BSc in Public Health, Health Education and Health Promotion health center of Chenaran, Mashhad University of Medical Sciences, Mashhad, IR Iran

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1 J Health Sci Technol July;1(2): Published online 2017 July 28. Reseach Aticle Application of the Theoy of Planned Behavio to pedict lownutient junk food consumption among male students Elham Chaoghchian Khoasani 1, Nooshin Peyman *2, Mohammad Moghzi 3 1 MSc, Student Reseach Committee, Depatment of Health Education & Health Pomotion, Social Deteminants of Health Reseach Cente, Faculty of Health, Mashhad Univesity of Medical Sciences, Mashhad, IR Ian 2 Social Deteminants of Health Reseach Cente, Mashhad Univesity of Medical Sciences, Mashhad, IR Ian 3 BSc in Public Health, Health Education and Health Pomotion health cente of Chenaan, Mashhad Univesity of Medical Sciences, Mashhad, IR Ian *Coesponding autho: Nooshin Peyman, Associate Pofesso, Depatment of Health Education and Health Pomotion, School of Health, Social Deteminants of Health Reseach Cente, Mashhad Univesity of Medical Sciences, Mashhad, Ian, Tel: , Fax: , peymann@mums.ac.i Received 2017 June 17; Revised 2017 July 10, 2017; Accepted 2017 July 18 Abstact Backgound: Students ae highly tended to consume junk foods. This study aimed to pedict the consumption of lownutient junk foods based on the constucts of the Theoy of Planned Behavio among male students acoss Chenaan city in Methods: This desciptive-analytic study incopoated 143 eighth-gade students who wee selected via simple andomization method. They completed the elevant questionnaie. The data wee analyzed in SPSS (vesion 18) using oneway analysis of vaiance, egession analysis, and Peason coelation test. Significance level was Results: The junk foods most fequently consumed compised of chocolate, cake, and fizzy dinks. Results indicated that subjective noms and peceived behavioal contol could pedict 9 pecent of changes in low-nutient junk food consumption. Fom among the constucts of the theoy of planned behavio, attitude, subjective noms, and peceived behavioal contol ae able to pedict 16 pecent of behavioal intention changes. Conclusions: Given the tendency of students towads the consumption of low-nutient junk foods, administation of theoybased educational inteventions such as the theoy of planned behavio seems necessay. Keywods: Theoy of Planned Behavio; Junk food; Students 1. Intoduction One of the nutitional poblems among adolescents is excessive use of low-nutient junk foods, which ae mainly chaacteized to be of low nutitional value and high levels of enegy due to salt o suga. Junk foods ae estimated to account fo 40 pecent of the daily enegy intake in Ianian students (1). The consequences of excessive consumption of these foods in childen such as obesity, tooth decay and chonic diseases have been well established (2).Nutitional poblems stand as the oot fo seveal majo chonic diseases in both the developed and developing counties. Changes in lifestyle among which the dietay factos, play an impotant ole in the pevalence o incidence of obesity and othe isk factos fo non-communicable diseases (3). A nationwide suvey in Ian showed that 51 pecent of childen used some type of junk foods, industial juices, cabonated dinks, candies and chocolates since a week pio to the suvey. Anothe study in 23 cities acoss Ian indicated poo nutitional habits among 6- to 18-yea-old students (4).It goes without saying that human behavio is a eflection of vaious factos and that health education as the canon of health activities and pogams equies knowledge of behavio and contibutos to behavioal modification as well as eplacement of poo behavios with pope ones; this highlights the ole of models and theoies in health behavio education (5). Coina intoduced the theoy of planned behavio (TPB) in 2000 as a compehensive and ational model to explain why people change thei health-elated behavios (6). TPB J Health Sci Technol July;1(2):

2 Chaoghchian Khoasani E et al in tems of food choices stands as a pominent theoy (1), which was initially intoduced by Ajzen and Fishbein (7). It is a model of socio-cognitive expected value that consides intention as the main deteminant of behavio (8), poposing that thee factos impact behavioal intention (2). These include attitude, subjective noms, and peceived behavioal contol. One s belief in and evaluation of the outcome of a cetain behavio ae conducive to the fomation of his/he attitude. Subjective noms ae influenced by peceptions about the judgment of othes as well as the motivation to meet thei expectations. Peceived behavioal contol epesents a degee of an individual s peception concening to what degee (non) pefomance of a cetain behavio follows his/he contol. Oveall, TPB can explain about 40% of the elationship between intention and health behavio (9). In addition to the main constucts of TPB, seveal empiical studies have consideed othe vaiables contibutoy to food intake. Among these vaiables is pevious behavio which is usually a stong pedicto of intention and behavio (10). The aim of this study was to exploe the pedictos of low nutient junk food consumption among eighth-gade students in Chenan city using TPB as well as the additional vaiable of pevious behavio. 2. Methods This coss-sectional study incopoated 143 eighthgade male students in Chenaan in Febuay and Mach Inclusion citeia consisted of being in the eighth gade in boys' school and tendency to paticipate in the study. Exclusion citeion included povision of flawed questionnaie. The sample size was detemined as 143 following a simila study (11).Based on multi-stage cluste sampling; two high schools wee andomly selected fom among all high schools in the city. Aftewads, the equied numbe of paticipants fom evey class was selected andomly fom the attendance list. Appovals wee aleady obtained fom the education depatment of the city and the students. Theeafte, the questionnaies wee completed by the students. The questionnaie used in this study consisted of fou pats. The fist pat coveed demogaphic chaacteistics, i.e., age, weight, height, numbe of family membes, education level and occupation of paents, and the amount of pocket money pe week. The second pat held items elated to knowledge about junk foods with low nutitional value (e.g., Consumption of these foods leads to oveweight and obesity.). At the beginning, the students wee explained about the meaning and type of junk foods including chocolate, falafel, cheese puffs, fizzy dinks, cisps, caamel ceam, sweets, biscuits, gummies, cake, ice dink, and factoy-made fuit juice. To assess knowledge, thee wee nine (tue/false/i don t know) items whee a coect answe was scoed 1, and othe options wee scoed 0. Scoe ange of knowledge was fom 0 to 9. The thid section of the questionnaie assessed the fequency of junk food consumption on a weekly scale (fom I neve use to I use moe than once a week). The foth section diectly assessed TPB constucts. Thee wee 9 items on attitude (e.g., the foods ae delicious), 2 items on behavioal intention (e.g., Next month, I'm going to cut on these junk foods), 4 items on subjective noms (e.g., My paents believe that I can have these foods.), and 4 items on peceived behavioal contol (e.g., I'm sue if I intend, I can cut on these foods.). The constucts wee scoed on a five-point Liket ating scale (stongly agee, agee, no comment, disagee, stongly disagee). Scoe ange fo attitude was between 9 and 45, fo behavioal intention between 2 and 10, fo subjective noms fom 4 to 20, and fo peceived behavioal contol fom 4 to 20. The questionnaie was designed on the basis of the study objectives and with due consideation of the existing papes and theses (5, 6, 15). Content validity was ensued via face validity as well as quantitative methods of content validity atio (CVR) and content validity index (CVI). Fist, to detemine the CVR, 10 expets in health education assessed each item based on a thee-point scale (necessay; useful but not necessay; it is not necessay).based on Lawche s table, items whose CVR values wee geate than 62% wee consideed significant and thus etained (p <0.05). Moeove, items whose CVI based on content validity index of Walts and Bausell wee geate than 0.7 wee consideed acceptable and the est wee emoved (12). To detemine the eliability of the questionnaie, a pilot study was conducted on 11 students, and intenal consistency was calculated with Conbach's alpha as α=0.74. The collected data wee analyzed in SPSS vesion 18. Peason test was used to detemine the elationship between the mean scoe of TPB constucts, quantitative demogaphic vaiables, and mean consumption of low- 76 J Health Sci Technol July;1(2):75-79.

3 Chaoghchian Khoasani E et al nutient junk foods. One-way analysis of vaiance was used to ddetemine the significant elationship between mean consumption junk food and qualitative demogaphic vaiables. The egession analysis (backwad method) was applied to pedict the behavio and intention of low-nutient fast food consumption. It should be noted that in linea egession analysis using the backwad method, the constucts whose significance coefficients wee between 0.05 and 0.1 wee etained in the model in ode to obtain the optimal model fo pediction of behavio esponse and intention vaiables. 3. Results Results of this study showed that the numbe of family membes of students was 5.39±1.70 on aveage, and thei mean age was 14.17±0.83 yeas. The mean body mass index was 19.89±4.83 and they watched television fo 2.74±0.95 hous on aveage. Accoding table 1, 18.9% of mothes and 11.2% of fathes wee illiteate. 54.6% of mothes and 60.2% of fathes wee below high school diploma. 20.3% of mothes and 18.2% of fathes wee diploma and 5.6% of mothes and 7.7% of fathes wee above high school diploma. 91.6% of mothes wee housewife and 0.07% of fathes wee unemployed. 16.8% of students did not have pocket money and 27.3%of students have moe of 3000 tomans weekly pocket money. One-way analysis of vaiance showed no significant diffeence between mean scoes of low-nutient junk foods and qualitative vaiables of mothe s education (p=0.509), fathe s education (p=0.422), fathe s occupation (p=0.208), mothe s occupation (p=0.459) and pocket money (p=0.234). Table 2 epots the Fequency and Pecentage of lownutient junk food consumption among students. The findings of this table show that the junk foods most fequently used by students compised of chocolates, cakes and fizzy dinks. In Table 3, pai wise Peason coelation coefficients between each two constucts of TPB ae displayed. The data in this table show negative coelation between junk food consumption behavio and any of the TPB constucts, although the associations between intention, subjective noms, and peceived behavioal contol constucts and the behavio of junk food consumption is significant. In addition, thee was a significant positive coelation between behavioal intention and both subjective noms and peceived behavioal contol. To pedict consumption behavio, invese linea egession model was used. Table 3 shows the esults of the linea egession test between consumption intention and behavio based on TPB. The esults fom the table indicate that subjective noms and peceived behavioal contol ae significant pedictos of low-nutient junk food consumption behavio, accounting fo 9% of its change. Othe constucts wee no significantly pedictive in the linea egession model. On the othe hand, attitude, subjective noms, and peceived behavioal contol ae also meaningful pedictos of behavioal intention, which in total can explain 16 pecent of vaiations in lownutientjunk food intention. Table 1: Demogaphic chaacteistics of the paticipating students in pecentage Vaiables Fathe (Pecentage) Education: Illiteate Elementay Seconday/High school dopout High school diploma Associate/Bachelo Maste s o above Occupation: House wife Unemployed Woke Employee Self-employed Mothe (Pecentage) Pecentage Weekly pocket money (Tomans): No pocket money > Table 2: Fequency and pecentage of low-nutient junk foods consumed by students on a daily basis Junk food Chocolate Cheese puffs Falafel Fizzy dinks Cisps Caamel Ceam Sweets Biscuits Gummy Cake Cheesecunchi es Fequency Pecentage Fuit juice Ice dink J Health Sci Technol July;1(2):

4 Chaoghchian Khoasani E et al Table 3: Paiwise Peason coefficients between the Theoy of Planned Behavio constucts and junk food consumption Behavioal intention Subjective noms Attitude Peceived behavioal contol Junk food consumption Component R Behavioal intention * 0.32* < Subjective noms 0.23* Attitude * Peceived behavioal contol Junk food consumption *significant level is set at =Peason coelation coefficient Table 4: Results of linea egession between low-nutient junk food consumption intention, junk food consumption behavio, and constucts of the theoy of planned behavio Regession Vaiable significance test Pedicto B SE Beta P R Squae Intecept <0.001 junk food Subjective noms Consumption P=0.002 Peceived behavioal behavio contol 0.09 Intecept Attitude Behavioal P<0.001 Subjective noms intention Peceived behavioal <0.001 contol 4. Discussion sweet dinks among Ianian childen has exceeded This study showed that the mean consumption of expectations, and the ate inceases along with age. sweets, cakes and fizzy dinks among the students wee Theefoe, students stand as a majo taget goup fo moe fequent than othe junk foods. In Dehdai et al. s inteventional planning and policy-making concening study, which was conducted on female students in oveweight and obesity pevention and modified lifestyle Kemanshah in 2011, the moe fequently consumed junk (15). foods compised of chocolate, cheese puffs, falafel, and The esults of this study showed that the two constucts fizzy dinks (12). Rezakhani and colleagues showed that of subjective noms and peceived behavioal contol can cakes and cookies accounted fo 58.1 pecent of all junk pedict 9 pecent of changes in low-nutient junk food foods consumed and wee the most widely used junk foods consumption. Moeove, attitude, subjective nom, and among students in Qazvin (13). peceived behavio contol wee significant pedictos of Kelishadiet al. epoted that Ianian adolescents behavioal intention, which in total can explain 16 pecent consumed sweets 10 times a week on aveage and vaious of consumption behavio changes. Dehdai et al. showed fatty and salty junk foods 4.9 times a week. Side-effects of that fom among the TPB constucts, it is only the peceived too much junk food consumption such as obesity, tooth behavioal contol that can pedict change in behavioal decay and chonic diseases in childen and adolescents have intention (with 44 pecent pedictive powe)and that attitude been demonstated (1). In Santich et al. s study on and subjective noms wee not pedictive of intention to use Ameican teenages, the most consumed snacks consisted low-nutient fast foods (12). The diffeence in the pedictive of all kinds of candy and fizzy dinks (14).Many studies powe of the constuct can be attibutable to the gende and have shown that consumption of unhealthy snacks among cultue of paticipants, as the pesent study incopoated students is gowing. In ecent yeas, the pevalence of boys and was pefomed in Chenan in notheast of Ian, obesity associated with the consumption of fast foods and wheeas Dehdai et al. s study was conducted on gils and 78 J Health Sci Technol July;1(2):64-69.

5 Chaoghchian Khoasani E et al Kemanshah in westen Ian. In Baati et al. s study on lownutient junk food consumption among pimay school students in Aak in 2015, peceived behavioal contol was able to pedict 23% of behavio change (16). The cuent study was limited as it failed to incopoate gils and othe age goups. Theefoe, the same is suggested to be fulfilled in futue eseach. Anothe limitation of this study was self-epot on the pat of students. 5. Conclusion Results showed that students will become less inclined to use low-nutient junk foods in case they have moe negative attitudes towads these foods, and thei intentions, o pessues on them, to use low-nutient junk foods is low. Futhemoe, the geate the peceived behavioal contol in students, the less likely they ae to use low-nutientjunk foods. Theefoe, negative attitude towads these junk foods should be einfoced in pactice via the media and educational inteventions. A decease in the students intention and social pessues exeted on them to use the junk foods can also be vey beneficial. Theeby, a geate level of peceived behavioal contol can incu in the students against low-nutientjunk foods. 6. Acknowledgements We deem it necessay to expess ou gatitude to the paticipating students, the education depatment of Chenaan, and manages of the schools. Refeences 1. Kaimi Shahanjaini A, Shojaezadeh D, Majdzadeh R, Rashidian A, Omidva N. Application of an integative appoach to identify deteminants of junk food consumption among female adolescents. Ianian Jounal of Nutition Sciences & Food Technology 2009; 4(2): Mohammadi Zeidi I, Pakpou Hajiaghaye A, Mohammadi Zeidi B. Investigating the effect of education based on the theoy of planned behavioon employee safety behavios. Jounal of knowledge Health 2013;8(3): Hosseini Esfahani F, Asghai G, Mimian P, JalaliFaahani S, Azizi F. Repoducibility and elative validity of food goup intake in a food fequency questionnaie developed fo the Tehan lipid and glucose study. Jounal of Ian univesity of medical sciences 2010;17(71): ZamaniAlavijeh F, Faghihzadeh S, Sadeghi F. Application of the health belief model fo unhealthyeating pevention among pimay school childen in Aak. Jounal of Kemanshah univesity of medical sciences 2008:11(4): Bashiian S, Hidania A, Allahvedi Pou H, Hajizadeh E. Application of Theoy of Planned Behavio in Pedicting Factos of Substance Abuse in Adolescents. Jounal of Fasa Univesity of Medical Sciences2012; 2(3): Yekaninejad MS, Akabei A, Pakpou A. Factos associated with physical activity in adolescents in Qazvin. An application of the theoy of planned behavio. Jounal of Noth Khoasan univesity of medical sciences 2012;4(3): Gasemi M, Dehdai T, Mohagheghi P, Gohai MR. The effect of educational intevention based on theoy of planned behavio (TPB) fo impoving method of cae of pematue infant by mothe,2013. Razi jounal of medical sciences2014;20(115): Delshad Noghabi A, Daabi F, Moshki M.The impact of education on the basis of the theoy of planned behavio on the level and method of supevision of thei paents on watching television by students. Jounal of Tobat Heydaiyeh univesity of medical sciences2013;1(4): Pakpou Hajiagha A, Saffai M. Application of planned behavio theoy in pedicting dental bush behavio among Ianian adolescents in Qazvin. The Jounal of Islamic Dental Association of IRAN 2012; 24(3): Yamohammadi P, Shaifiad G R, Azadbakht L, Moovati Shaifabad M A, Hassanzadeh AP. Pedictos of Fast Food Consumption among High School Students based on the Theoy of Planned Behavio. Health system eseach 2011;7(4): Fila S A, Smith Ch. Applying the Theoy of Planned Behavio to healthy eating behavios in uban Native Ameican youth. Intenational Jounal of Behavioal Nutition and Physical Activity 2006; 3(11): Dehdai T, Chegni M, Dehdai L. Application Planned Behavio in theoy Pedicting Junk Food Consumption among Female Students. PCNM 2013:2(2): Rezakhani H, Soheili Azad A, Razaghi M, Nemati A. Patten of beakfast and snak consumption and thei effective factos among pimay school students, Qazvin. Jounal of health Adabil univesity of medical sciences 2012; 2(4): Ghiasvand R, Ashafi M, Ashafzadeh E, Asgai Gh R, Hasanzadeh A. Relationship between junk foods intake and weight in 6-7 yeas old childen, Shahinshah and Meimeh,2009. Health system eseach 2010; 6(2): Mohammadi Zeidi I, Pakpou A. Effectiveness of educational intevention based on theoy of planned behavio fo pomoting beakfast and healthy junk food eating among elementay school students.rjms2013; 20(112): Baati F, Shamsi M, Khosandi M, Ranjbaan M. Measuing the Constucts of Planned Behavio Theoy Regading the Behavios Peventing of Junk Food Consumption in Elementay Students in Aak in Aak Medical Univesity Jounal (AMUJ) 2016; 18(104): J Health Sci Technol July;1(2):