SnackingBehaviourandItsDeterminantsamongCollege-Going...

Research ArticleSnacking Behaviour and Its Determinants among College-GoingStudents in Coastal South India

Prasanna Mithra 1 Bhaskaran Unnikrishnan 1 Rekha Thapar 1 Nithin Kumar 1

Sharana Hegde2 Anjali Mangaldas Kamat 1 Vaman Kulkarni1 Ramesh Holla 1

B B Darshan1 Kanchan Tanuj 3 Vasudev Guddattu4 and Avinash Kumar1

1Kasturba Medical College Manipal Academy of Higher Education Mangaluru Karnataka India2Georgetown University Hospital Washington Hospital Center Washington DC USA3All India Institute of Medical Sciences Basni Industrial Area Phase-2 Jodhpur 342005 Rajasthan India4Prasanna School of Public Health Manipal Academy of Higher Education Manipal Karnataka India

Correspondence should be addressed to Rekha apar rekhathaparmanipaledu

Received 14 February 2018 Revised 13 March 2018 Accepted 20 March 2018 Published 18 April 2018

Academic Editor Jose Marıa Huerta

Copyright copy 2018 PrasannaMithra et al is is an open access article distributed under the Creative Commons Attribution Licensewhich permits unrestricted use distribution and reproduction in any medium provided the original work is properly cited

Background Consumption of snacks in between the regular meals is a poor snacking behaviour It is an established risk factor forseveral lifestyle-related disorders and has long-term effects among the younger individuals Objectives To study the snackingbehaviour and to assess their determinants among college-going students Methods is cross-sectional study was conductedamong 865 college-going students in Mangaluru Data were collected using a pretested pro forma that was coded and analyzedusing Statistical Package for Social Sciences (SPSS) version 115e chi-square test and random-effect logistic regression analyseswere used Results Overall there were 524 females and 476 males and 768 of them were aged lt20 years More than half ofthe participants (543) had the habit of snacking in between regular meals Among them a large proportion (787) did not haveany specific timings for snacking Also 511 of the students were snacking while watching TV and 319 of them snacked whilestudying Breakfast was the most commonly skipped meal (262) of those missing the breakfast regularly 123 (719) had poorsnacking behaviour A significantly larger proportion of males had a higher frequency of snacking per day (693 versus 572plt 00001) and consumed aerated drinks more frequently (226 versus 158 p 0011) skipped meals more often (586versus 506 p 0022) and preferred adding fruits in snacks (781 versus 694 p 0005) Snacking frequency wasproportionately higher among students of private colleges (736) than that in the government colleges (551) Participants fromnonscience stream nonvegetarians and those with a tendency to skip the regular meals had significantly higher levels of poorsnacking behaviour Conclusions e study population had a high level of poor snacking behaviour Appropriate measures areneeded among younger people to follow fixed eating patterns and avoid skipping of regular meals

1 Introduction

Snacking refers to the consumption of food and drinks in-cluding items such as chips chocolates and soft drinks Studiesfrom across the globe have shown high rates of snacking amongyoung people especially school-going students [1] Consump-tion of snacks in between the regular meals amounts to poorsnacking behaviour [1 2] Irregular snacking behaviour posesextreme risks to the health of children and adolescents includingcardiovascular neurological and metabolic complications [2]

e extent of harmful effects increases with an early age of onsetof irregular snacking behaviour [2]

Irregular eating habits are attributed to various factors likepeer influence parental behaviour and influence of westernfood Irregular snacking may even lead to skipping of regularmeals and increased frequencies of snacking in between [2 3]In developed countries a high percentage of children andcollege students have reported skipping of meals and increasedsnacking behaviour [3] e regular breakfast which is the firstnutritious meal of the day consumed on a regular basis helps in

HindawiJournal of Nutrition and MetabolismVolume 2018 Article ID 6785741 6 pageshttpsdoiorg10115520186785741

maintaining the positive health Skipping breakfast leads toadverse health outcomes and also increases the chances of poorsnacking behaviour [3] Similar behaviour is observed amongthe children and adolescents of developing countries India isalso facing this transition and more college students andadolescents are adopting western dietary styles along with thesnacking behaviour According to a previous research veryhigh proportion (621) of adolescents had the habit ofsnacking in between meals [4] Among several influencing anddetermining factors of adolescent snacking parental behaviourand family status play important roles Unhealthy snacking andskipping meals tend to be more common among adolescentsfrom families where both parents are working [5] Stress is alsoconsidered as an important factor which tends to influencesnacking and eating patterns among young individuals [6]

Despite the potential link between intake of snacks andobesity and the reportedly high prevalence of snackingamong adolescents the snacking patterns of adolescentshave not been extensively examined Little is known aboutthe context of snacking in adolescents or how snackingmay influence other dietary habits like skipping mealsis study was conducted among college-going students toassess the level of poor snacking behaviour snacking pat-terns and their lifestyle factors contributing to the pattern offood consumption along with sociodemographic correlates

2 Methods

is cross-sectional study was conducted among studentspursuing graduation in different colleges of the Mangalurucity in Southern India between October 2013 and July 2016Mangaluru is one of the port cities with a population of398745 It is a rapidly developing city with a high literacyrate [7]e sample size was calculated as 865 assuming 50of the students having poor snacking pattern (because of lackof previous studies reflecting the level of poor snackingbehaviour) 10 relative precision and 95 confidenceinterval (α error of 05) adding 10 nonresponse errorconsidering a design effect of 2 and using the formula n

z2p(1minusp)d21113864 1113865lowast design effect [8] where p 05 z 196

for 95 confidence interval and ldquodrdquo at 10 [9]e study was approved by the Institutional Ethics

Committee (IEC) of Kasturba Medical College (ManipalAcademy of Higher Education) Mangaluru India Fol-lowing this the list of degree colleges was obtained from theDistrict Education Authorities e multistage samplingtechnique was used to select the study subjects e list ofcolleges was stratified as government and private collegeswhich reflected the socioeconomic status of the study par-ticipants wherein those from lower socioeconomic statusmainly depended on the government run colleges Here theclasses within the colleges were taken as the units of thestudy Owing to the similarity of students within a class asa group they were considered as clusters Among 126 degreecolleges 6 were selected using stratified random sampling toget an equal number of colleges from each strata (3 gov-ernment and 3 private) and students were selected fromeach of those colleges using cluster sampling e collegeswere visited on a preinformed date after seeking permission

from the Heads of each of the selected colleges e studentswere explained about the study following which a writteninformed consent was obtained and they were called in toparticipate in the study For those subjects aged less than 18years a written assent was taken and their parentsrsquo writtenconsent was taken through them after which the face-to-faceinterview was conducted for each of the study participantsose students who were not willing to participate in thestudy remaining absent despite 2 visits to the college andthe ones suffering from seriousmedical illness were excludedfrom the study

e data were collected using a prepilot-tested content-validated (by the senior researchers and experts in the field ofyoung adult nutrition) and semistructured pro forma thatincluded questions on the diet and snacking patterns of thestudy participants Consumption of food and drinks includingsoft drinks chips chocolates and other fried items was con-sidered as snacking and consuming such snacks betweenregular meals for over gt3 times a week was considered as poorsnacking behaviour e questions included their predominantdiet (vegetarian or nonvegetarian) habit of having snacks inbetween regular meals the frequency and time of snackingpreferred snacks activity along with which snacking happenedmore frequently reasons for snacking tendency to miss regularmeals and their parents missing their regular meals Any habitof consuming snacks in between regular meals was consideredas poor snacking behaviour for the analysis

e collected data were coded and entered into StatisticalPackage for Social Sciences (SPSS version 115 Inc ChicagoIL USA)e results were expressed as proportionse chi-square test was used to compare the differences across thegroups Mixed-effect logistic regression analysis with de-viance was carried out using STATA data analysis andstatistical software (StataCorp LP) version 13 with poorsnacking behaviour among the study participants as theoutcome variable against which the other variables werecompared (available here) For odds ratios all the othercovariates used in the regression model were adjustedp value lt005 was considered as statistically significant

3 Results

e study population included 865 college-going studentsTo reach the desired sample size 900 eligible students hadto be approached and the attrition rate (nonresponse rate)was 38 Table 1 describes the demographic details of thestudy population Overall the study participants comprised453 (524) females and 412 (476) males e partici-pants were pursuing graduation courses in various disci-plines and most of the students were aged less than20 years (768)

More than half of the participants (543) had the habit ofsnacking in between regular meals Table 2 depicts the snackingbehaviour of the study participants Among the participantswho had the habit of snacking in between the regular mealsa large number (787) did not have any specific timings forsnacking Breakfast was the most commonly skipped meal(262) Also 511 of the students were snacking whilewatching TV

2 Journal of Nutrition and Metabolism

e genderwise distribution of general snacking be-haviour is described in Table 3 Males had a higher frequencyof snacking per day (693 versus 572 plt 00001) andconsumed aerated drinks more frequently (226 versus158 p 0011) A significantly higher proportion of fe-males preferred snacks over fixed meals (538 versus464 p 0035)

Snacking frequency was proportionately higher amongstudents of private colleges (736) than that in the gov-ernment colleges (551) In contrast 585 of the studentsfrom the government colleges preferred snacks over fixedmeals compared to the students from private colleges(395) (plt 005) e snacking behaviour of the studypopulation with respect to the type of management ofschools in which they studied has been depicted in Table 4

Snacking frequencyge 2 per day consumption of aerateddrinks regularly and preference of taste over the nutritivevalue of the food item were significantly higher among thestudents from private colleges (plt 005)

Table 5 shows unadjusted and adjusted odds ratios (ORs)for the covariates of poor snacking behaviour among thestudy subjects Tendency to skip meals had the highestadjusted OR (294 (95 CI 217ndash400)) followed by thepredominant diet (nonvegetarian diet 174 (95 CI 129ndash235)) and subject specialtystream in which they studied(nonscience 159 (95 CI 107ndash236)) All the covariatesshowed statistically significant (plt 005) association withsnacking behaviour in the study group

4 Discussion

Snacking behaviour varies across the different regions of theglobe With the rapid development and the changing life-styles of adolescents the eating habits have also beenchanging ese are reflected in the current study findingsere have been studies from developed countries regardingsnacking and eating behaviour of school- and college-goingstudents and adolescents in general Cros et al from theUnited States of America reported that 87-88 of adoles-cents aged 12ndash18 years consumed at least one snack per daywith snacks contributing approximately 25 of their dailyenergy intake [10] A study by Anderson et al in Scotlandreported an average of 55 eating occasions per day (27 mainmeals and 28 snacks) these eating occasions being con-centrated towards the end of the day [11] A similar study byMarques et al showed that Portuguese youth (aged 5ndash15years) consumed 15 snacks per day [12] In Asian countriessnacking rates among youth (aged 2ndash19 years) are morevariable For example in the Philippines Russia and China86 71 and 10 of youth consume at least one snack ona daily basis with snacks providing 18 16 and 1 oftheir total daily energy respectively [13] Our study showedthat 543 of the subjects consumed at least one type ofsnack beyond the timings of regular food intake for gt3 timesa week Out of these 787 did not have any specific timingpatterns for snacking

Our study observed a higher proportion of students fromgovernment managed colleges having poor snacking be-haviour as compared to those from private CollegesCommonly those from lower socioeconomic class familiesdepend on the government run colleges and this selection inour study reflects the indirect way used to assess the so-cioeconomic status of the study participants However thecurrent snacking behaviour could be explained by the factthat the snacks are available easily and more economicallyas compared to regular food items us the easieravailability can trigger the snacking behaviour among thosefrom lower socioeconomic background Another influ-encing factor could be television viewing which our studysubjects stated as one of their most frequent activities whilesnacking e programmes and advertisements in thetelevision in turn can promote the use of snacks and en-hance the poor snacking behaviour Savige et al fromAustralia found that the most common contexts for

Table 2 Snacking behaviour of the study population

Characteristic Number ()Snacking in betweenthe regular meals(n 865)

Yes 470 (543)

No 395 (457)

Time of snacking(n 470)

Not specific 370 (787)Mid-morning 029 (062)Before dinner 044 (094)After dinner 023 (049)

Activity during whichsnacking is mostcommon (n 470)

Television viewing 240 (511)Studying 150 (319)

Hanging out 031 (066)No specific activity 049 (104)

Meal that was mostcommonly skippedamong subjects withpoor snackingbehaviour (n 470)

Breakfast 123 (262)Lunch 104 (221)Dinner 070 (149)

Anyonemore than one 027 (057)No response 146 (311)

Meal that wascommonly skipped bysubjects without poorsnacking behaviour(n 395)



Reasons for snacking(n 470)

Snacks are tastier 221 (470)To lose weight 036 (077)

Snacks are convenient 032 (068)No specific reason 181 (385)

Table 1 Demographic details of the study population (n 865)

Characteristic Number ()

Age group (years) lt20 664 (768)ge20 201 (232)

Gender Male 412 (476)Female 453 (524)

Subject specialtystreamComputer applicationsand science students 146 (169)

Nonscience students 719 (831)

School management Government 490 (566)Private 375 (434)

Predominant diet Vegetarian 390 (451)Nonvegetarian 475 (549)

Journal of Nutrition and Metabolism 3

snacking among adolescents were after school (46 timesper week) while watching TV (35 times per week) andwhile hanging out with friends (24 times per week) [14]Another study showed that non-Hispanic adolescentsshowed stronger association between television exposureand cravings for sweet snacks salty snacks and sweeteneddrinks which was similar to our findings ey also foundthat being Hispanic was associated with stronger associ-ations between phone messaging and cravings for sweetsnacks salty snacks and sweetened drinks and that males

showed stronger associations between video game use andsalty snack cravings [15] Similarly Falbe et al found thatthe increase in screen time (ie television electronicgames digital versatile discs (DVDs)videos and totalscreen time) was associated with increased consumption offoods and beverages of low nutritional quality and de-creased consumption of fruits and vegetables [16] Our studyobservations are similar to other studies as snacking wasassociated with watching TV in more than half of the studyparticipants Grenard et al found that watching TV was

Table 4 Snacking behaviour of the study population according to the type of school management

Characteristic Number of governmentcollege studentstotal ()

Number of private college studentstotal() p value

Snacking in between meals 277480 (577) 193364 (530) 0175Snacking frequencygt twice a day (irrespective ofthe timings) 270490 (551) 276375 (736) lt00001lowast

Consumption of oily food itemsgt 4 times a week 364490 (743) 274375 (731) 0686Consumption of aerated drinksgt 4 times a week 044490 (090) 118375 (315) lt00001lowastPreference of snacks to fixed meals 282482 (585) 147372 (395) lt00001lowastTendency to skip meals 284470 (604) 180371 (485) 0001lowastInclusion of fruits 349475 (735) 275367 (749) 0632Taste over nutrition 285461 (618) 278372 (747) lt00001lowastlowastp value significant at 005 cutoff level

Table 5 Determinants of poor snacking behaviour among the study participants based on random-effect logistic regression analysis(n 865)

Characteristics Poor snacking behaviour(n 470) number ()

Unadjusted OR(95 CI)

Adjusted OR(95 CI)

Gender Female (n 453) 242 (534) mdash mdashMale (n 412) 228 (553) 112 (084ndash149) 107 (079ndash145)

Age group (years) lt20 (n 664) 343 (517) mdash mdashge20 (n 201) 127 (632) 158 (109ndash227) 154 (105ndash227)

SubjectstreamComputer applications and science

(n 146) 057 (390) mdash mdash

Nonscience (n 719) 413 (574) 187 (127ndash275) 151 (101ndash225)lowast

School management Government (n 490) 277 (565) 109 (021ndash574) 116 (029ndash462)Private (n 375) 193 (515) mdash mdash

Predominant diet Vegetarian (n 390) 188 (482) mdash mdashNonvegetarian (n 475) 282 (594) 173 (130ndash231) 174 (129ndash235)lowast

Usual tendency to skipany meal

Yes (n 464) 324 (698) 312 (227ndash416) 294 (217ndash400)lowastlowastNo (n 401) 146 (364) mdash mdash

lowastp value significant at 005 cutoff level lowastlowastplt 00001 deviance 7432

Table 3 Snacking behaviour of the study population according to the gender (n 865)

Characteristic Number of malestotal () Number of femalestotal () p valueSnacking in between meals 228412 (564) 242453 (547) 0618Snacking frequencygt twice a day (irrespective of thetimings) 276398 (693) 254444 (572) 00001lowast

Consumption of oily food itemsgt 4 times a week 306398 (768) 315444 (709) 0051Consumption of aerated drinksgt 4 times a week 90398 (226) 70444 (158) 0011lowastPreference of snacks to fixed meals 183394 (464) 235437 (538) 0035lowastTendency to skip meals 200395 (506) 249425 (586) 0022lowastInclusion of fruits in snacks 268386 (694) 338433 (781) 0005lowastTaste over nutrition 263390 (674) 280425 (682) 0807lowastp value significant at 005 cutoff level


associated with consuming sweet snacks but not with saltysnacks or sweet drinks [17] Studies by Santaliestra-Pasıaset al [18] Pearson et al [19] Ouwens et al [20] and Nivenet al [21] also found that watching TV was associated withincreased snacking Our study showed that among the stu-dents who snack a majority of the students (511) snackwhile watching TV as compared to while studying or whilehanging out with friends concurrent with the above studiesCros et al found that children and adolescents select snacksbased on taste over nutrition ey more often choose saltycrunchy foods as snacks over healthier alternatives [10] Minget al found that out of a total of 3508 students 199(n 699) of them skipped at least one meal a day e mostfrequently missed meal was breakfast (126) followed bylunch (67) and dinner (44) [22]

Another study also had similar findings with breakfastbeing the most commonly skipped meal [23] Our studyshowed that 375 of a total of 865 students skip mealsamong which breakfast was the most commonly skippedmeal (379 n 324) followed by lunch and then dinneris has direct implications on the long-term health status ofyoung individuals because the importance of timely breakfastand not skipping it has already been proved to be beneficialfor health [3]

e association between gender and snacking behaviourhas been variable in previous studies from different regionsMore frequent snacking has been reported among boys thangirls [24 25] and vice versa [26] while a few studies did notobserve any gender differences in snacking behaviour at all[10 27] Anding et al found that males reported an averageof 26 snacks per day compared to the 19 snacks per dayreported by females (pgt 005) [28] Our study observationsare similar in this regard and showed that more number ofmales snack frequently (more than twice a day) compared tofemales On comparing male and female snacking behav-iour we observed that females more often tend to replacetheir meals with snacks (538) and had a tendency to skipmeals (586) Males tend to snack more of oily snacks andaerated drinks as compared to females who include morefruits in their snacks e pattern of skipping meals variedwith gender and area of inhabitance Females were morelikely than males to skip breakfast and lunch Similarlyadolescents from metropolitan areas were more likely thantheir peers from nonmetropolitan areas to skip breakfastOur observations are similar to previous studies that havereported a higher frequency of skipping of breakfast amongfemale adolescents [29 30]

Also the study population in the computer applicationsand science stream had lower levels of poor snacking be-haviour as compared to those in nonscience stream erecould be multiple factors responsible for this differencee students with science background are taught and trainedabout various aspects of diet and its biological concepts as partof the curricula us the knowledge about the snackingbehaviour among the subjects from computer applicationsand science background could translate into better behaviour

Overall the strategies policies and plans addressing thesnacking behaviours have to be based on the optimumunderstanding along with the analyses of complex outcomes

of snacking behaviours on their weight [31] is study isone of its kind taking into account the educational streamalong with other covariates influencing the snacking patternof the young individuals Limitations of the current studycould be that factors such as stress and emotion that arelikely to influence snacking behaviour were not taken intoconsideration

5 Conclusions

Our study reports poor snacking behaviour among theyounger generation of the region e various aspects ofsnacking behaviour varied across gender stream of studyand socioeconomic status e tendency to skip regularmeals and nonvegetarian diet were associated with the poorsnacking behaviour among the study population

Additional Points

Recommendations ere is a need to increase the awarenessamong younger generation towards the health impact ofsnacking poor snacking behaviour and importance offollowing the regular meal pattern Also some curriculum-oriented health education needs to be implemented foryounger people in the institutions highlighting the im-portance of snacking behaviour in health

Disclosure

e contents of this publication are solely the responsibilityof the authors and do not necessarily represent the officialviews of the National Institutes of Health or the ASCENDResearch Network

Conflicts of Interest

e authors declare that they have no conflicts of interest

Acknowledgments

PrasannaMithra was supported by the Fogarty InternationalCentre National Institutes of Health under Award numberD43TW008332 (ASCEND Research Network) e authorsalso express their sincere gratitude to all the study partici-pants and the Department of Community Medicine Kas-turba Medical College (Manipal Academy of HigherEducation) Mangaluru India

Supplementary Materials

e data file includes the variables incorporated in thisstudy (Supplementary Materials)

References

[1] Snacking Patterns in United States of America 2e UnitedStates Department of Agriculture and Agricultural ResearchService Website 2011 httpwwwarsusdagovSP2UserFiles


Place80400530pdfDBrief5_adult_snacking_mypyramid_0708pdf

[2] S M Nickols-Richardson K E Piehowski C J MetzgarD L Miller and A G Preston ldquoChanges in body weightblood pressure and selected metabolic biomarkers with anenergy-restricted diet including twice daily sweet snacks andonce daily sugar-free beveragerdquo Nutrition Research andPractice vol 8 no 6 pp 695ndash704 2014

[3] ldquoAmerican Dietetic Association Foundation Survey findschildren skipping meals snacking frequentlyrdquo 2014 httpwwweatrightorgMediacontentaspxid6442459600

[4] M Shrivastav and S omas ldquoSnack consumption amongunderprivileged adolescent girlsrdquo Indian Pediatrics vol 47pp 888ndash890 2010

[5] L L Birch and K K Davison ldquoFamily environmental factorsinfluencing the developing behaviour controls of food intakeand childhood overweightrdquo Pediatric Clinics of NorthAmerica vol 48 no 4 pp 893ndash907 2001

[6] L Sominsky and S J Spencer ldquoEating behavior and stressa pathway to obesityrdquo Frontiers in Psychology vol 5pp 434ndash442 2014

[7] ldquoe demographic details of Mangaluru city from Govern-ment of India Census 2011rdquo 2017 httpwwwcensusindianet

[8] S K Lwanga and S Lemeshow Sample Size Determinationin Health Studies A Practical Manual e World HealthOrganization Website 1991 httpwwwwhointirishandle1066540062

[9] M A Pourhoseingholi M Vahedi and M RahimzadehldquoSample size calculation in medical studiesrdquo Gastroenterologyand Hepatology from Bed to Bench vol 6 no 1 pp 14ndash172013

[10] A T Cros D Babicz and D Cushman ldquoSnacking patternsamong 1800 adults and childrenrdquo Journal of the AmericanDietetic Association vol 94 no 12 pp 1398ndash1403 1994

[11] A S Anderson S Macintyre and P West ldquoAdolescent mealpatterns grazing habits in the west of Scotlandrdquo HealthBulletin vol 51 pp 158ndash165 1993

[12] V P Marques P Ravasco C M Dias and M E CamiloldquoTrends of food intake in Portugal 1987ndash1999 results fromthe National Health Surveysrdquo European Journal of ClinicalNutrition vol 60 no 12 pp 1414ndash1422 2006

[13] L S Adair and B M Popkin ldquoAre child eating patternsbeing transformed globallyrdquo Obesity Research vol 13 no 7pp 1281ndash1299 2005

[14] G Savige AMacFarlane K Ball AWorsley andD CrawfordldquoSnacking behaviours of adolescents and their association withskipping mealsrdquo International Journal of Behavioral Nutritionand Physical Activity vol 4 no 1 p 36 2007

[15] N Borgogna G Lockhart J L Grenard T Barrett S Shiffmanand K D Reynolds ldquoEcological momentary assessment ofurban adolescentsrsquo technology use and cravings for unhealthysnacks and drinks differences by ethnicity and sexrdquo Journal ofthe Academy of Nutrition and Dietetics vol 115 no 5pp 759ndash766 2015

[16] J FalbeWCWillett B Rosner S L Gortmaker K R Sonnevilleand A E Field ldquoLongitudinal relations of television electronicgames and digital versatile discs with changes in diet in adoles-centsrdquo American Journal of Clinical Nutrition vol 100 no 4pp 1173ndash1181 2014

[17] J L Grenard AW Stacy S Shiffman et al ldquoSweetened drinkand snacking cues in adolescents a study using ecologicalmomentary assessmentrdquo Appetite vol 67 pp 61ndash73 2013

[18] A M Santaliestra-Pasıas T Mouratidou I Huybrechts et alldquoIncreased sedentary behaviour is associated with unhealthydietary patterns in European adolescents participating in theHELENA studyrdquo European Journal of Clinical Nutritionvol 68 no 3 pp 300ndash308 2014

[19] N Pearson S J Biddle L Williams AWorsley D Crawfordand K Ball ldquoAdolescent television viewing and unhealthysnack food consumption the mediating role of home avail-ability of unhealthy snack foodsrdquo Public Health Nutritionvol 17 no 2 pp 317ndash323 2014

[20] M A Ouwens A Cebolla and T van Strien ldquoEating styletelevision viewing and snacking in pre-adolescent childrenrdquoNutricion Hospitalaria vol 27 no 4 pp 1072ndash1078 2012

[21] P Niven M Scully B Morley et al ldquoWhat factors are as-sociated with frequent unhealthy snack-food consumptionamong Australian secondary-school studentsrdquo Public HealthNutrition vol 18 no 12 pp 2153ndash2160 2014

[22] M F Ming G C Ying and S Z M Kassim ldquoEating patternsof school children and adolescents in Kuala LumpurrdquoMalaysian Journal of Nutrition vol 12 no 1 pp 1ndash10 2006

[23] A H El-Gilany and G Elkhawaga ldquoSocioeconomic de-terminants of eating pattern of adolescent students in Man-soura Egyptrdquo Pan African Medical Journal vol 13 p 22 2012

[24] L Jahns A M Siega-Riz and B M Popkin ldquoe increasingprevalence of snacking among US children from 1977 to1996rdquo Journal of Pediatrics vol 138 no 4 pp 493ndash498 2001

[25] G J de Bruijn S P Kremers H Schaalma W van Mechelenand J Brug ldquoDeterminants of adolescent bicycle use fortransportation and snacking behaviorrdquo Preventive Medicinevol 40 no 6 pp 658ndash667 2005

[26] J T Dwyer M Evans E J Stone et al ldquoAdolescentsrsquo eatingpatterns influence their nutrient intakesrdquo Journal of theAmerican Dietetic Association vol 101 no 7 pp 798ndash802 2001

[27] C Zizza A M Siega-Riz and B M Popkin ldquoSignificantincrease in young adultsrsquo snacking between 1977-1978 and1994ndash1996 represents a cause for concernrdquo PreventiveMedicine vol 32 no 4 pp 303ndash310 2001

[28] J D Anding K S Kubena and A M McIntosh ldquoSnackingobesity cardiovascular fitness and television viewing amongadolescentsrdquo Journal of the American Dietetic Associationvol 95 no 9 p A98 1995

[29] A Keski-Rahkonen J Kaprio A Rissanen M Virkkunenand R J Rose ldquoBreakfast skipping and health-compromisingbehaviors in adolescents and adultsrdquo European Journal ofClinical Nutrition vol 57 no 7 pp 842ndash853 2003

[30] M E Shaw ldquoAdolescent breakfast skipping an Australianstudyrdquo Adolescence vol 33 pp 851ndash861 1998

[31] N I Larson J M Miller A W Watts M T Story andD R Neumark-Sztainer ldquoAdolescent snacking behaviors areassociated with dietary intake and weight statusrdquo Journal ofNutrition vol 146 no 7 pp 1348ndash1355 2016


Stem Cells International

Hindawiwwwhindawicom Volume 2018


MEDIATORSINFLAMMATION

of

EndocrinologyInternational Journal of



Disease Markers


BioMed Research International

OncologyJournal of



Oxidative Medicine and Cellular Longevity


PPAR Research

Hindawi Publishing Corporation httpwwwhindawicom Volume 2013Hindawiwwwhindawicom

The Scientific World Journal

Volume 2018

Immunology ResearchHindawiwwwhindawicom Volume 2018

Journal of

ObesityJournal of



Computational and Mathematical Methods in Medicine


Behavioural Neurology

OphthalmologyJournal of


Diabetes ResearchJournal of



Research and TreatmentAIDS


Gastroenterology Research and Practice


Parkinsonrsquos Disease

Evidence-Based Complementary andAlternative Medicine

Volume 2018Hindawiwwwhindawicom

Submit your manuscripts atwwwhindawicom

maintaining the positive health Skipping breakfast leads toadverse health outcomes and also increases the chances of poorsnacking behaviour [3] Similar behaviour is observed amongthe children and adolescents of developing countries India isalso facing this transition and more college students andadolescents are adopting western dietary styles along with thesnacking behaviour According to a previous research veryhigh proportion (621) of adolescents had the habit ofsnacking in between meals [4] Among several influencing anddetermining factors of adolescent snacking parental behaviourand family status play important roles Unhealthy snacking andskipping meals tend to be more common among adolescentsfrom families where both parents are working [5] Stress is alsoconsidered as an important factor which tends to influencesnacking and eating patterns among young individuals [6]

Despite the potential link between intake of snacks andobesity and the reportedly high prevalence of snackingamong adolescents the snacking patterns of adolescentshave not been extensively examined Little is known aboutthe context of snacking in adolescents or how snackingmay influence other dietary habits like skipping mealsis study was conducted among college-going students toassess the level of poor snacking behaviour snacking pat-terns and their lifestyle factors contributing to the pattern offood consumption along with sociodemographic correlates

2 Methods

is cross-sectional study was conducted among studentspursuing graduation in different colleges of the Mangalurucity in Southern India between October 2013 and July 2016Mangaluru is one of the port cities with a population of398745 It is a rapidly developing city with a high literacyrate [7]e sample size was calculated as 865 assuming 50of the students having poor snacking pattern (because of lackof previous studies reflecting the level of poor snackingbehaviour) 10 relative precision and 95 confidenceinterval (α error of 05) adding 10 nonresponse errorconsidering a design effect of 2 and using the formula n

z2p(1minusp)d21113864 1113865lowast design effect [8] where p 05 z 196

for 95 confidence interval and ldquodrdquo at 10 [9]e study was approved by the Institutional Ethics

Committee (IEC) of Kasturba Medical College (ManipalAcademy of Higher Education) Mangaluru India Fol-lowing this the list of degree colleges was obtained from theDistrict Education Authorities e multistage samplingtechnique was used to select the study subjects e list ofcolleges was stratified as government and private collegeswhich reflected the socioeconomic status of the study par-ticipants wherein those from lower socioeconomic statusmainly depended on the government run colleges Here theclasses within the colleges were taken as the units of thestudy Owing to the similarity of students within a class asa group they were considered as clusters Among 126 degreecolleges 6 were selected using stratified random sampling toget an equal number of colleges from each strata (3 gov-ernment and 3 private) and students were selected fromeach of those colleges using cluster sampling e collegeswere visited on a preinformed date after seeking permission

from the Heads of each of the selected colleges e studentswere explained about the study following which a writteninformed consent was obtained and they were called in toparticipate in the study For those subjects aged less than 18years a written assent was taken and their parentsrsquo writtenconsent was taken through them after which the face-to-faceinterview was conducted for each of the study participantsose students who were not willing to participate in thestudy remaining absent despite 2 visits to the college andthe ones suffering from seriousmedical illness were excludedfrom the study

e data were collected using a prepilot-tested content-validated (by the senior researchers and experts in the field ofyoung adult nutrition) and semistructured pro forma thatincluded questions on the diet and snacking patterns of thestudy participants Consumption of food and drinks includingsoft drinks chips chocolates and other fried items was con-sidered as snacking and consuming such snacks betweenregular meals for over gt3 times a week was considered as poorsnacking behaviour e questions included their predominantdiet (vegetarian or nonvegetarian) habit of having snacks inbetween regular meals the frequency and time of snackingpreferred snacks activity along with which snacking happenedmore frequently reasons for snacking tendency to miss regularmeals and their parents missing their regular meals Any habitof consuming snacks in between regular meals was consideredas poor snacking behaviour for the analysis

e collected data were coded and entered into StatisticalPackage for Social Sciences (SPSS version 115 Inc ChicagoIL USA)e results were expressed as proportionse chi-square test was used to compare the differences across thegroups Mixed-effect logistic regression analysis with de-viance was carried out using STATA data analysis andstatistical software (StataCorp LP) version 13 with poorsnacking behaviour among the study participants as theoutcome variable against which the other variables werecompared (available here) For odds ratios all the othercovariates used in the regression model were adjustedp value lt005 was considered as statistically significant

3 Results

e study population included 865 college-going studentsTo reach the desired sample size 900 eligible students hadto be approached and the attrition rate (nonresponse rate)was 38 Table 1 describes the demographic details of thestudy population Overall the study participants comprised453 (524) females and 412 (476) males e partici-pants were pursuing graduation courses in various disci-plines and most of the students were aged less than20 years (768)

More than half of the participants (543) had the habit ofsnacking in between regular meals Table 2 depicts the snackingbehaviour of the study participants Among the participantswho had the habit of snacking in between the regular mealsa large number (787) did not have any specific timings forsnacking Breakfast was the most commonly skipped meal(262) Also 511 of the students were snacking whilewatching TV






4 Discussion





Yes 470 (543)

No 395 (457)


































Adjusted OR(95 CI)




(n 146) 057 (390) mdash mdash

















5 Conclusions


Additional Points


Disclosure




Acknowledgments




References







































of




Disease Markers



OncologyJournal of





PPAR Research



Volume 2018


Journal of

ObesityJournal of























4 Discussion





Yes 470 (543)

No 395 (457)


































Adjusted OR(95 CI)




(n 146) 057 (390) mdash mdash

















5 Conclusions


Additional Points


Disclosure




Acknowledgments




References







































of




Disease Markers



OncologyJournal of





PPAR Research



Volume 2018


Journal of

ObesityJournal of





























Adjusted OR(95 CI)




(n 146) 057 (390) mdash mdash

















5 Conclusions


Additional Points


Disclosure




Acknowledgments




References







































of




Disease Markers



OncologyJournal of





PPAR Research



Volume 2018


Journal of

ObesityJournal of

























5 Conclusions


Additional Points


Disclosure




Acknowledgments




References







































of




Disease Markers



OncologyJournal of





PPAR Research



Volume 2018


Journal of

ObesityJournal of























































of




Disease Markers



OncologyJournal of





PPAR Research



Volume 2018


Journal of

ObesityJournal of



















SnackingBehaviourandItsDeterminantsamongCollege-Going...

Documents

Transcript of SnackingBehaviourandItsDeterminantsamongCollege-Going...