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The Adolescent Food Habits Checklist: reliability and validity of a measure of

healthy eating behaviour in adolescents

Article in European Journal of Clinical Nutrition · August 2002

DOI: 10.1038/sj.ejcn.1601371 · Source: PubMed

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 European Journal of Clinical Nutrition (2002) 56, 644–649
ß 2002 Nature Publishing Group All rights reserved 0954–3007/02 $25.00
www.nature.com/ejcn

ORIGINAL COMMUNICATION
The Adolescent Food Habits Checklist: reliability and
validity of a measure of healthy eating behaviour in
adolescents
F Johnson1, J Wardle1* and J Griffith1

1
ICRF Health Behaviour Unit, University College London, UK

Objective: Amid concerns about the quality of young people’s diets, this paper describes the development of a measure of
healthy eating behaviour for use with adolescents.
Design: Items for the measure were selected from a larger pool on the basis of responses from a pilot study. The 23-item
checklist was validated using measures of dietary fat and fibre intake, fruit and vegetable consumption, dietary restraint,
nutrition knowledge and a measure of family income.
Setting: Participants came from seven secondary schools in the north-west of England.
Subjects: A total of 1822 adolescents aged between 13 and 16 y took part in the study, representing 84% of those invited to
participate.
Results: Correlations between measures indicate a good level of convergent validity, and the checklist is also shown to have high
internal and test – retest reliability.
Conclusions: The focus on choices available to adolescents means that the checklist will provide a useful addition to food
frequency-type approaches to the measurement of adolescent eating behaviour.
Sponsorship: This research was funded by the Medical Research Council and the Economic and Social Research Council’s Health
Variations Programme.
European Journal of Clinical Nutrition (2002) 56, 644 – 649. doi:10.1038=sj.ejcn.1601371

Keywords: food habits; adolescence; psychometrics; diet

Introduction 1998). In the light of these concerns there has been an

The eating behaviour of young people has come increasingly interest in novel approaches to measurement of the diet
under the spotlight in recent years amid claims that many and eating behaviour of young people. Most instruments
adolescents in Western countries have a poor diet (Anderson focus on nutrient intake, which has been measured using
et al, 1994; Neumark-Sztainer et al, 1998; Cavadini et al, various methods of dietary recall, dietary records and food
2000). Particular areas of concern have included high levels frequency questionnaires (Crawley & While, 1996; Milligan
of dietary fat (Crawley, 1993) and a low fruit and vegetable et al, 1998; Samuelson et al, 1996; Devaney et al, 1995). These
intake (Hurson & Corish, 1997; Prescott-Clarke & Primatesta, approaches have been shown to have reasonable levels of
validity and reliability (Sjoden et al, 1986; Hann et al, 2001)
and may provide appropriate methods for the examination
*Correspondence: J Wardle, ICRF Health Behaviour Unit, Department of of outcomes related to the effects of dietary intake or to
Epidemiology and Public Health, University College London, Gower studies of the nutritional status of young people. However,
Street, London WC1E 6BT, UK. where the research interest is in food-related behaviours and
E-mail: [email protected]
attitudes, and predicting or influencing levels of involve-
Guarantor: J Wardle.
Contributors: The study was conceived and designed by all the ment in healthy eating practices, then an approach more
contributors. Data were collected by FJ and JG. Interpretation of the linked to patterns of behaviour may be fruitful.
results, statistical analyses and writing of the paper was carried out by Variation in young people’s dietary intake is likely to
FJ and JW. All the contributors commented on and approved the final
reflect foods available and the values and circumstances of
draft.
Received 8 May 2001; revised 24 October 2001; parents, school and peers, as much as the adolescents’ own
accepted 29 October 2001 motivations (Adams, 1997; Feunekes et al, 1998; Lytle et al,
 The adolescent food habits checklist
F Johnson et al
645
1996). Nonetheless, there are many opportunities for young eating behaviours, and so a strong, negative correlation was
people to make personal food choices, which makes it expected between dietary fat intake and AFHC score. Simi-
important to examine the more voluntary aspects of healthy larly, the relationship between AFHC score and daily fruit
eating. Most adolescents are economically active, at least to and vegetable intake was hypothesised to be strongly posi-
the extent of having the resources to buy snacks, and they tive. Items on the checklist are relevant to dietary fibre intake
consume snack foods more frequently than adults (Anderson through questions on fruit and vegetable consumption, and
et al, 1993). Some adolescents will be involved in the pur- so a positive but weaker correlation was also predicted
chase and preparation of food at home, and many will between dietary fibre and AFHC score. A positive correlation
choose their own meals at school. Adolescents can also with family affluence was also predicted, as social class and
refuse food offered to them. Looking at patterns of eating income have both been associated with healthier eating
behaviour in situations in which young people are likely to practices (Margetts et al, 1998; Johansson et al, 1999).
be able to make personal choices may provide a useful Furthermore the major role played by healthy eating in
complement to assessing dietary intake. weight control (Nichter et al, 1995) meant that AFHC was
There have been a number of approaches to the measure- hypothesised to be positively associated with dietary
ment of healthy eating from a behavioural rather than a restraint. Finally, nutrition knowledge has been linked with
simply nutritional perspective. Some studies have focused on a more healthy diet in some studies (Wardle et al, 2000b),
measuring a small number of specific ‘healthy’ or and such an association was predicted here.
‘unhealthy’ practices such as snacking or eating breakfast
(Steptoe & Wardle, 1999; Monneuse et al, 1997; Speed et al,
1998; Wardle et al, 2000a). These measures have not, how- Method
ever, attempted to assess a broad range of food habits, or the Participants
balance between healthy and unhealthy practices in an Participants for this study were 1822 adolescents, aged
individual’s eating patterns, but have tended to be more between 13 and 16 (mean age 14 y 5 months) participating
concerned with the covariance of a small number of food in a larger study of health and weight related behaviour in
habits with other behaviours. Kristal et al (1990) developed a adolescents in the north-west of England, which received
more comprehensive adult measure of fat-related healthy ethical approval from the Joint UCL=UCLH Committee on
habits, which was later expanded to incorporate fibre-related the Ethics of Human Research. Girls’ and mixed-sex schools
items (Shannon et al, 1997). This scale asks questions about in Wirral and West Cheshire were classified for levels of
modification of foods so as to lower their fat content, social deprivation (high, intermediate and low) according
avoidance of high-fat foods, substitution of low-fat alterna- to the number of pupils eligible to receive free school meals.
tive foods, and selection of fruit, vegetables and other high- A stratified sample of seven schools was selected, incorporat-
fibre foods. Although the scale has the advantage of focusing ing at least one girls’ and one mixed school from each of the
on food choices in relation to specific situations, its orienta- three levels. All pupils in school years 9 and 10 at the seven
tion towards North American foodstuffs and inclusion of schools were invited to participate, and the sample was 68%
items relating to the purchase and preparation of food, limits female. Data were collected during class sessions by research-
its value with British adolescents. Another fat avoidance ers who visited the school, and usable data were obtained
scale designed for use with a Mexican-American population from 84% of pupils enrolled in the eligible year groups at the
(Knapp et al, 1988) presents similar obstacles for use with seven participating schools. Missing data were predomi-
British young people. nantly because of absence from class on the day of the
The scale presented here, the Adolescent Food Habits survey (15%). Less than 2% of those eligible refused to
Checklist (AFHC), aims to provide a measure of adolescent participate or were withdrawn by parents.
healthy eating behaviour with reference to those situations
in which young people are likely to have a degree of personal
control. It addresses areas in which adolescents may be able Materials
to affect how closely their diets conform to guidelines on Adolescent Food Habits Checklist
healthy eating, with reference to the avoidance of specific Item selection. Items were selected for the AFHC on the
energy-dense foods, selection of low-fat alternatives, con- basis of findings from a pilot study carried out with 178
sumption of fruit and vegetables and snacking behaviour. In adolescent girls attending an independent girls’ school in the
order to assess the convergent validity of the AFHC, a north-west of England (mean age 15 y 10 months). A pre-
number of hypotheses were generated with regard to the liminary pool of 70 items for the AFHC were generated with
associations between AFHC score and scores on other related reference to existing literature, and dietary health recom-
measures. It was predicted that girls would score more highly mendations and in discussion with health psychologists and
on the AFHC than boys, since young women are known to nutritionists. Participants were asked to reply ‘true’ or ‘false’
involve themselves in healthy eating to a greater degree than or ‘not applicable to me’ with regard to whether they usually
young men (Anderson et al, 1994; Prescott-Clarke & Prima- followed specific dietary practices. These practices included
testa, 1998). Many of the items of the AFHC refer to low-fat the purchase, preparation and consumption of specific

European Journal of Clinical Nutrition

 The adolescent food habits checklist
F Johnson et al
646
foods, as well as snacking habits. Items referred to both potatoes) they ate in a usual day. Responses to these two
healthy and unhealthy behaviours. Participants were also questions were summed to provide a score for daily intake of
asked to add any other things that they regularly did in order fruit and vegetables. This assessed proximity to the minimum
to make their diet more healthy. five portions of fruit and vegetables a day recommended for a
healthy diet (World Health Organization, 1990).
Analysis of pilot data. Responses to the pilot questionnaire
were analysed first using factor analysis with varimax rota-
tion in order to establish whether there was a multidimen- Dietary restraint
sional structure underlying the patterning of food habits. A shortened, five-item version of the restraint subscale of the
Results from this analysis suggested a weak factor structure. A Dutch Eating Behaviour Questionnaire (DEBQ; Van Strien
five-factor solution accounted for just 32% of the variance, et al, 1986) was included. The scale was abbreviated on the
and intercorrelations between factors were high. Internal basis of factor loadings reported by the authors and others
reliability for the item pool as a whole was good (Cronbach’s (Van Strien et al, 1986; Wardle, 1987).
a ¼ 0.91). In light of the weakness of the factors, and other
evidence that healthy eating patterns often do not form
stable, replicable factors (Birkett & Boulet, 1995; Prewitt Nutrition Knowledge
et al, 1997), items for the final scale were selected according Nutrition knowledge was measured using an adapted version
to other criteria. It was decided to limit the scale to items of the Nutrition Knowledge Questionnaire (Parmenter &
pertaining to intake of fruit, vegetables and energy-dense Wardle, 1999). This questionnaire examines knowledge of
foods. Items with a low item-total correlation (r < 0.20) and dietary guidelines, fat content of common foods and diet –
those which made reference to situations likely to be unfa- disease relationships.
miliar to adolescents were omitted from the scale. Four items
referring to general aims to eat a diet that is low in fat, low in
sugar, high in fruit and vegetables and healthy were retained. Household affluence
No items were added in response to comments from the pilot Participants responded to four items, asking about housing
sample as no widely used practices emerged from these tenure, eligibility to receive free school meals, and family
comments. This resulted in a 23-item scale, which had an ownership of one or more cars and a computer. This scale has
internal reliability of Cronbach’s a ¼ 0.83 in the pilot sample. been found to correlate significantly with the Townsend area
The 23 items of the AFHC are shown in Appendix 1. A level indicator of deprivation (Townsend et al, 1988; Wardle
true=false response format was selected to make the checklist et al, in press).
easier to complete. Ten items also had an alternative A number of demographic questions were included in
response, equivalent to ‘not applicable’. Participants received order to characterise the participants in the study. These
one point for each ‘healthy’ response. The final score was included sex, age, ethnicity and whether individuals had
adjusted for ‘not applicable’ and missing responses using the been trying to gain or lose weight in the past 12 months.
formula: AFHC score ¼ no of ‘healthy’ responses(23=no. of
items completed).
Results
Test – retest reliability. The test – retest reliability of the 23- Characteristics of the sample are indicated in Table 1. Over
item AFHC was examined using a sample of 24 adolescents 90% of participants were white, and around one-third came
aged between 13 and 14 y (mean age 13 y 8 months). Parti- from low-income families as indicated by their eligibility to
cipants completed the AFHC twice, with a delay of 2 weeks receive free school meals. Girls were, on average one month
between the two completions. The correlation between score older than boys in the sample (F(1, 1787) ¼ 7.7, P < 0.01). The
at T1 and score at T2 was very high (r ¼ 0.90 P < 0.001). most striking difference between boys and girls in the sample
was in the numbers attempting to change their body size in
the past 6 months (w2(d.f. ¼ 2) ¼ 173.3, P < 0.001). Girls were
Dietary fat and fibre intake more than twice as likely as boys to be trying to reduce their
Levels of dietary fat and fibre intake were measured using a body size (55 vs 22%), whilst almost four times as many boys
version of the Dietary Instrument for Nutrition Education as girls were trying to increase their body size (8 vs 2%).
(DINE; Roe et al, 1994). This food frequency questionnaire Internal reliability of the AFHC in the main study was
was slightly modified for self-report use with adolescents. high (Cronbach’s a ¼ 0.82), and similar to that found in the
pilot sample. Data were analysed separately for boys and girls
(Table 2). Significant sex differences emerged for all the
Daily intake of fruit and vegetables variables except family affluence (F(1, 1796) ¼ 3.0, NS).
Participants were asked how many portions of fruit (fresh, Girls reported more healthy habits than boys (F(1,
frozen or tinned) they ate in a usual day, and how many 1821) ¼ 92.3, P < 0.001). They also had lower levels of dietary
portions of vegetables (fresh, frozen or tinned, not including fat (F(1, 1812) ¼ 164.6, P < 0.001) and fibre (F(1,

European Journal of Clinical Nutrition

 The adolescent food habits checklist
F Johnson et al
647
1811) ¼ 49.0, P < 0.001), and consumed more fruit and vege- knowledge about dietary health and nutrition engaged in
tables (F(1, 1818) ¼ 10.1, P < 0.01). Higher levels of dietary more healthy practices. AFHC score was also associated with
restraint (F(1, 1812) ¼ 218.8, P < 0.001) and nutrition knowl- affluence, such that adolescents from more affluent families
edge (F(1, 1590) ¼ 9.5, P < 0.01) were also associated with reported more healthy eating behaviours.
being female.
To examine convergent validity, correlations between Table 3 Correlations between AFHC and validation measures
AFHC and the other variables were calculated (Table 3). As Girls Boys Total
predicted, among both boys and girls a strong negative (n ¼ 1246) (n ¼ 576) (n ¼ 1822)
correlation was observed between AFHC score and levels of
Fruit and vegetable intake 0.44 0.45 0.45
dietary fat. Similarly, daily fruit and vegetable intake and DINE — dietary fat 7 0.41 7 0.46 7 0.46
AFHC score was strongly associated for both sexes. The DINE — dietary fibre 0.18 0.24 0.16
correlation with dietary fibre was less strong but still highly DEBQ — dietary restraint 0.39 0.43 0.43
significant and in the predicted direction for girls and boys. Nutrition knowledge questionnaire 0.14 0.18 0.17
Family affluence 0.16 0.13 0.14
Dietary restraint was positively associated with healthy
habits, and those participants who had a higher level of All correlations significant at P < 0.001.

Table 1 Sample characteristics

Girls Boys
(n ¼ 1246) (n ¼ 576) Significance of gender differences

Age (s.d.) 14 y 5 months (6.9 months) 14 y 4 months (7.7 months) F(1, 1787) ¼ 7.7, P < 0.01
Ethnicity
White 1149 (92.1%) 517 (89.8%) w2[1] ¼ 0.03, NS
Non-white 85 (6.8%) 59 (6.4%)
Missing 14 (1.1%) 22 (3.8%)
Deprivation
2
Eligible for free school meals 393 (32.0%) 184 (33.1%) w [1] ¼ 0.21, NS
School type
Single sex 636 (51.0%) — N=A
Mixed sex 612 (49.0%) 576 (100%)
Trying to change body weight
2
Lose weight 688 (55.2%) 129 (22.4%) w [2] ¼ 173.3, P < 0.001
Gain weight 27 (2.2%) 48 (8.3%)
Stay the same=do nothing 512 (41.1%) 364 (63.2%)
Missing 19 (1.5%) 33 (5.7%)

Table 2 Scores for each measure divided by gender

Girls Boys Total

(n ¼ 1246) (n ¼ 576) (n ¼ 1822) Significance of gender differences

Adolescent Food Habits Checklist

Mean 11.7 9.4 11.0 F(1, 1821) ¼ 92.3, P < 0.001
(s.d.) (4.7) (5.0) (4.9)
Fruit and vegetable intake (servings per day)
Mean 3.9 3.5 3.8 F(1, 1818) ¼ 10.1, P < 0.01
(s.d.) (2.2) (2.3) (2.3)
DINE — dietary fat score
Mean 27.1 34.2 29.4 F(1, 1812) ¼ 164.6, P < 0.001
(s.d.) (9.7) (12.9) (11.3)
DINE — dietary fibre score
Mean 26.4 29.6 27.4 F(1, 1811) ¼ 49.0, P < 0.001
(s.d.) (8.8) (9.8) (9.3)
DEBQ — dietary restraint
Mean 12.0 8.4 10.9 F(1, 1812) ¼ 218.8, P < 0.001
(s.d.) (5.2) (3.9) (5.1)
Nutrition knowledge questionnaire
Mean 12.0 11.5 11.8 F(1, 1590) ¼ 9.5, P < 0.01
(s.d.) (2.7) (3.0) (2.8)
Family affluence
Mean 3.5 3.6 3.5 F(1, 1796) ¼ 3.0, NS
(s.d.) (1.4) (1.4) (1.4)

European Journal of Clinical Nutrition

 The adolescent food habits checklist
F Johnson et al
648
Several analyses were carried out in order to further inves- beliefs about the importance of diet between males and
tigate the source of gender differences in AFHC scores. To females (Wardle et al, 1997).
examine whether the inclusion of single-sex girls’ schools, The observed association between family affluence and
but not boys’ schools, may be a factor in the observed gender healthy habits is consistent with the findings of others that
differences, the effect of single sex education on girls’ AFHC social status and income predict healthier food attitudes and
scores was examined. No significant effect of school type a better diet (Margetts et al, 1998; Johansson et al, 1999).
emerged (t(1244) ¼ 1.34, NS). In order to examine the possi- Amongst adolescents this relationship may be mediated in
bility that dietary restraint and nutrition knowledge might part by snacking behaviour, since a disadvantaged home life
mediate gender differences, a stepwise multiple regression has been linked to less regular meal patterns and a higher
was carried out examining the relationship between gender consumption of sweet and fatty snacks in US adolescents
and AFHC score whilst controlling for these two variables. (Siega-Riz et al, 1998).
Entering gender alone shows that it accounts for 4.8% of the The AFHC should provide a useful tool for the examination
variance in AFHC score. If dietary restraint and nutrition of healthy eating behaviours in adolescents. In particular, the
knowledge are entered first they account for 20.4% of the orientation of the AFHC towards situations in which adoles-
variance (F(2, 1586) ¼ 204.6, P < 0.001). Entering gender at cents are likely to have a degree of personal choice in their
step two shows a significant but very small effect (additional eating behaviour gives it an advantage over standard food-
variance ¼ 0.6% F(1, 1585) ¼ 12.9, P < 0.00). This indicates frequency-type questionnaires, which may be much influ-
that dietary restraint and nutrition knowledge account for a enced by social circumstances and the decision-making of
large proportion of the sex differences in AFHC scores, but others. The AFHC measures active investment on the part of
gender still makes a small independent contribution. the adolescent in their diet, and so may be of value in
examining the underlying cognitions, attitudes and circum-
Discussion stances that lead to involvement in healthy eating.
The development of a measure of healthy eating habits
designed specifically for use with adolescents is likely to be References
a useful complement to existing methods of dietary assess- Adams L (1997): An overview of adolescent eating behaviour barriers
ment. In contrast to other published measures of healthy to implementing dietary guidelines. Ann. N.Y. Acad. Sci. 817, 36 –
48.
eating behaviours the AFHC refers to food choice situations Anderson AS, MacIntyre S & West P (1993): Adolescent meal pat-
in which adolescents are likely to have a degree of personal terns: grazing habits in the west of Scotland. Health Bull. (Edinb.)
control. Furthermore, the AFHC focuses specifically on areas 51, 158 – 165.
of the adolescent diet which present cause for concern, Anderson AS, MacIntyre S & West P (1994): Dietary patterns among
adolescents in the west of Scotland. Br. J. Nutr. 71, 111 – 122.
particularly the consumption of energy dense foods and Birkett NJ & Boulet J (1995): Validation of a food habits question-
fruit and vegetable intake. Items were selected from a large naire: poor performance in male manual labourers. J. Am. Diet.
pool generated by dietitians and health psychologists, and Assoc. 95, 558 – 563.
adolescents in the pilot group had the opportunity to con- Cavadini C, Siega-Riz AM & Popkin BM (2000): US adolescent food
intake trends from 1965 – 1996. Arch. Dis. Child. 83, 18 – 24.
tribute, which ensured items were relevant both to recom- Crawley HF (1993): The energy, nutrient and food intakes of teen-
mendations for a healthy diet and to the decision-making agers aged 16 – 17 y in Britain. (1) Energy, macronutrients and
opportunities available to adolescents. The resulting instru- non-starch polysaccarides. Br. J. Nutr. 70, 15 – 26.
ment has a high level of internal and test – retest reliability. Crawley HF & While D (1996): Parental smoking and the nutrient
intake and food choice of British teenagers aged 16 – 17 y. J.
All a priori predictions regarding associations of the check- Epidemiol. Community Health 50, 306 – 312.
list with other measures were supported at a high level of Devaney BL, Gordon AR & Burghardt JA (1995): Dietary intakes of
significance, indicating good convergent validity. High cor- students. Am. J. Clin. Nutr. 61, 205s – 212s.
relations between the AFHC and dietary fat and fruit and Feunekes GI, de Graaf C, Meyboom S & van Staveren WA (1998):
Food choice and fat intake of adolescents and adults: associations
vegetable intake suggest that AFHC is successful in measur- of intakes within social networks. Prev. Med. 27, 645 – 656.
ing an adequately representative sample of adolescent’s Hann CS, Rock CL, King I & Drewnowski A (2001): Validation of the
healthy eating activities, with regard to behaviours linked Healthy Eating Index with use of plasma biomarkers in a clinical
sample of women. Am. J. Clin. Nutr. 74, 479 – 486.
to fat and fruit and vegetable consumption.
Hurson M & Corish C (1997): Evaluation of lifestyle, food consump-
In common with the findings of other studies, greater tion and nutrient intake patterns among Irish teenagers. Ir. J. Med.
involvement in healthy dietary habits was associated with Sci. 166, 225 – 230.
being female. The link between dietary restraint and healthy Johansson L, Thelle DS, Solvoll K, Bjorneboe GE & Drevon CA
(1999): Healthy dietary habits in relation to social determinants
eating appears to account for a high proportion of these
and lifestyle factors. Br. J. Nutr. 81, 211 – 220.
gender differences, with the better nutrition knowledge of Knapp JA, Hazuda HP, Haffner SM, Young EA & Stern MP (1988): A
girls playing a further small role. Nonetheless, a weak rela- saturated fat=cholesterol avoidance scale: sex and ethnic differ-
tionship between gender and healthy habits remains even ences in a biethnic population. J. Am. Diet. Assoc. 88, 172 – 177.
Kristal AR, Shattuck AL & Henry HJ (1990): Patterns of dietary
after controlling for both of these factors. One possibility is
behavior associated with selecting diets low in fat: reliability and
that girls’ greater involvement in healthy eating is due in validity of a behavioural approach to dietary assessment. J. Am.
part to differences both in the value placed on health and Diet. Assoc. 90, 214 – 220.

European Journal of Clinical Nutrition

 The adolescent food habits checklist
F Johnson et al
649
Lytle LA, Stone EJ, Nichaman MZ, Perry CL, Montgomery DH, Siega-Riz AM, Carson T & Popkin B (1998): Three squares or mostly
Nicklas TA et al (1996): Changes in nutrient intakes of elementary snacks — what do teens really eat? A sociodemographic study of
school children following a school-based intervention: results of meal patterns. J. Adolesc. Health 22, 29 – 36.
the CATCH study. Prev. Med. 25, 465 – 477. Sjoden P, Fellenius J & Lappalainen R (1986): Assessment methods for
Margetts BM, Thompson RL, Speller V & McVey D (1998): Factors eating behavior, food intake and food preferences. Scand. J. Behav.
which influence ‘healthy’ eating patterns: results from the 1993 Ther. 15, 163 – 177.
Health Education Authority health and lifestyle survey in Eng- Speed E, West P & Sweeting H (1998): The west of Scotland 11 – 16
land. Public Health Nutr. 1, 193 – 198. study. Basic frequencies of the 13 y old (S2) sweep. MRC Medical
Milligan RA, Burke V, Beilin LJ, Dunbar DL, Spencer MJ, Balde E & Sociology Unit Working Paper no. 66.
Gracey MP (1998): Influence of gender and socioeconomic status Steptoe A & Wardle J (1999): Motivational factors as mediators of
on dietary patterns and nutrient intakes in 18 y old Australians. socioeconomic variation in dietary intake patterns. Psychol Health
Aust. N.Z. J. Public Health 22, 485 – 493. 14, 391 – 402.
Monneuse MO, Bellisle F & Koppert G (1997): Eating habits, food and Townsend P, Phillimore P & Beattie A (1988): Health and deprivation:
health related attitudes and beliefs reported by French students. inequality and the north. London: Croom Helm.
Eur. J. Clin. Nutr. 51, 46 – 53. Van Strien T, Frijters JE, Bergers GP & Defares PB (1986): The Dutch
Neumark-Sztainer D, Story M, Resnick MD & Blum RW (1998): Eating Behaviour Questionnaire (DEBQ) for assessment of
Lessons learned about adolescent nutrition from the Minnesota restrained, emotional and external eating behaviour. Int. J. Eat.
Adolescent Health Survey. J. Am. Diet. Assoc. 98, 1449 – 1456. Disord 5, 295 – 315.
Nichter M, Ritenbaugh C, Nichter M, Vuckovic N & Aickin M (1995): Wardle J (1987): Eating style: a validation of the Dutch Eating
Dieting and watching behaviours among adolescent females: Behaviour Questionnaire in normal subjects and women with
report of a multimethod study. J. Adolesc. Health 17, 153 – 162. eating disorders. J. Psychosom. Res. 31, 161 – 169.
Parmenter K & Wardle J (1999): Development of a Nutrition Knowl- Wardle J, Steptoe A, Bellisle F, Davou B, Reschke K, Lappalainen R &
edge Questionnaire. Eur. J. Clin. Nutr. 53, 298 – 308. Fredrikson M (1997): Healthy Dietary practices among European
Prescott-Clarke P & Primatesta P (1998): Health Survey for England: students. Health Psychol. 16, 443 – 450.
The Health of Young People 1995 – 1997. London: The Stationery Wardle J, Griffith J, Johnson F & Rapoport L (2000a): Intentional
Office. weight control and food choice habits in a national representative
Prewitt TE, Durazo-Arvisu R, McGee DL, Luke A & Cooper RS (1997): sample of adults in the UK. Int. J. Obes. Relat. Metab. Disord. 24,
One size fits all: implications for assessing dietary behaviour. J. Am. 534 – 540.
Diet. Assoc. 97, s70 – s72. Wardle J, Parmenter K & Waller J (2000b): Nutrition knowledge and
Roe L, Strong C, Whiteside C, Neil A & Mant D (1994): Dietary food intake. Appetite 34, 269 – 275.
assessment in primary care: validity of the DINE method for Wardle J, Johnson F & Robb K: J. Epidemiol. Community Health
dietary assessment. Fam. Pract. 11, 375 – 381. (in press).
Samuelson G, Bratteby LE, Enghardt H & Hedgren M (1996): Food World Health Organization (1990): Diet, nutrition and the prevention of
habits and energy and nutrient intake in Swedish adolescents chronic diseases. WHO Technical Report Series no. 797. Geneva:
approaching the year 2000. Acta Paediatr. 415(Suppl), 1 – 19. WHO.
Shannon J, Kristal AR, Curry SJ & Beresford SA (1997): Application of
a behavioral approach to measuring dietary change: the fat and
fibre related diet questionnaire. Cancer Epidemiol. Biomarkers Prev.
6, 355 – 361.

Appendix: The Adolescent Food Habits Checklist 13. I try to ensure I eat plenty of fruit and vegetables.
True=False
14. I often eat sweet snacks between meals. True=False
1. If I am having lunch away from home, I often choose a
15. I usually eat at least one serving of vegetables (exclud-
low-fat option. True=False=I never have lunch away from
ing potatoes) or salad with my evening meal. True=False
home
16. When I am buying a soft drink, I usually choose a diet
2. I usually avoid eating fried foods. True=False
drink. True=False=I never buy soft drinks
3. I usually eat a dessert or pudding if there is one avail-
17. When I put butter or margarine on bread, I usually
able. True=False
spread it thinly. True=False=I never have butter or margar-
4. I make sure I eat at least one serving of fruit a day. ine on bread
True=False 18. If I have a packed lunch, I usually include some choco-
5. I try to keep my overall fat intake down. True=False late and=or biscuits. True=False=I never have a packed
6. If I am buying crisps, I often choose a low-fat brand. lunch
True=False=I never buy crisps 19. When I have a snack between meals, I often choose
7. I avoid eating lots of sausages and burgers. True=False=I fruit. True=False=I never eat snacks between meals
never eat sausages or burgers 20. If I am having a dessert or pudding in a restaurant, I
8. I often buy pastries or cakes. True=False usually choose the healthiest one. True=False=I never
9. I try to keep my overall sugar intake down. True=False have desserts in restaurants
10. I make sure I eat at least one serving of vegetables or 21. I often have cream on desserts. True=False=I don’t eat
salad a day. True=False desserts
11. If I am having a dessert at home, I try to have some- 22. I eat at least three servings of fruit most days. True=False
thing low in fat. True=False=I don’t eat desserts 23. I generally try to have a healthy diet. True=False
12. I rarely eat takeaway meals. True=False

European Journal of Clinical Nutrition

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