PUi IS 99: 1 UNTVERsnI MALAYSIA S.tW.L\H

JUDUL: D\SPAR\i Y &ETWE.t:.N HEALTHY EAT.II\I~ ANI) l-IEAL1!-\'1 l BORANG PENGES.AJ1A.' STATUS TESIS

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rnengaku membenarkan tesis (L PSI Sarjanal Doktor Falsafah) ini di simpan di Perpustakaan Universiti Malaysia Sabah dengan syarat-syarat kegunaan seperti berikut:

I. Tesis adalah hakmilik Universiti Malaysia Sabah. 2. Perpustakaan Universiti Malaysia Sabah dibenarkan membuat salinan untuk tujuan pengajian sahaja. 3. Perpustakaan dibenarkan membuat salinan tesis ini sebagai bahan pertukaran antara institusi pengajian tinggi. 4. ** Sila tandakan ( / )

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CATATAN: * Potong yang tidak berkenaan.

(Mengandungi ma1rJumat yang berdarjah keselamatan atau kepentingan Malaysia seperti yang tennaktub di dalam AKTA RAHSIA RASMl 1972)

(Mengandungi maklumat TERHAD yang telab ditentukakan oleh organisasilbadan di mana penyelidikan dijalankan)

Disahkan oleh

(T Al'ilJATANGAN PUST AKA WAN)

D~. YA-SMIN &E~G( H~U\ 00' --~-------~----

Nama Penyelia

Tarikh:_ -?_.)-tr=~-tr_..2_Cl_l,)-+~ _____ _

* Jika tesis ini SULIT atau TERHAD, sila lampiran surat daripada pihak berkuasalorgansasi berkenaan dengan menyatakan sekali sebab dan tempoh tesis ini perlu dikelaskan sebagai SULIT

* ~;sTsEd~:~ldkan sebagai tesis bagi Ijazah Doktor Falsafah dan Sarjana secara penyehct~an, atau d isertasl bagi pengaj ian secara kerj a kursus dan penyelidibm, atau Laporan Proj ek Sarj ana Muda (LPSM).

DISPARITY BETWEEN HEALTHY EATING AND HEALTHY LIVING AWARENESS AND

PRACTICE AMONGST UNIVERSITY STUDENTS ON SELF-CATERING

TEE KAI SHIN

THESIS SUBMITTED IN PARTIAL FULFILLMENT FOR THE DEGREE OF BACHELOR OF FOOD SCIENCE WITH

HONOURS (FOOD SCIENCE AND NUTRITION)

SCHOOL OF FOOD SCIENCE AND NUTRITION UNIVERSITI MALAYSIA SABAH

2009

DECLARATION

I hereby declare the material in this thesis is my own except for quotations, excerpts,

equations, summaries and references, which have been duly acknowledged.

18 May 2009

Tee Kai Shin

HN200S-4776

TITLE

DEGREE

VIVA DATE

: DISPARITY BETWEEN HEALTHY EAnNG AND

HEALTHY LMNG AWARENESS AND PRACTICE

AMONGST UNIVERSITY STUDENTS ON SELF­

CATERING

: BACHELOR OF FOOD SCIENCE WITH HONOURS

(FOOD SCIENCE AND NUTRITION)

: 11 MAY 2009

DECLARED BY

1. SUPERVISOR

2.

3.

4.

(DR. Y ASMIN BENG HOUI 001)

EXAMINER 1

(ADlLAH MD. RAMU)

EXAMINER 2

(DATIN RUGAYAH ISSA)

DEAN

(ASSOC. PROF. DR. MOHO ISMAIL ABDULLAH)

ii

.....L-I-+f--- J

ACKNOWLEDGEMENT

I would like to express my deepest gratitude and appreciation to my supervisor, Dr,

Yasmin Beng Houi Doi for all her advices, guidance and support in this study that led

to the completion of this thesis. Without her encouragement and enormous amount

of patience, this thesis would not been completed.

I would also like to thank lecturers of School of Food Science and Nutrition in

Universiti Malaysia Sabah for their guidance and sharing of knowledge during my

study. My appreciation also goes to friends who have helped me in my final year

project and those self-catering Universiti Malaysia Sabah students who have

participated in my study.

Last and foremost, I am truly grateful to my parents for their love and above

of all, their encouragement, support and strong belief in me throughout my life that

word cannot express my love and gratitude.

iii

ABSTRACT

This study aimed to determine disparity between healthy eating and healthy living awareness and practice amongst university students on self-catering. A number of 95 Universiti Malaysia Sabah students with mean age of 23.02±O.99 years who were living off campus had participated in this study. Average of 7.52±1.44 persons were staying in each rented house. Students completed self-administered questionnaire on demographics, nutritional knowledge, Food Frequency Questionnaire, healthy living awareness and practice. Result shows that students comprised three school clusters namely health cluster (n= 29, 30.50%), science and technology cluster (n=45, 47.40%), arts and humanities cluster (n=21, 22.10%). Students were categorised to poor (n=16, 16.84%), satisfactory (n=37, 38.95%), good (n=39, 41.05%) and excellent (n=3, 3.16%) on nutritional knowledge. Percentage of recommended energy intake achieved by students with satisfactory nutritional knowledge was significantly higher than students with poor, good and excellent nutritional knowledge (p=O.029). Percentage of recommended nutrient intake (RNI) achieved for protein, calcium, iron, vitamin B1, vitamin B2, niacin, vitamin C and percentage of energy comprising of carbohydrate and fat intakes were not significantly different between different nutritional knowledge levels. Better nutritional knowledge does not lead to healthier eating practice. A number of 53 (55.79%) students had healthy living awareness while 44.21% of them did not and 48 (50.53%) students practised healthy living practice while 49.47% did not. Healthy living awareness was not significantly associated with healthy living practice (X2=3.042, p=0.081). Disparity did exist between healthy eating and healthy living awareness and practice amongst these students. Nutrition intervention in university students should be encouraged to promote healthier diets and lifestyles.

iv

ABSTRAK

KETIDAKSAMAAN ANTARA AMALAN DAN KESEDARAN MAKAN OENGAN SIHAT DAN HIDUP SIHAT 01 KALANGAN PELAJAR UNIVERSm DENGAN PENYEDIAAN MAKANAN

SENOIRI

Kajian ini bertujuan untuk menentukan ketidaksamaan antara amalan dan kesedaran makan dengan sihat dan hidup sihat di kalangan pelajar universiti dengan penyediaan makanan sendiri. Seramai 95 pelajar Universiti Malaysia Sabah dengan purata umur 23.02IO.99 tahun yang tinggal di luar kampus telah menyertai kajian ini. Seramai 7.52±1.44 orang tinggal di setiap rumah sewaan. Pelajar-pelajar telah melengkapkan soal selidik soalan demografik, pengetahuan pemakanan, kesedaran hidup sihat, amalan hidup sihat dan 80rang Kekerapan Pangambilan Makanan (FFQ). Keputusan menunjukkan pelajar-pelajar terdiri daripada tiga gugusan sekolah iaitu gugusan kesihatan (n=2~ 30.50%), gugusan sains dan teknologi (n=45, 47.40%), gugusan seni dan ilmu kemanusiaan (n=21, 22.10%). Pelajar-pelajar telah dikategorikan kepada lemah (n=l6, 16.84%), memuaskan (n=37, 38.95%), baik (n=39, 41.05%) dan cemeriang (n=3, 3.16%) dalam tahap pengetahuan pemakanan. Peratusan pencapaian RNI tenaga bagi pelajar dengan pengetahuan pemakanan yang memuaskan adalah lebih tinggi daripada pelajar lain (p=0.029). Peratusan pencapaian RNI bagi protein, kalsium, zat bes~ vitamin 81, vitamin 82, niasin, vitamin C dan peratusan tenaga daripada pengambilan kaobohidrat dan lemak tidak mempunyai perbezaan ketara antara tahap pengetahuan pemakanan yang berlainan. Tahap pengetahuan makanan yang lebih tinggi tidak menyebabkan amalan makan yang lebih sihat. Seramai 53 (55.79%) pelajar mempunyai kesedaran hidup sihat manakala 42 (44.21%) pelajar tidak mempunyai kesedaran tersebut. Seramai 48 (50.53%) pelajar mempunyai amalan hidup sihat manakala 47 (49.47%) pelajar tidak mempunyai amalan tersebut. Kesedaran hidup sihat tidak mempunyai kaitan ketara dengan amalan hidup sihat 61=3.042, p=0.081). Ketidaksamaan antara kesedaran dan amalan makan dengan sihat dan hidup sihat wujud di ka/angan pelajar universiti dengan penyediaan makanan sendiri. Penerapan dari segi pemakanan di ka/angan pelajar universiti patut digalakkan untuk mempromosikan diet dan cara hidup yang lebih sihat.

v

List of Contents

DECLARATION

ACKNOWLEDGEMENT

ABSTRACT

ABSTRAK

LIST OF TABLES

LIST OF ABBREVIATIONS

LIST OF SYMBOLS

CHAPTER 1

INTRODUCTION

1.1 BACKGROUND

1.1.1 Healthy eating

1.1.2 Healthy living

1.2 RATIONALE OF STUDY

1.3 HYPOTHESIS

1.4 OBJECTIVE

CHAPTER 2

LITERATURE REVIEW

2.1 HEALTHY EATING

2.2 HEALTHY LIVING

CHAPTER 3

METHODOLOGY

3.1 SUBJECTS

3.2 METHOD

3.2.1

3.2.2

Demographic questionnaire

Nutritional knowledge questionnaire

3.2.3 Food Frequency Questionnaire

3.2.4 Healthy living practice questionnaire

3.2.5 Healthy living awareness questionnaire

3.3 PILOT TEST

3.4 DATA ANALYSIS

3.4.1 Nutritional knowledge

vi

iii

iv

v

viii

ix

x

1

1

1

1

1

2

3

3

4

4

4

8

13

13

13

14

14

15

15

16

17

18

18

18

3.4.2 Food Frequency Questionnaire

3.4.3 Healthy living awareness

3.4.4 Healthy living practice

3.5 STATISTICAL ANALYSIS

CHAPTER 4

RESULTS AND DISCUSSION

4.1 DEMOGRAPHIC DATA

19

19

19

19

21

21

21

4.2 HEALTHY EATING AWARENESS AND HEALTHY EATING PRACTICE 24

4.3 HEALTHY LIVING AWARENESS AND HEALTHY LIVING PRACTICE 36

CHAPTER 5 40

CONCLUSION 40

5.1 CONCLUSION

5.2 LIMITATION

5.3 STATEMENT OF KEY FINDINGS

REFERENCES

APPENDIX A

APPENDIX B

APPENDIXC

APPENDIXD

APPENDIXE

vii

40

40

41

42

47

48

49

SO 76

List of tables

Table 4.1: Demographic characteristics of subjects 22

Table 4.2: Number of cooking facility in a house according to monthly income 24

Table 4.3: Types of food often cooked according to food expenditure in a week 24

Table 4.4: Nutritional knowledge according to cluster of school in UMS 25

Table 4.5: Types of food often cooked by subjects with different nutritional

knowledge level 26

Table 4.6: Nutrient intake of subjects according to cluster of school in UMS 26

Table 4.7: Percentage of RNI achieved for particular nutrients according to cluster of

school in UMS 27

Table 4.8: Percentage of energy intake comprised by carbohydrate and fat for three

clusters of school 28

Table 4.9: Correlation between demographic characteristics and percentage of RNI

achieved and percentage of energy comprised by particular nutrients 30

Table 4.10: Number of cooking facility in house rented by subjects with different

nutritional knowledge level 31

Table 4.11: Nutrient intakes of subjects according to nutritional knowledge 31

Table 4.12: Percentage of RNI achieved for particular nutrients according to

nutritional knowledge 33

Table 4.13: Percentage of energy intake comprised by carbohydrate and fat for

different nutritional knowledge level 34

Table 4.14: Percentage of RNI achieved and percentage of energy comprised by

particular nutrient according to food purchasing expenditure 34

Table 4.15: Percentage of RNI achieved in energy intake and percentage of energy

comprised by fat intake according to cooking method 35

Table 4.16: Healthy living awareness according to cluster of school 36

Table 4.17: Healthy living practice according to cluster of school 37

Table 4.18: Percentage of RNI achieved and percentage of energy comprised by

particular nutrients according to healthy living awareness 37

Table 4.19: Healthy living practice according to nutritional knowledge level 38

Table 4.20: Number of subjects for healthy living awareness and practice 39

viii

ANOVA FFQ LARN MOH NCCFN NSM RE RNI SD SPSS SRI TSC UMS

LIST OF ABBREVIATIONS

Analysis of Variance Food Frequency Questionnaire Italian Recommended Daily Allowance Ministry of Health Malaysia National Coordinating Committee on Food and Nutrition Nutrition Society of Malaysia Retinol Equivalent Recommended Nutrient Intake Standard deviation Statistical Package for Social Science Spanish Recommended Intake Technical Sub-Committee Universiti Malaysia Sabah

ix

LIST OF SYMBOLS

& and % percent > more than < less than ± less or more ~ at least ~ at most

Z a/2 critical value

n sample size p population proportion E margin of error

= equal to '" similar to '" kcal kilocalories g gram I-Ig microgram mg milligram

x2 Chi-square rs Spearman rank correlation coefficient p pvalue

x

1.1 BACKGROUND

1.1.1 Healthy eating

CHAPTER 1

INTRODUCTION

Healthy eating is about meeting daily nutritional requirement, while avoiding the

deficiencies and excesses that contribute to the risk of diet related disease (NSM,

2000). Healthy eating can be achieved by having balanced diet, eating variety of

foods and being moderate in food consumption . This can be done by following the

Food Guide Pyramid and eating according to the types of foods and serving sizes

recommended in the Food Guide Pyramid (NSM, 2002). A person's daily meal should

consist more of the foods from the lower level of the Food Guide Pyramid and the

least from the upper level. Overeating should be avoided to ensure balance in diet by

emphasizing in moderate daily food intake.

The Technical Working Group on Nutritional Guidelines under the National

Coordinating Committee on Food and Nutrition (NCCFN) has produced the Malaysian

Dietary Guidelines 1999 with eight basic messages to guide Malaysians in healthy

eating practice. These messages include enjoy a variety of food, maintain healthy

body weight by balancing food intake with regular physical activity, eat more rice and

other cereal products, legumes, fruits and vegetables, minimize fat in food

preparation and choose foods that are low in fat and cholesterol, use salt sparingly

and choose foods low in salt, reduce sugar intake and choose foods low in sugar,

drink plenty of water daily, practice and promote breastfeeding.

1.1.2 Healthy living

Healthy lifestyles include actions aimed to promote wellness like physical activities

and stress management as well as behaviors that prevent disease like avoidance of

bad health habits (Abel, 1991). According to the Health Education Division of Ministry

of Health Malaysia (2005), the keys of healthy living are by eating healthily, be

1

physically active, handling stress and do not smoke. Healthy living also include other

health promoting behaviors such as not drinking alcohol, not taking drugs and

getting enough sleep (Uphold et aI., 2007).

Practising a healthy lifestyle can help to improve health status, reduce risk of

getting disease, enable a person to have more stamina and energy to enjoy life and

create a healthy personality in a person. Healthy living can be achieved through

eating on regular basis and maintaining healthy body weight, and at the same time,

doing physical activities and movements which use energy such as exercise,

recreation and sports. Smoking can increase the risk of getting diseases like lung

cancer, heart disease while stress which is the physical, emotional and mental

response to change that can be harmful to health (Health Education Division, 2005).

Therefore, avoiding or quitting smoking and efforts to sustain a stress-free life are

important factors in maintaining healthy lifestyle (Uphold et aI., 2007).

The terms "self-catering" or "self-catered" are only used in the United

Kingdom, Australia, Canada and other countries of the British Commonwealth (Johns

& Lynch, 2007). According to Lynch & Johns (2007), the definition of self-catering is

given as exclusive use of self-contained accommodation which is available without a

supply of prepared food, but must have access to facilities for the letting party to

store and prepare food on the premises. Hence students on self-catering would be

students who had cooking facilities at their rented houses where they could prepare

and cook their own foods.

1.2 RATIONALE OF STUDY

No research has been done to determine the healthy eating and healthy living

awareness and practice amongst self-catering university students in Malaysia that

living away from home for the first time. Hence, the lifestyle and ~ating habits of

self-catering students can be known through this study. Information and results of

this study can be used as reference in the future in nutrition and health education to

promote healthy eating and healthy.

2

1.3 HYPOTHESIS

The university students with healthy eating and healthy living awareness are

expected to have healthy eating and healthy living practice in daily life.

1.4 OBJECTIVE

1. To determine the disparity between healthy eating awareness and practice

amongst university students on self-catering

2. To determine the disparity between healthy living awareness and practice

amongst university students on self-catering

3

CHAPTER 2

LITERATURE REVIEW

2.1 HEALTHY EATING

Papadaki et al. (2007) had studied about the effect of living away from home on the

dietary habits of Greek undergraduate students (n=84, age: 22.3 ± 1.8 years).

Although students living away from family home had made some positive changes,

but they decreased their weekly consumption on fresh fruits, raw and cooked

vegetables, fish, seafood and they increased the consumption of sugar, fast food and

alcohol. The study showed that students living away from home had developed more

unfavourable eating habits than students living at home. This is because living away

from home has changed students' food preparation method and food purchasing

decision thus affecting their eating habits.

Eating patterns such as eating frequency, skipping of breakfast and frequency

of meals eaten away from home might influence students' nutritional status, which

will then influence health and academic performance. According to Moy et al. (2006),

3620 primary and secondary school children were surveyed using a pre-tested

questionnaire while their weights and heights were measured. It was found that as

the students' age increased, the prevalence of eating breakfast and lunch in school

increased and skipping breakfast is related to age, gender, body mass index and the

intake of nutritional supplement. The most frequently missed meal is breakfast

(12.6%), followed by lunch (6.7%) and dinner (4.4%). Therefore promotion of

healthy eating should be targeted at students since they tend to eat outside foods.

A person with greater health concerns would have different food choice

motives and better attitudes towards healthy eating (Sun, 2007). Sun (2007) showed

that the relationship between health concern on developing diseases and attitudes

toward healthy eating was fully mediated by food choice motives while the

relationship between calorie consumption health concern and healthy eating attitudes

4

was only partially mediated by food choice motives (n=456, age: 21 years). The

result indicated that individuals who had health concern on developing disease or

consuming too many calories would have different food choice motives, and these

result in an effect of choosing healthy diet.

Hearty et al. (2007) found that most people had a positive attitude or

motivation towards their healthy eating behavior (n=1256, age: 18 - 64 years).

People who perceived their own eating habits to be healthy were more likely to

comply with current dietary guidelines than those who did not. Results showed that

attitudes or motivation towards eating healthily was related to measured dietary and

lifestyle behaviors. For example, an increased intake of breakfast cereals, vegetables,

fruits and poultries were associated with decrease in negative attitudes towards

healthy eating behavior, while increased intake of high-calorie beverages was

associated with an increased in negative attitudes towards healthy eating behavior.

Nutritional knowledge could influence food attitudes and beliefs, which in turn

affect the eating behavior. Thus, increasing a person's level of knowledge could

change attitudes and have the desired effect on food choice (Tepper et al., 1997).

The study examined the effects of restrained eating, nutritional knowledge, beliefs on

selected foods and demographic variables on food choice (n=137, age: 19 - 56

years). Results showed that food choice was most affected by dietary restraint while

nutritional knowledge and food beliefs played only modest role in subjects' food

choice.

Hop et al. (2007) stated that food consumption of women in Vietnamese

communes improved compared to level before intervention. The total knowledge

scores and nutrition practice of women of intervention commune had significant

improvement compared to data at baseline and were higher compared to subjects of

control commune (n=196, age: 20 - 35 years). The nutrition practice among the

women was better than those in control commune and improper practice were

significantly decreased compared to the baseline data. This showed that intervention

and implementation of nutritional knowledge did improve the nutrition practice of the

subjects.

5

Studies regarding the effectiveness of nutrition education showed that while

improvement in knowledge occurred, there was no difference observed in eating

behaviour (Nicholos et aI., 2005). People may have knowledge, which can be cited or

recalled on a test but not applied to problems or behavioural decisions (Gabrys et aI.,

1993). In other words, information may be available but consciously ignored or

overwritten by reasons with higher priority because individuals may possess the

relevant information but they only use what is important to 'them (Wi ita &

Stombaugh, 1996).

A study done by Packman & Kirk (2000) to explore the nutritional knowledge,

attitudes and dietary fat consumption in male university students (n=56, age: 20 -

51 years) found that subjects with a high fat intake had significantly more negative

attitudes towards reducing fat consumption compared to those with lower fat intake.

However, results showed that there was no significant difference between nutritional

knowledge and fat consumption and no relationship was found between level of

nutritional knowledge and attitudes.

Rousset e al. (2006) found that the nutrition information not only increased

protein intake but also dramatically improved participants' knowledge about nutrition

requirements and sensory loss, as well as their relationships to eating habits, health

and their perceived control over health (n=82, age: 65 - 75 years). Moreover, result

showed that women are more convinced of the relationship between health and

nutrition where women modified their attitudes and improved their nutrition

knowledge more than men. So it is possible to change the dietary practices and

attitudes toward foods and health by giving and discussing nutrition information

which people are lacked of. People who believe that they have no control over their

health are likely to be less concerned about what they eat. Conversely, those

perceiving that they have control over their health have more nutritional knowledge

and who are aware may be more discriminating in food choices (Wallston et al.,

1978). Thus, improving nutritional knowledge might be a way to influence food

consumption and to improve the perception of health control.

Despite the intuitive appeals of education as a mean to improve diet, many

studies have failed to significant associations between nutritional knowledge and 6

dietary behaviour (Axelson et al., 1985). The explanation for the inconsistent

associations between knowledge and dietary behaviour is because knowledge could

be being assessed poorly. A reliable and valid questionnaire needs to be developed to

help identify weakness of people in understanding healthy eating and dietary

behaviour (Parmenter & Wardle, 1999).

Knowledge of eating patterns enables the formulation of public policies

directed toward health promotion, maintenance, or recovery where diet has an

important impact on health and is one of a list of environmental factors that have the

capability for modifying the prevailing morbidity and mortality profile (Fisberg et al.,

2006). Studies using indices that measured dietary quality and summarised the main

characteristics of healthful eating habits enable evaluation of possible associations

between diet and demographic, socioeconomic, and lifestyle factors (Fisberg et aI.,

2006). Reports have shown that individuals with higher incomes and schooling levels

could modify the quality of their diets by eating more healthful foods such as fruits,

vegetables, and low-fat milk. These people had greater possibilities for gaining

access to information regarding the relationship between diet and health. Therefore,

higher dietary quality is associated with higher income, higher education level, better

nutritional status, and being a non-smoker and the knowledge of these factors is

important for implementing programs for preventive nutrition or intervention.

Coulson et al. (2004) reported that people knew about healthy diet but many

did not practice this behavior. Many participants indicated that they found nutrition

guides were difficult to follow where the numbers of serving in the different food

categories were too many and too large and, for them personally, the guide was not

helpful. Participants expressed that a user friendly approach to understanding good

nutrition is needed.

Quinn (1997) and Walker (1997) reported that there are several reasons why

older adults do not consume healthy diets. These include decreased ability to smell

and taste food, less ability to shop for groceries, poor appetite, and inadequate

money to eat well when balancing the costs of food with the costs associated with

their medications. Policies and programs are needed to assist older adults in

understanding and consuming a healthy diet. Furthermore, policy-makers need to 7

consider the development of nutritional standards, such as food guides, that older

adults could understand and find more appropriate to their daily lives (Quinn, 1997).

Foods prepared away from home have long been recognised to contain more

energy and fat and less nutrients than foods prepared at home (Guthrie et al., 2002).

In the study of Kolodinsky et al. (2007), significant differences in nutrition knowledge

scores were seen for the consumption of fruit, dairy, protein, arid whole grains

(n=200, age: 18 - 20 years). Moreover, when asked about individual food chOices,

nutritional knowledge was related to making more healthful choices in every case. It

showed that when posed with a question about a specific type of food, students were

able to use their knowledge to make a more healthful choice and increased

knowledge of dietary guidance did appear to be positively related to more healthful

eating patterns among college students (Kolodinsky et aI., 2007).

According to Hii et al. (1997) in determining the food consumption behavior,

nutrition and health knowledge and dietary changes among Malaysian university

students (n=153, age: 21 - 25 years), meals consumed daily by Malaysian students

were breakfast (43%), lunch (63%), dinner (77%) and one snack (69%). And meals

were missed due to lack of time (45%), inconvenience meal hours (35%), need for

sleep (34%) and no cooking skills (34%). Hii et al. (1997) suggested that nutrition

information and simple meal preparation techniques using local foods need to be

widely disseminated to all students through various food outlets on and off campus

to promote healthy lifestyles for all students.

2.2 HEALTHY LIVING

Pon et al. (2004) found that although eating behavior and physical activity patterns

were not significantly different between overweight and normal weight Malaysian

female adolescents, more overweight students skipped one or more daily meals as

compared to normal weight students (n=100, age: 14.76 ± 1.15 years). More

overweight subjects (64%) had a low level of weight management knowledge than

normal weight subjects (52%). Pon et al. (2004) suggested that correct information

on nutrition and weight management need to be taught besides incorporation of

increasing physical activity level in daily routine and adopting healthy eating habits to

improve their body image and weight management perception.

8

In assessing health promotion and risk behaviors of college students (n=251,

age: 19.0 ± 4.1), study showed that participants believed they were in control of

their health and their personal behaviors like personal stress, smoking, alcohol

consumption and taking drugs were responsible for their health (Rozmus et al., 2005).

Students also reported that happiness and health were the most important personal

values for them showing that students did aware about their own health and

personal behaviors.

University students may encounter personal, social, family and financial

stresses which might affect their eating behavior and health status (Khor et al.,

2002). In this study which determined the students' eating behavior and social self

concept, results showed that psychological and emotional factors had a significant

relationship on the eating behavior of university students (n=180; age: 18 - 30

years). Negative self concept feelings and attitudes could lead to social, health and

psychological problems like eating disorders and depression. Several studies reported

that eating behavior is related to poor self-esteem, body image, peer and family

relationships (Rieden & Koff, 1997; Buddeberg-Fisher et aI., 1996; Grant & Fodor,

1988).

Having the knowledge of health recommendations but not followed can be

considered a form of risk taking (Tyas & Pederson, 1998). Cook & Bellis (2001)

showed that knowledge of health risks and risk-taking behaviour were related where

those with precise risk assessment were high risk takers while those who repeatedly

over-estimated the risks exhibited low level of risk-taking behaviour. Better

nutritional knowledge does not necessarily have a positive effect on individual health.

In the study of Raymond-Barker et al. (2007), athletes with heightened awareness

might engage in risk taking behaviour by making excessive efforts to reduce calorie

intake in order to stay lean, with negative consequences on performance and

ultimately on health. Athletes might justify their unhealthy eating habits as being

controlled, temporal and goal oriented behaviour. Athletes might know that the

advisable behaviour is regarding eating and nutrition but tend not to follow these

guidelines if it was not practical.

9

Coulson et al. (2004) acknowledged that increasing knowledge may not

ensure healthy lifestyle practice as the correlations between lifestyle knowledge and

lifestyle behaviors were generally low (n=281, age: 55 - 94 years). This was

particularly in the case with lifestyle behaviors associated with healthy nutrition.

However other study results showed that after controlling the effect of other

independent variables, those who expressed greater self-assessment of health status,

higher knowledge of interpersonal relationships and medical knowledge and lower

stress levels demonstrated a higher healthy lifestyle score (Coulson et al., 2001).

Therefore, the disparity between knowledge and practice is not surprising and

confirms that health education is a necessary ingredient in behavioral change

(Steptoe et aI., 1997).

From the aspects of physical activity, the awareness might not associate with

the practice although people do have knowledge. For example, participants often had

the knowledge about checking their pulse rate, but many did not practice this

behavior when exercising (Gill et aI., 2000). Participants thought that they need to

consult with their physician before starting an exercise program and learning how to

take their pulse rate to avoid adverse cardiac events. Besides that, participants

thought that some exercise programs which are light might not require stress tests

and body status checking since no extreme movements are required.

Coulson et al. (2001) confirmed that, while many older adults knew that

Canadian and Australian participants did realised relaxation and stress management

techniques were important for the maintenance of health, but many did not practice

this behavior. They expressed that they did not have the knowledge about how to

manage stress, although they knew it was important. Many people did not realise

stress management as one of the criteria in healthy living as this is because stress

management might be viewed as part of the newer way in health promotion.

Previous research has demonstrated a clustering of positive health behaviors;

individuals with good health practices probably acted in a similar way towards other

health behaviours (Gates & DelUCia, 1998). The hypotheSis of this study was that

diet quality and nutrition knowledge, attitudes, beliefs and behaviors influence

lifestyle patterns like smoking, alcohol consumption, and physical activity. Gates &

10

Delucia (1998) found that subjects in the healthy group who smoked and drank less,

and exercised more had higher diet quality scores, more positive attitudes, and

healthier food preparation behaviors than subjects in other groups; These findings

showed that adults with healthy lifestyle patterns also make good diet choices, and

these choices might be influenced by greater knowledge and more positive attitudes

and beliefs about nutrition.

Health lifestyles include a broad range of behaviors involving alcohol and drug

use, smoking, diet, exercise, coping with stress, rest and relaxation, automobile

seatbelt use, personal hygiene, and other health practices (Cockham, 2000). These

behaviors can have either positive or negative consequences for health and form an

overall pattern of practices that constitutes a lifestyle. According to Steptoe & Wardle

(2001), a healthy lifestyle implies healthy practices across a range of personal

behaviours and activities.

Steptoe & Wardle (2001) investigated the prevalence of unhealthy options in

twelve health behaviours to obtain evidence concerning lifestyle differences between

Western and Eastern Europe (n=6463, age: 18 - 25 years). They also investigated

factors that might be associated with differences in health behaviour and thought

that people might be lacked of information about health and behaviour, or have little

control over provision like limiting dietary and exercise choices. University students

are generally better educated than other young adults, and therefore are associated

with differences in healthy practices and with knowledge of the role of behaviour in

disease risk (Steptoe & Wardle, 2001). The respondents in the study might therefore

have carried out more healthy behaviour and have been better informed about risks

than young adults who had not entered tertiary education.

Glanz et at. (1998) have done a study to examine the self-reported

importance of taste, nutrition, cost, convenience, and weight control on personal

dietary choices and whether these factors vary across demographic groups, are

associated with lifestyle choices related to health lifestyle and eating behaviour

(n=2967). Glanz et at. (1998) found that demographic factors were significant

predictors of the importance of taste, nutrition, cost, convenience, and weight control

for consumers and health lifestyle was significantly associated with the relative 11

importance of these factors, especially nutrition and weight control. The factors like

demographics, the health lifestyle and the importance of taste, nutrition, cost,

convenience, and weight concerns played a role in determining food consumption.

12

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