PWM: Eating Behaviors of Children (2006)
To determine the prevalence of abnormalities in weight, eating attitudes and eating behaviors among an (inner-city) urban teenage population.
Not specified, but each questionnaire was successfully completed (if there were two or fewer blank answers) by approximately 75% of students.
- Not described.
- Data collected from students from a single New York City high school as a part of a health education program (Health Screening Week) developed by school-based clinic staff, faculty, administration and students. Each student attending regularly scheduled PE class was assessed for height, weight, visual acuity and blood pressure. Approximately 70 high school students on a nursing assistant career track were trained to do the assessments and were supervised by school staff. Several questionnaires were also administered during the week.
- X2 analysis to determine variations by age, gender and grade
- ANOVA and two-tailed T-tests to determine significance of mean score differences
- Spearman correlation coefficients to detect relationships among weight status and eating attitudes, self-esteem and anxiety.
- Blinding: None.
- Weight status: Height and weight measured; based on percentage IBW (ideal weight based on weight-for-height tables of Baldwin, 1961) (N=1,001)
- Obese: =120% IBW (25% of subjects)
- Overweight: 110-119% IBW (18% of subjects)
- Normal weight: 86-109% IBW (52% of subjects)
- Underweight: =85% (5% of subjects).
- Nutritional behaviors survey: More than three times in prior week; N=753
- Breakfast skipping
- Lunch skipping
- Dinner skipping
- Eating three meals per day
- Eating fast food
- Eating candy
- Drinking soda
- Drinking coffee
- Eating fruits or vegetables
- Eating bread or grains
- Drinking milk.
- Exercised: At least 30 minutes more than three times in prior week; N=753
- Smoking: Five to 10, more than three times in prior week; N=753
- Weight status perceptions: Questionnaire; N=577
- Eating attitudes: Eating Attitudes Test (EAT-26); questionnaire by Garner and Garfinkel (1979) to measure three factors: Dieting behavior, bulimic behavior and control around eating; N=683
- Global self-esteem: Rosenberg Self-Esteem Scale (Rosenberg, 1979); N=711
- Chronic anxiety: Spielberger Trait Anxiety Scale (Spielberger, 1973); N=691.
- Gender (separate analyses).
- 1,001 (45% male, 55% female) high school students
- Participation rate: Roughly 66% of total student body of approximately 1,500
- Sample size varies by instrument (see data collection), but for outcomes of interest; N=753.
- Mean, 16 years.
- 66% black
- 23% Hispanic
- 8% white
- 3% Asian (total student body).
- Low income: 66%
- No health insurance: 20%
- Medicaid: 14%
- Private insurance (total student body): Over 50% of public housing in borough of Queens is located in Far Rockaway.
[Note: School would not allow individual student assessment of ethnicity and SES.]
- The Far Rockaway peninsula, New York City.
Reported Diet-related Behaviors
- Breakfast skipping: 59% (male<female)
- Lunch skipping: 43% (male<female)
- Dinner skipping: 14%
- Ate three meals per day: 43% (male>female)
- Ate fast foods: 28%
- Ate candy: 60% (male<female)
- Drank soda: 55% (male>female)
- Drank coffee: 10%
- Ate fruits or vegetables: 55%
- Ate bread or grains: 66% (male>female)
- Drank milk: 70% (male>female).
Relationship of Diet-related Behaviors with Weight Status:
- Breakfast skipping: Obese (72%) > underweight (30%); P<.001; among obese, male<female
- Ate three meals per day: Obese (32%) < underweight (59%), Among obese, male>female
- Lunch skipping: N/S
- Dinner skipping: N/S
- Fast food intake: N/S
- No discussion of other diet-related behaviors.
[Note: See paper for additional details on the results of the other measures.]
- 39% (male>female).
Eating attitude scores
- Abnormal for 15% females and 6% males (similar to other studies).
- Mean score of 1.4 (higher self-esteem than in other studies).
- High anxiety in 17% (similar to other studies).
- Spearman correlations: No significant relationships between %IBW and the Eat-26, self-esteem or anxiety
- T-tests: Higher weight status students had more abnormal eating attitudes than those who were normal or underweight.
Among this population of urban high school students there were:
- A large number of overweight adolescents
- A significant subgroup with eating attitudes suggestive of an eating disorder
- High levels of self-esteem and normal levels of anxiety, which were independent of weight status.
- Large sample size of minority, low-income teens
- Multiple measures.
- No comparison of those included and not included in the study or those that completed and did not complete questionnaires
- Subject ethnicity and SES defined on the basis of school rather than personal data, which may result in misclassification
- No inclusion or exclusion criteria
- Recruitment not described
- Used weight and height stated that it is not routinely used limiting comparison with other studies
- Unclear how meal skipping and fast foods were defined (or if simply relied on self-perception of subjects
- Incomplete reporting of results for diet-related behaviors in relation to weight status.
Quality Criteria Checklist: Primary Research
|1.||Would implementing the studied intervention or procedure (if found successful) result in improved outcomes for the patients/clients/population group? (Not Applicable for some epidemiological studies)||N/A|
|2.||Did the authors study an outcome (dependent variable) or topic that the patients/clients/population group would care about?||Yes|
|3.||Is the focus of the intervention or procedure (independent variable) or topic of study a common issue of concern to dieteticspractice?||Yes|
|4.||Is the intervention or procedure feasible? (NA for some epidemiological studies)||N/A|
|1.||Was the research question clearly stated?||Yes|
|1.1.||Was (were) the specific intervention(s) or procedure(s) [independent variable(s)] identified?||Yes|
|1.2.||Was (were) the outcome(s) [dependent variable(s)] clearly indicated?||Yes|
|1.3.||Were the target population and setting specified?||Yes|
|2.||Was the selection of study subjects/patients free from bias?||No|
|2.1.||Were inclusion/exclusion criteria specified (e.g., risk, point in disease progression, diagnostic or prognosis criteria), and with sufficient detail and without omitting criteria critical to the study?||N/A|
|2.2.||Were criteria applied equally to all study groups?||No|
|2.3.||Were health, demographics, and other characteristics of subjects described?||Yes|
|2.4.||Were the subjects/patients a representative sample of the relevant population?||???|
|3.||Were study groups comparable?||No|
|3.1.||Was the method of assigning subjects/patients to groups described and unbiased? (Method of randomization identified if RCT)||N/A|
|3.2.||Were distribution of disease status, prognostic factors, and other factors (e.g., demographics) similar across study groups at baseline?||N/A|
|3.3.||Were concurrent controls or comparisons used? (Concurrent preferred over historical control or comparison groups.)||N/A|
|3.4.||If cohort study or cross-sectional study, were groups comparable on important confounding factors and/or were preexisting differences accounted for by using appropriate adjustments in statistical analysis?||No|
|3.5.||If case control study, were potential confounding factors comparable for cases and controls? (If case series or trial with subjects serving as own control, this criterion is not applicable.)||N/A|
|3.6.||If diagnostic test, was there an independent blind comparison with an appropriate reference standard (e.g., "gold standard")?||N/A|
|4.||Was method of handling withdrawals described?||Yes|
|4.1.||Were follow-up methods described and the same for all groups?||Yes|
|4.2.||Was the number, characteristics of withdrawals (i.e., dropouts, lost to follow up, attrition rate) and/or response rate (cross-sectional studies) described for each group? (Follow up goal for a strong study is 80%.)||Yes|
|4.3.||Were all enrolled subjects/patients (in the original sample) accounted for?||Yes|
|4.4.||Were reasons for withdrawals similar across groups?||???|
|4.5.||If diagnostic test, was decision to perform reference test not dependent on results of test under study?||N/A|
|5.||Was blinding used to prevent introduction of bias?||No|
|5.1.||In intervention study, were subjects, clinicians/practitioners, and investigators blinded to treatment group, as appropriate?||N/A|
|5.2.||Were data collectors blinded for outcomes assessment? (If outcome is measured using an objective test, such as a lab value, this criterion is assumed to be met.)||No|
|5.3.||In cohort study or cross-sectional study, were measurements of outcomes and risk factors blinded?||No|
|5.4.||In case control study, was case definition explicit and case ascertainment not influenced by exposure status?||N/A|
|5.5.||In diagnostic study, were test results blinded to patient history and other test results?||N/A|
|6.||Were intervention/therapeutic regimens/exposure factor or procedure and any comparison(s) described in detail? Were interveningfactors described?||N/A|
|6.1.||In RCT or other intervention trial, were protocols described for all regimens studied?||N/A|
|6.2.||In observational study, were interventions, study settings, and clinicians/provider described?||N/A|
|6.3.||Was the intensity and duration of the intervention or exposure factor sufficient to produce a meaningful effect?||N/A|
|6.4.||Was the amount of exposure and, if relevant, subject/patient compliance measured?||N/A|
|6.5.||Were co-interventions (e.g., ancillary treatments, other therapies) described?||N/A|
|6.6.||Were extra or unplanned treatments described?||N/A|
|6.7.||Was the information for 6.4, 6.5, and 6.6 assessed the same way for all groups?||N/A|
|6.8.||In diagnostic study, were details of test administration and replication sufficient?||N/A|
|7.||Were outcomes clearly defined and the measurements valid and reliable?||Yes|
|7.1.||Were primary and secondary endpoints described and relevant to the question?||Yes|
|7.2.||Were nutrition measures appropriate to question and outcomes of concern?||Yes|
|7.3.||Was the period of follow-up long enough for important outcome(s) to occur?||N/A|
|7.4.||Were the observations and measurements based on standard, valid, and reliable data collection instruments/tests/procedures?||Yes|
|7.5.||Was the measurement of effect at an appropriate level of precision?||Yes|
|7.6.||Were other factors accounted for (measured) that could affect outcomes?||No|
|7.7.||Were the measurements conducted consistently across groups?||Yes|
|8.||Was the statistical analysis appropriate for the study design and type of outcome indicators?||No|
|8.1.||Were statistical analyses adequately described and the results reported appropriately?||Yes|
|8.2.||Were correct statistical tests used and assumptions of test not violated?||Yes|
|8.3.||Were statistics reported with levels of significance and/or confidence intervals?||Yes|
|8.4.||Was "intent to treat" analysis of outcomes done (and as appropriate, was there an analysis of outcomes for those maximally exposed or a dose-response analysis)?||N/A|
|8.5.||Were adequate adjustments made for effects of confounding factors that might have affected the outcomes (e.g., multivariate analyses)?||No|
|8.6.||Was clinical significance as well as statistical significance reported?||No|
|8.7.||If negative findings, was a power calculation reported to address type 2 error?||No|
|9.||Are conclusions supported by results with biases and limitations taken into consideration?||Yes|
|9.1.||Is there a discussion of findings?||Yes|
|9.2.||Are biases and study limitations identified and discussed?||Yes|
|10.||Is bias due to study's funding or sponsorship unlikely?||Yes|
|10.1.||Were sources of funding and investigators' affiliations described?||???|
|10.2.||Was the study free from apparent conflict of interest?||Yes|