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Mirhadyan L, Moradi Latreyi S, Pasha A, Kazem Nejad Leili E. Junk Food Consumption and its Associated Factors in High School Students in Rasht in 2017. J Res Dev Nurs Midw. 2020; 17 (1) :52-66
URL: http://nmj.goums.ac.ir/article-1-1195-en.html
1- School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran.
2- School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran. , saeid.300371@gmail.com
3- Social Determinants of Health Research Center, Guilan University of Medical Sciences, Rasht, Iran.
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Abstract



 
Background: Junk food consumption is an unhealthy adolescent nutritional habit that is affected by family structure, peer groups, and socioeconomic status. The present study was conducted to determine the association between junk food consumption and personal, familial, and social characteristics considering high school students in Rasht, Iran.
Methods: This cross-sectional study was conducted on 341 students in their second year of high school in Rasht, Iran in 2017. They were selected using a two-stage cluster random sampling. Data was collected using a checklist. Data was analyzed in SPSS 16 using Mann-Whitney and Kruskal-Wallis tests at a significance level of 0.05.
Results: Sweet snacks were consumed the most (27.3%). Frequency of junk food consumption was significantly higher in students whose fathers had a university degree (P=0.037) and those with monthly family income of more than 2 million Rials. (P=0.004).
Conclusions: The results indicate that students whose fathers have a higher education and income level have more tendencies toward junk food consumption; hence, it is worth considering the relevant factors in order to improve the adolescents' health.
Keywords: Adolescent; Nutrition; Snacks; Family; Fast food



 

Introduction



The "junk food" term was introduced by Michael Jacobson in 1972 and it covered the salty and sweet snacks, fried fast food, and sweet carbonated drinks. Furthermore, burgers, pizzas, and sandwiches can be put in this category based on their ingredients and preparation methods (1, 2). These foods which have high calories, salt or sugar, while low vitamins, minerals, and fiber increase the incidence of diseases such as obesity, diabetes, cardiovascular diseases, and hypertension in adulthood (2 -4).
As adolescents reach puberty, significant changes are made in their appearance, mood, social behavior, and mental state (5) that exposes them to high-risk health behaviors including inappropriate nutritional habits (6, 7). Refusing to eat breakfast, low consumption of fruits, high consumption of fast food and non-nutritious snakes, low quality and quantity of meals, eating outdoors and variable dietary patterns are common habits that cause problems such as obesity in adolescents (8).
According to studies, the causes of dramatic increase in consumption of junk food in adolescents are the taste change, quick and easy access, being delicious, family structure, low cost, and tendency to these foods (9). Other studies have mentioned the roles of factors such as family and peers in the acquisition of nutrition knowledge and in taking measure to conduct a nutritional behavior (8, 10, 11). Family is the first founder of character, and intellectual values and standards of children. Psychologists believe that parents significantly affect the creation of thoughts and behavior in children (12). Studies indicate that the most important cues for action in the field of students' nutrition are mother, teachers, father, TV, friends, books, sister, brother, and magazines (10). The nutrition styles are different in terms of marital status, gender, and social class, furthermore, it should be mentioned that the age, body mass index, and social, cultural and economic capital affect nutrition styles in different ways (13).
Many studies have pointed out the association between low socioeconomic status and malnutrition in adolescents and their parents (14-16). In this regard, the economic status is the most important factor affecting the amount and the type of food. Food intake is strongly associated with income and has a positive relationship with dietary patterns and healthy food choices (17, 18). According to the General Population and Housing Census in 2011, Gilan has a morbid situation with uneven development in terms of economic parameters mainly due to unemployment. The province was the second unemployed province with an unemployment rate of 16.4% after Lorestan in 2013 (19).
Positive changes can be made in dietary patterns to reduce the prevalence of obesity and prevent chronic diseases by identifying effective factors in adolescents' nutrition behavior and their modification (20). Considering the increasing trend of adolescents' tendency to junk food and negative consequences of its consumption as well as the lack of detailed evidence of use and the differences in food culture of people in Gilan compared to the rest of Iran (21), present study was conducted with the aim to determine the relationship between consumption of junk food and the personal- familial and social variables among students in their second year of high school and in the school year of 2016-2017.


 



Methods






The present study was a cross-sectional descriptive-analytical research conducted during the school year of 2016-2017. The geographic focus of the study consisted of the second year of public high schools (Grades 10, 11 and 12) in educational districts 1 and 2 of Rasht (except for technical and vocational disciplines) including 14 and 8 all-girls and all-boys schools in District 1; and 12 and 11 all-girls and all-boys schools in District 2 (a total of 13654 students). One all-girls and one all-boys school (a total of four schools) were randomly selected from each district. In selection of samples, at first dual educational districts were selected as a sampling class, consequently, all-girls and all-boys schools as sampling clusters, and a school was randomly selected from each cluster per class. Considering 30 students per class, 12 classes (4 classes from each grade) were randomly selected. According to a research by Dehdari et al. (3), the sample size was obtained equal to 113 by equalizing r to -0.30 relating to the correlation coefficient between snack consumption and behavioral intention variables in Table 1, at a 95% confidence interval and test precision of 0.05 in the following equation.
n=   

In the present study, each class was considered as a cluster. The sample size was calculated by taking into account the design effect factor of 1.5 as follows:
224 × 1.5 = 336
Finally, 342 samples were studied and solely a male student refused to complete the questionnaire. Therefore, 341 questionnaires were completed and collected. The inclusion criteria were as follows: studying at grade 10, or 11 or 12, and the absence of any non-specific disease that influenced samples' diets. Data collection tool of study were questionnaires containing the demographic information, and the researcher-made questionnaire for measuring the consumption of fast food and snacks, derived from Kristen Dunn's standard food frequency inventory with determined validity and reliability by two questions for measuring frequency of junk food consumption with a range of "never" to "more than once a day" and the frequency of junk food consumption by type (drinks, fast food, fried foods, sweet and salty snacks ) ranging from "never" to "more than 4 times a week to every day" in students. In order to determine the reliability, the content validity was evaluated by a panel of ten professors from Shahid Beheshti Faculty of Nursing and Midwifery of Rasht. Since the CVR score (content validity ratio) should be greater than 0.62 for each question, and the CVI (content validity indicator) should be greater than 0.79, a question was deleted because the CVR score was 0.60. The CVR of total questionnaire was 0.97 after removal of this question; and the CVI of total questionnaire was 0.97. The questionnaire was distributed among the studied high schools of Rasht and completed by the self-report method at 20 minutes. The data collection process was carried out during 4 working days from 7th to 14th December, 2016. Data was analyzed by SPSS 21. The frequency distribution was used to describe qualitative variables; and Mann-Whitney and Kruskal-Wallis tests at a significance level of 0.05 were utilized to compare the median frequency of junk food consumption with demographic variables.

 

Results



According to the findings, 52.2% of participants were female, 40.2% were the first children, 37.5% were studying in the eleventh grade, and 86.8% lived with their parents. The majority of them reported the father's job of self-employed (51.6%) and the mother's job of housewife (78.9%), in addition they reported both the father's and the mother`s education level of high school diploma (48.1%) and (49.6%). Totally, 36.1% reported the family income of 1 to 5.1 million Rials. Based on the findings of Table 1, 9.4% of units ate junk food once or more per day.
 
 
 
 
 
 
Table 1. Frequency distribution of the students' junk food consumption
Junk food consumption frequency N %
Never 2 0.6
Occasionally (Less than once a month) 77 22.6
Once per month 30 8.8
Once per fortnight 40 11.7
Once per week 66 19.4
2-3 times per week 74 21.7
4-6 times per week 20 5.9
Once a day 13 3.8
More than once per day 19 5.6
Total 341 100
 
Table 2 indicates that sweet snacks with 27.3% were the most abundant kind of junk food.
Table 2. Frequency distribution of the students' junk food consumption during the last week
Type of junk food Frequency More than 4 imes/Week or Every day 3-4 times/week 1-2 times/ week Rarely Never Total
Sweet and carbonated drinks, Energy drinks, Fruit flavored drinks N 18 21 123 125 54 341
% 5.3 6.2 36.1 36.7 15.8 100
Fast food meals (e.g. Hamburgers, Pizza, Sandwiches, etc. N 15 64 109 121 32 341
% 4.4 18.8 32 35.5 9.4 100
Fried foods N 40 117 126 49 9 341
% 11.7 34.3 37 14.4 2.6 100
Sweet snacks N 93 104 74 58 14 341
% 27.3 29.9 21.7 17 4.1 100
Salty snacks N 39 72 105 96 29 341
% 11.4 21.1 30.8 28.2 8.5 100
 
 Table 3 presents that the father's education (P-0.037) and family income (P=0.004) had a significant relationship with median frequency of junk food consumption; and the consumption was greater among students with university-educated fathers and family income of more than 2 million Rials.
Table 3. Comparing between students' junk food consumption frequency and demographic characteristics
variables Mean SD P
Grade 10th 4.8 2.1 .803
11th 4.6 1.9
12th 4.6 2.2
Gender Male 4.9 2 .059
Female 4.5 2
Birth Rank First child 4.7 2 .110
Middle child 4 2
The Last child 4.9 2
Only child 4.8 2.2
How to live with
family members
Parents 4.7 2.1 .227
Only Father 4 2.6
Only Mather 3.7 1.7
Other family members 4.7 2
Father's job Staff 4.9 2.2 .390
Worker 4.7 2.2
Farmer 3.3 2.1
Self-employment 4.6 1.9
Retired 4.9 1.9
Jobless 4.5 2.7
Mother's job Staff 5.2 2.4 .507
Worker 3 1.4
Farmer 5 0
Self-employment 4.9 2.1
Retired 5 1.8
Jobless 4.6 2
Father's degree Illiterate 4.4 1.8 .037
Under the diploma 4.4 1.9
Diploma 4.6 2
Graduate 5.4 2.3
Mother's degree Illiterate 4.2 1.9 .158
Under diploma 4.6 2
Diploma 4.6 2
Graduate 5.4 2.4
Monthly income (Rails) More than 20 5.4 2.3 .004
15 to 20 5 2.1
10 to 15 4.5 1.9
Less than 10 4.2 1.9
BMI Thin 3.9 2 .096
Normal weight 4.7 2.1
Over weight 4.9 2
Fat 3.7 1.6
Rate of exposure Rarely 3.6 2 <.0001
From time to time 4.5 1.9
Often 4.9 2
Type of exposure Television 4.2 1.8 .143
Radio 0 0
School 4.8 1.8
Newspaper 2.5 0.7
Magazine 3.4 1.3
Internet and social networks 4.8 1.9
Outdoor billboards in public places 4.3 1.8
Several sources 4.9 2.2
 

Discussion




In the present study, 9.4% of units reported the frequency of junk food consumption as "once or more per day". Seventy two percent of girls in a study by Ricci, (24), 31.5% of adolescents in a study by Akman et al. (25), and 33.6% of units in a study by Akman et al. consumed junk food (26). Different results were due to the different definitions of junk food, different living environment of adolescents, and thus different food styles in different geographic regions, and finally different ways of collecting data. Compared to many similar studies, results of the present study indicated the lower consumption of junk food among high school students.
Our results on the use of sweet snacks revealed that 29.9% consumed "3-4 times per week"; and it was consistent with the findings of a research by Montazerifar et al (35). In the present study, 27.3% used "more than 4 times per week or every day". Gharib et al. found that 24.2% of girls and 29.7% of boys consumed junk food at the same rate (36). High intake of sweet snacks may increase the risk of weight gain and tooth decay in the short term and also the risk of diabetes in adulthood for adolescents in long term. According to our results based on the more consumption of sweet snacks than other junk food, it seems essential to limit the supply of these items and replace them with healthier food in buffets of educational centers.
In our study, there was a statistical significant relationship between father's education level and median frequency of junk food consumption; therefore, the median frequency of junk food consumption was higher among adolescents with university-educated fathers. The studies by Sharifirad et al. (43), Aljilani et al. (18) and Yarmohammadi et al. (44) were in line with the results of present study which confirms significant association between parental education and junk food consumption. On the other hand some studies had inconsistent results with ours; for instance, Ho et al. found that the behaviors such as eating were affected by external factors (such as smell, taste, etc.) in children whose parents had lower education level with a higher frequency of 28% and 28.3% than other factors (40). Dehdari et al. reported that the consumption of carbonated drinks significantly decreased in students with educated parents (45). Likewise, Karimi et al., stated that the parental education had a statistical significance relationship with the frequency of healthy snacks consumption by children as the frequency of healthy food increased in children with educated parents (46). However,Some studies such as Ghaffari et al. found no significant difference between parents' education and fast food consumption (8) and also Dehdari et al. reported no difference between the consumption of junk food in students and their parents' education (3). Despite the expectation that the increase in parental education level may create negative attitudes towards the junk food consumption and more aware of the importance of healthy nutrition for adolescents in families, the tendency consume junk food among adolescents increases in such families in today's urban communities, as a result of longer working hours and more involvement of educated parents in outdoor work environments.
In the present study, there was a statistical significant relationship between the families' income levels and frequency of junk food consumption, therefore the frequency of junk food consumption was higher among adolescents with family income of greater than 2 million Tomans; and as a result the increased incomes enhanced frequency of junk food consumption. In a study by Aljilani et al., there was a significant relationship between socio-economic status and consumption of fast food consumption; the consumption was greater in children at higher socio-economic levels (18). Ghaffari et al. noted that there was also a significant association between fast food consumption and family income; accordingly, students with higher economic level used greater amounts of fast food (47). In studies by Kouhi et al. (13), Sharifirad et al. (43), Yarmohammadi et al. (44), and Ghaffari et al. on students, there was a direct relationship between economic status and fast food consumption in adolescents (8). However, the inconsistent results with the present study were also obtained in some studies, for instance, Karimi et al. found that frequency of healthy snacks increased in families with higher income, but there was no significant relationship between family's economic status and dietary behavior in adolescents (40). Dehdari et al. concluded that there was no significant difference between the score of junk food consumption in students and their pocket money (3). Bauer et al. found that adolescents with low socioeconomic status ate more fast food (48). It can be concluded that the favorable economic status acts as a double-edged sword. Although a favorable economic status can lead to the consumption of healthy snacks and proper nutrition for children, it can increase their purchasing power for junk food. It seems that the problem can be solved by the parental supervision and management of children's pocket money for purchasing food items, while maintaining their independence.
In the present study, there was no significant relationship between the median frequency of junk food and education grade, gender, birth order, way of living with family, parents' jobs, and mother's education.

 

Conclusion






Despite the fact that high school students were in a better status in terms of junk food consumption than similar studies, the harmful and pathogenic nature of such foods still necessitates the greater attention to the reason for adolescents' tendency towards consumption of junk food. According to the results of our research significant frequency of junk food consumption due to the socio-economic factors, and the higher economic status can have a negative impact on the adolescents' nutritional status. Therefore, the amounts of pocket money and its spending way should be controlled in adolescents. Furthermore, the opportunity for more consumption of healthy food and snacks should be provided by managing the hours of parental outdoor presence.
Limitations of the present study included the possibility of errors in recall and willingness to idealism during the self-report. Strengths of the present study included the study of nutritional status in both sexes as well as evaluation of all groups of junk food.

 

Acknowledgements








The present paper was part of the master's thesis entitled "The assessment of factors associated with the consumption of junk food based on the theory of planned behavior (TPB) among high school students of Rasht in the school year of 2016-2017", with the registration number of 932413 and the code of ethics (IR.GUMS.REC.1395.257). We are grateful to the esteemed head of Social Determinants of Health (SDH) research center at Gilan University of Medical Sciences, the professors involved in the design and psychometric evaluation of the questionnaire, as well as the principals and the students of high schools in Rasht.



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Bibliographic information of this paper for citing:
Mirhadyan L, Moradi Latreyi S, Pasha A, et al. Junk food consumption and its associated factors in high school students in Rasht in 2017
J Res Dev Nurs Midw, 2020; 17(1): 52-66.
Type of Study: Original Article | Subject: Psychology and Psychiatry

References
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