourse: Studies in the C11ltural Politics of Ed11cation. 2000;21 :253-268.

56. Yung M. Statlls, Sign(ficance and S11r­vi11al of Home Economics in Hong Kong: A Historical Investigation [PhD thesis] . Norwich, United Kingdom: University of East Anglia; 2005.

57 . Ming Pao. Secondary schools' intention to offer NSS subjects included in the technology key learning area in 2009 [in Chinese]. Ming Pao Daily; 25 Dec 2006. p. A03.