Relationship between Student Diet and Academic Performance

Relationship between Student Diet and Academic Performance 1.0  Ã‚   Introduction For many young adults joining university, it is a time of substantial change in social, economic and environmental surroundings.1 Currently, there is increasing advocacy for an emphasis on healthy lifestyle behaviours for student populations.2 Researchers have established that academic attainment plays a key role in an individual’s future health, wealth and social outcomes.3, 4 Providing this, academic achievement must be considered by public health decision makers aiming to improve health across the lifespan.5 A balanced and nutritious diet means it is adapted to special individual needs to reach optimal health, that is it supplies optimal levels of nutrients to maintain healthy function.6 Diet quality is a composite measure of scoring food patterns, with a focus on whole food intake.7 The objective is to maintain a high diet quality, through consuming the correct amounts of the food groups from relevant dietary guidelines. Assessment of dietary patterns can allow unfavourable intakes to be identified.8 Poor diet quality introduces nutritional inadequacies and is a significant predictor of poorer health status.9 While the connections between health and education are widely accepted, the mechanisms that contribute to this relationship remain poorly understood. Scholars propose that health behaviours contribute towards cognitive function and maintaining a productive work day.10, 11 The main goal for university students is academic attainment, yet despite this, a high proportion of students report engaging in poor health behaviours during the study period.12 Australian university students are consuming less than the recommended intake of fruit and vegetables, and have a high intake of convenience foods.12, 13 To ensure students are provided best opportunity for success, it is important to understand the determinants of academic performance. It is suggested that the type and variety of foods an individual consumes has an important influence on academic outcomes.14 Diet quality has an association with academic performance, though the isolated effects are yet to be fully explored.15 The scores gen erated may be able to determine areas that can be improved to increase academic performance. There are several variables which affect diet quality and this review will focus on four major themes which emerge repeatedly throughout the literature. These themes are: overall diet quality, eating patterns and behaviours, fruit and vegetable intake and convenience food intake. In order to understand how diet quality is linked to academic performance, the literature was searched for relevant articles released in the last ten years. An analysis of terms identified the key words of: â€Å"student†, â€Å"university student†, â€Å"diet quality†, â€Å"health behaviour†, â€Å"eating pattern†, â€Å"academic performance† and â€Å"academic achievement†. These were used across the electronic data bases of Cochrane library, Web of science, Pubmed, CINAHL and Scopus. Although preference was given to recent articles involving university students, the final search was expanded to incorporate sources of all years, as well as children and adolescent population groups. The aim of this review is to critique current literature between diet quality and university student academic performance. Furthermore, it will assess current measures of diet quality, and the significance of other factors that contribute towards overall diet quality. 2.0  Ã‚   Diet quality Diet is a key behavioral risk factor that can be modified to have an impact on health.16 Free living people consume whole foods, which contain both nutrient and non-nutrient substances.17 Dietary patterns have synergistic effects, which provide insights beyond the role of nutrients and single foods.18 For researchers, it can be difficult to quantify the diet, and any established values should only be used as an approximation. Diet quality is a composite measure of diet in its entirety, and involves the relationships between food groups.7, 8 This qualitative perspective is an alternative approach to provide more detailed dietary information. It can give an indication to the types of food people consume, and therefore where the nutrients are derived from. Diet quality encompasses the central areas of dietary variety, balance, adequacy, and moderation.19 These have been found to contribute to a nutritious diet and can give a greater understanding of dietary habits. Variety and balance involve the consumption of a range of options from the food groups, according to proportionality. Adequacy is attaining the recommended energy intakes to meet nutrient requirements, whilst moderation is regulating the intake of certain foods to prevent harmful effects on health (including convenience foods that are high in sugar and fat).20 It is widely recognised that a high quality diet should be safe, able to promote optimal development and reduce the risk of nutritional inadequacies.6, 21 Diet quality describes how well an individual’s diet conforms to dietary recommendations, and this differs according to country. Australia employs the ‘Eat for Health’ guidelines,6 which were developed through extensive research to provide information on the types and amounts of foods needed to promote health and wellbeing as well as reduce the risk of diet-related conditions. The food groups in the ‘Eat for health’ guidelines consist of: Vegetables and legumesFruitLean meats and poultry, fish, eggs, tofu, nuts and seeds, legumes/beansGrain (cereal) foods, mostly wholegrain and/or high cereal fibre varietiesLow fat milk, yoghurt, cheese and/or alternatives, mostly reduced fat. 2.1 Measuring diet quality The main tools used to measure diet quality are surveys and questionnaires.19 These are useful for time management, easily sorting data, are relatively simple to design and can be used on a large sample. The questions developed should be well thought out, and it is also necessary to define serving sizes and how often foods are consumed (such as once weekly). The chosen tool needs to consider recall bias, and the respondent’s level of literacy skills. A number of dietary indices have been developed, tested and validated to reflect various aspects of diet quality.7, 17 They are based on existing knowledge of optimal dietary patterns and provide a clear nutritional benchmark. The indices vary in design from simple tools measuring adherence to dietary recommendations, to intricate analyses of macronutrient and micronutrient intakes. The main diet quality indices have scored food patterns in terms of alignment with key dietary recommendations and diversity of healthy choices within core food groups.7 Food-based indices of diet quality are important, as they retain the complexity of foods and permit assessments of single, as well as grouped nutrient components. The dietary indices which are best translated to the Australian guidelines are the Diet Quality Index International (DGI-I), Healthy Eating Index (HEI) and the Dietary Guideline Index (DGI). These are all validated tools and are useful in various population groups.17 The indices have separate nutritional components which are combined into a single ‘overall diet quality’ score. This incorporates cut-off values or ranges for the food groups and selected dietary variables (considered to be representative of healthy eating). The DQI-I was derived from the original Diet Quality Index, and provides an effective means of cross-national comparative work for global understanding of diet quality.22 The DQI-I provides a ‘priori’ analysis (predetermined what is ‘healthy’ and ‘unhealthy’), as it incorporates both nutrient and food perspectives of the diet. The index is validated in both China and the United States, and so reflects a cross-section of cultural attributes.22 It is an in-depth measure which investigates multiple variables and gives a broad picture of diet quality. The DQI uses ranges to find more associations which broadens the information gathered and strengthens the validity of the results.23 The four aspects of a healthy diet comprise the four main categories of the DQI-I. Firstly, there are two variety components, which include the servings across food groups and the diversity within them. The adequacy components use eight food types, and indicates areas in the diet which may need to be improved, and moderation highlights areas that should be decreased (total fat, saturated fat, cholesterol, sodium, food types with empty calories). The balance component involves calculating the macronutrient ratio and fatty acid ratio. The scores for all four categories are summed, resulting in the total DQI-I score, ranging from 0 to 100 (the higher the score, the higher the diet quality).22 The HEI has been used in several studies that evaluate food consumption. It was originally based on the Dietary Guidelines for Americans, but has been adapted to other areas.24 It is similar to the DQI, with the addition of total fruit and whole fruit, plant proteins and seafood, and the moderation component includes refined grains.   Food group servings are evaluated on a per-thousand-calorie basis. The scores are calculated proportionally between 0 and 10, according to how well a food group recommendation is achieved.25 The main strength of the HEI is that it assesses diets on a given energy intake level, to characterise diet quality while controlling for diet quantity. The DGI was developed and predefined to the Australian Dietary Guidelines with an adherence to specific aspects of a healthful diet.26 However, it does not account for all aspects of diet quality, and could be beneficial if combined with other measures. The DGI consists of fifteen food components using standard adult portion sizes and the score calculation is based on regular consumption of food frequency questionnaire items. Each component contributed 0 to 10 points, where 10 indicated an optimal diet intake (meeting the recommended serves per week). The total DGI score is the sum of the thirteen items, indicating a maximum possible score of 130.27 Selecting a dietary index remains a complex matter with a large degree of subjectivity. It is important to consider whether the index is adaptable to the chosen dietary guidelines and that it fits within the constraints of the study. The specific context in which they are used should be noted when interpreting results and making comparisons. The main limitation of dietary indices is that there is no universal dietary guidelines representative of a healthful diet.7 The tools used need to consistently be revised if they are to truly reflect the latest nutrition science and policy. 3.0  Ã‚   University Students University academic performance is measured through grade point average, which incorporates the scores from all subjects during a study period.10 Identifying the factors that contribute towards academic performance has clear implications for university students. Diet quality is a health behaviour that may improve a student’s chances of furthering their academic career.15 The rate of enrolment for Australian universities is continuing to grow, with a large percentage being young adults (18 – 34 years old).28 A high proportion of students have an increase in independency, an altered support system and are perceived to be time poor.29 University can be a highly stressful environment, where health behaviours change (health may not be a high priority).1, 30 Amongst this group, there is an increased level of socio-economic disadvantage associated with the prevailing issues of food insecurity.28 This may be related to limited resources to source and prepare healthy foods, wher e individual diets decline in quality due to food insecurity.31 Food choice for university students can be influenced by their environment and can include the primary factors of: affordability, accessibility, peer influence and nutrition knowledge.32 Very few young Australians are following the dietary guidelines of consuming from the five food groups and are generally below recommended levels for fruit and vegetable serves.13 Approximately one-tenth are meeting the daily recommended serves of vegetables, and one-third are meeting recommended daily fruit serves.12 These health determinants mean that the diets of university students are quite poor and may be at risk of nutritional inadequacies. This is an issue, as it has been shown that being undernourished negatively effects academic outcomes.31 As the quality of food and drinks consumed have a significant impact on the health and wellbeing of individuals, better nutrition has a potential to improve public health outcomes. Performance management is always a concern for university administration bodies as they aim to provide the best environment for student growth and wellbeing. The food environment of a university campus should encourage students to adopt a 30healthful eating pattern.15 An institution is an effective setting for intervention, as it has the structure to bring together multiple strategies to a large group of people. A higher level of education can positively affect future health and employment opportunities.3 The development of healthy behaviors that can be continued during a student’s professional life should be strongly supported during tertiary education. 4.0  Ã‚   Diet quality and academic performance There is increasing evidence that nutrition behaviours have an influence on academic performance, which in turn influences future successes.33, 34 The aim of this review is to evaluate the association between dietary quality and academic performance in university students. However, there is a limited amount of literature related to the population group of university students, which is why much of the following research relates to children and adolescents (school-aged students). Current research has established a relationship between overall diet quality and student academic achievement.14, 35-39 Nutrition and health status have a complex and multifaceted effect on cognitive function.40 It has been identified that moderate associations exist between several aspects of diet quality and student performance.14, 34, 36, 38, 39, 41-43 There are a number of factors which have a direct effect on diet quality, and therefore have been included in this review. They include a person’s habitual eating patterns, fruit and vegetable intake, and convenience food (as well as take-away food) intake. The reviewed studies compared a variety of health behaviours to determine which are most significant to student outcomes. The majority reported statistically significant outcomes between diet and academic performance, which is likely a result of the relatively large numbers of participants. The results concerning dietary components strengthened the concept that diet quality has an influence on academic performance. All included research was adjusted for the modifiable and non-modifiable factors which affect student academic performance. The studies acknowledge that the health behaviours relating to academic work are multifactorial, and involve several influencing variables.    It should be noted there were some common limitations amongst the reviewed studies. The majority of the studies were cross-sectional in design, and were not able to determine an independent association between diet quality and academic achievement. This impedes any inferences that can be made about causality. It was important that authors controlled for significant confounding factors, including attendance, economic status, social support and family background. The nature of these studies left open the possibility that other intervening variables may have been related to the observed pattern of results. 4.1 Overall diet quality Overall diet quality was found to be associated with student academic performance. Across all studies, dietary habits that were in accordance with guidelines were related to better student outcomes.14, 33, 35, 37, 39, 44-46 Furthermore, an improvement in overall diet quality score increased likelihood of an improved academic performance. Students with a high intake of ‘high quality’ nutrient-dense foods, and a low intake of ‘low quality’ nutrient poor foods, had increased odds of a favorable school performance.44 The strongest outcome would be achieved through the combined effects of meeting multiple dietary recommendations. When controlling for the key health behaviors of physical activity and weight status, diet quality was a leading contributor to academic performance.45, 47, 48 Emerging evidence indicates that diet quality may have the strongest correlation to high academic achievement, though this warrants further research. The study by Florence et al.14 on school aged Canadian children found an independent association between diet quality attributes and academic achievement. Furthermore, dietary adequacy and variety were identified as specific components of diet quality which influence academic performance. These outcomes reflect the value of consuming a diverse range of foods from the core food groups. The studies with the best depth in information conducted a full assessment of diet quality, and used a validated tool. It is difficult to make sound comparisons when studies do not use similar diet quality parameters and scoring systems. Different cultures have a diverse range of cuisines which means they differ in how diet quality scores were measured. There were also vast variations in the reporting time period for the outcome measures for frequency of food consumption and academic achievement. Poor nutritional intakes do not meet macronutrient and micronutrient requirements, and this can impede on a person’s health status. Diet quality has been shown to be important for health and wellbeing, and may be beneficial to concentration and productivity levels.37 The consistency of this association across various indicators of diet quality gives emphasis to the importance of nutrition. An improvement in diet quality may be linked to enhanced learning and outcomes beneficial to students and institutions. 4.2 Eating patterns and behaviours Specific eating patterns have an influence on academic performance, as they contribute to the overall balance of a diet. It was found that adhering to a ‘healthy’ Mediterranean style diet pattern (high in fruit, vegetables, whole grains, legumes, fish and olive oil), as well as regularly consuming three meals per day, were positively associated with academic outcomes.37, 49-52 There is evidence that suggests habitual breakfast intake, compared to a period of fasting, is moderately related with an improved school performance.50, 53-59 Through a regular eating pattern, a person is more likely to consume the recommended serves from the core food groups, which contributes to an enhanced nutritional status. Eating behaviours influence the quality of a person’s diet, and generally account for whether a person is consciously controlling what they eat. In the studies regarding university students, eating patterns described uncontrolled eating (food consumption is attached to emotions) or cognitive restriction (highly controlling food intake). Overall, the results indicate that lower levels of uncontrolled or emotional eating is associated with a higher grade point average.34 Students reporting to be strict dieters, with a high amount of restrictive practices, were found to have a lower grade point average.15 On the other hand, the use of more ‘flexible’ cognitive restriction, which still involves self-regulation of food intake, but has allowances for all types of foods, may have the best indication to improving academic achievement.34 Additionally, frequency of alcohol consumption is found to be negatively associated with self-reported attendance, motivation and academic performance.15 If students were found to be in the alcohol dependent criteria, they had an excess risk of failing during the study period.60 High alcohol intakes are correlated with other adverse health behaviours, such as sleep deprivation and an increase in discretionary food consumption.11 4.3 Fruit and vegetable intake A higher fruit and vegetable intake is another aspect of diet quality which has a positive relationship with academic performance. When the self-reported daily intake of fruit and vegetables increased, there was a relatable increase in student grade point averages.10, 33, 36, 37, 39, 41, 52, 61-64 The main message is that an adequate fruit and vegetable intake is beneficial to health, and a vital component to good diet quality. Although, results in this area are inconsistent, with a small number of studies reporting no association between consumption of fruit and vegetables and academic performance.65-67 This may be attributed to their study design, as these may have lacked sufficient power to detect certain effects. It was difficult to detect differences between students when a large proportion did not meet the initial recommendations for fruit and vegetable consumption. 4.4 Convenience foods An increased consumption of convenience or ‘take-away’ foods and beverages has a strong link to poorer academic performance. There were consistent results amongst all studies which measured these associations, as well as across all age groups. 33, 37, 39, 41, 47, 52, 65, 68-73   Convenience foods are highly refined, and generally rich in salt, simple sugars or saturated fats, and included: sugar sweetened beverages, confectionary items and fried foods37.Serve sizes and options for convenience and take-away foods differed between studies, and thus interpretations may be difficult to generalise. Students who frequently consumed convenience snacks were less likely to pass standardised tests, in comparison with those who consumed healthier options.69 Poor dietary habits are shown to be a significant predictor of health and weight status, which contribute towards school performance.52 Even a moderate reduction in convenience food intake may lessen the negative influence it has on academic performance.   Current recommendations advise that discretionary foods should only be included in a diet once the other food group recommendations are met, to ensure that a high proportion of a person’s energy intake is comprised of nutritious sources.6 They should only be considered in the diet in moderation, with the consumption of foods from the core food groups being the priority.   5.0  Ã‚   Conclusion The findings from this review indicate that there is a positive association between diet quality and student academic performance. Furthermore, some evidence suggests that this is a dose-response relationship, as the higher the diet quality score, the higher the effect on academic outcomes. Diet quality and variety involve food groups and how a dietary pattern aligns with national recommendations. Several variables which impact on diet quality were investigated and shown to also be associated with academic performance. A number of gaps in the literature have been identified throughout this review. Research in this area is still developing, and there are limitations of the published research investigating the relationship between diet and academic outcomes. It is yet to be determined what specific aspects of diet quality have the greatest effect on student performance. Further investigation is needed to establish if the components of overall diet quality, variety, adequacy, balance and moderation have an independent relationship with academic performance. Longitudinal research is necessary to compare these associations over time. Public health investigations should consider whether interventions aiming at promoting healthy dietary behaviours could have a positive impact on academic performance. To date, there have been no studies regarding diet quality and academic performance at Australian universities. It is unknown how dietary intake influences a university student population group, as their stage in life and lifestyle differs from other student populations. Implications from this research support the broader implementation of effective university nutrition programs that aim to improve student’s diet quality, academic performance, and, in the long term, their health. They highlight the importance of promoting good dietary patterns, especially increasing fruit and vegetable consumption, whilst decreasing convenience food intake. 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The combined impact of diet, physical activity, sleep and screen time on academic achievement: A prospective study of elementary school students in Nova Scotia, Canada. Int J Behav Nutr Phys Act. 2017; 14. 36  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Abudayya A, Shi Z, Abed Y, Holmboe-Ottesen G. Diet, nutritional status and school performance among adolescents in Gaza Strip. East Mediterr Health J. 2011; 17: 218-25. 37  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Kim SY, Sim S, Park B, Kong IG, Kim JH, Choi HG. Dietary habits are associated with school performance in adolescents. Medicine. 2016; 95. 38  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   So ES, Park BM. Health Behaviors and Academic Performance Among Korean Adolescents. Asian Nurs Res. 2016; 10: 123-27. 39  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Sigfà ºsdà ³ttir ID, Kristjà ¡nsson AL, Allegrante JP. Health behaviour and academic achievement in Icelandic school children. Health Educ Res. 2007; 22: 70-80. 40  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Ells LJ, Hillier FC, Shucksmith J, et al. A systematic review of the effect of dietary exposure that could be achieved through normal dietary intake on learning and performance of school-aged children of relevance to UK schools. Br J Nutr. 2008; 100: 927-36. 41  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Kristjà ¡nsson AL, Sigfà ºsdà ³ttir ID, Allegrante JP. Health behavior and academic achievement among adolescents: The relative contribution of dietary habits, physical activity, body mass index, and self-esteem. Health Educ Behav. 2010; 37: 51-64. 42  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   McIsaac JL, Kirk SF, Kuhle S. The Association between Health Behaviours and Academic Performance in Canadian Elementary School Students: A Cross-Sectional Study. Int J Environ Res Public Health. 2015; 12: 14857-71. 43  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Taras H. Nutrition and student performance at school. J Sch Health. 2005; 75: 199-213. 44  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Fu ML, Cheng L, Tu SH, Pan WH. Association between Unhealthful Eating Patterns and Unfavorable Overall School Performance in Children. J Am Diet Assoc. 2007; 107: 1935-43. 45  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   McIsaac JLD, Kirk SFL, Kuhle S. The association between health behaviours and academic performance in Canadian elementary school students: A cross-sectional study. Int J Environ Res Public Health. 2015; 12: 14857-71. 46  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Correa-Burrows P, Burrows R, Blanco E, Reyes M, Gahagan S. Nutritional quality of diet and academic performance in Chilean students. Bull World Health Organ. 2016; 94: 185-92. 47  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Snelling A, Belson SI, Beard J, Young K. Associations between grades and physical activity and food choices: Results from YRBS from a large urban school district. Health Educ. 2015; 115: 141-51. 48  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Edwards JU, Mauch L, Winkelman MR. Relationship of Nutrition and Physical Activity Behaviors and Fitness Measures to Academic Performance for Sixth Graders in a Midwest City School District. J Sch Health. 2011; 81: 65-73. 49  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Esteban-Cornejo I, Izquierdo-Gomez R, Gomez-Martinez S, et al. Adherence to the Mediterranean diet and academic performance in youth: the UP&DOWN study. Eur J Nutr. 2016; 55: 1133-40. 50  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Acham H, Kikafunda JK, Malde MK, Oldewage-Theron WH, Egal AA. Breakfast, midday meals and academic achievement in rural primary schools in Uganda: Implications for education and school health policy. Food Nutri Res. 2012; 56. 51  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Kim HYP, Frongillo EA, Han SS, et al. Academic performance of Korean children is associated with dietary behaviours and physical status. Asia Pac J Clin Nutr. 2003; 12: 186-92. 52  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Stea TH, Torstveit MK. Association of lifestyle habits and academic achievement in Norwegian adolescents: A cross-sectional study. BMC Public Health. 2014; 14. 53  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Adolphus K, Lawton CL, Dye L. The effects of breakfast on behavior and academic performance in children and adolescents. Front Hum Neurosci. 2013; 7: 425. 54  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Boschloo A, Ouwehand C, Dekker S, et al. The Relation Between Breakfast Skipping and School Performance in Adolescents. Mind Brain EDucation. 2012; 6: 81-88. 55  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Fernà ¡ndez Morales I, Aguilar Vilas MV, Mateos Vega CJ, Martà ­nez Para MC. Relation between the breakfast quality and the academic performance in adolescents of Guadalajara (Castilla-La Mancha). Nutr Hosp. 2008; 23: 383-87. 56  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Gajre NS, Fernandez S, Balakrishna N, Vazir S. Breakfast eating habit and its influence on attention-concentration, immediate memory and school achievement. Indian Pediatr. 2008; 45: 824-28. 57  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Lien L. Is breakfast consumption related to mental distress and academic performance in adolescents? Public Health Nutr. 2007; 10: 422-28. 58  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Rampersaud GC, Pereira MA, Girard BL, Adams J, Metzl JD. Breakfast habits, nutritional status, body weight, and academic performance in children and adolescents. J Am Diet Assoc. 2005; 105: 743-60; quiz 61-2. 59  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   So WY. Association between frequency of breakfast consumption and academic performance in healthy Korean adolescents. Iran J Public Health. 2013; 42: 25-32. 60  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Aertgeerts B, Buntinx F. The relation between alcohol abuse or dependence and academic performance in first-year college students. J Adolesc Health. 2002; 31: 223-25. 61  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Alhazmi A, Stojanovski E, McEvoy M, Brown W, Garg ML. Diet quality score is a predictor of type 2 diabetes risk in women: The Australian Longitudinal Study on Womens Health. Br J Nutr. 2014; 112: 945-51. 62  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Harrington J, Fitzgerald AP, Layte R, Lutomski J, Molcho M, Perry IJ. Sociodemographic, health and lifestyle predictors of poor diets. Public Health Nutr. 2011; 14: 2166-75. 63  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   MacLellan D, Taylor J, Wood K. Food intake and academic performance among adolescents. Can J Diet Pract Res. 2008; 69: 141-44. 64  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Nyaradi A, Foster JK, Hickling S, et al. Prospective associations between dietary patterns and cognitive performance during adolescence. J Child Psychol Psychiatry Allied Discip. 2014; 55: 1017-24. 65  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Ickovics JR, Carroll-Scott A, Peters SM, Schwartz M, Gilstad-Hayden K, McCaslin C. Health and academic achievement: Cumulative effects of health assets on standardized test scores among urban youth in the United States. J Sch Health. 2014; 84: 40-48. 66  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Martà ­nez-Gà ³mez D, Veiga OL, Gà ³mez-Martà ­nez S, et al. Gender-specific influence of health behaviors on academic performance in Spanish adolescents; The afinos study. Nutr Hosp. 2012; 27: 724-30. 67  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Nigg CR, Amato K. The Influence of Health Behaviors During Childhood on Adolescent Health Behaviors, Health Indicators, and Academic Outcomes Among Participants from Hawaii. Int J Behav Med. 2015; 22: 452-60. 68  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Deliens T, Clarys P, De Bourdeaudhuij I, Deforche B. Determinants of eating behaviour in university students: A qualitative study using focus group discussions. BMC Public Health. 2014; 14. 69  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Correa-Burrows P, Burrows R, Orellana Y, Ivanovic D. The relationship between unhealthy snacking at school and academic outcomes: a population study in Chilean schoolchildren. Public Health Nutr. 2015; 18: 2022-30. 70  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Li J, Oconnell AA. Obesity, high-calorie food intake, and academic achievement trends among U.S. school children. J Educ Res. 2012; 105: 391-403. 71  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Nyaradi A, Li J, Hickling S, et al. A western dietary pattern is associated with poor academic performance in Australian adolescents. Nutrients. 2015; 7: 2961-82. 72  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Park S, Sherry B, Foti K, Blanck HM. Self-reported academic grades and other correlates of sugar-sweetened soda intake among US adolescents. J Acad Nutri Diet. 2012; 112: 125-31. 73  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Tobin KJ. Fast-food consumption and educational test scores in the USA. Child Care Health Dev. 2013; 39: 118-24.

Exploring Autism in the Movie, Rain Man Essay -- Rain Man Movie Film A

Exploring Autism in the Movie, Rain Man Autism is considered a unique disorder that affects 1 in 500 people. Autism impairs three main areas of human development: speech, communication, and social interaction. The trademark feature of autism is impaired social interaction. All impairments can range from mild to severe. Individuals with autism may lack speech altogether or only learn basic language specific to their needs. In the area of social interaction, the individual is often withdrawn from others. They lack the ability to comprehend facial expressions and the actions of others are confusing. Many individuals with autism lack interest in social interaction. There is a lack of imagination and a preference to engage in routines. Individuals usually find security in the routines, and become very dependent on them. What causes autism? No one is sure what causes autism research seems to suggest that it is caused by both genetic and environmental factors. There are no medical tests for diagnosing autism. A diagnosis is based on an observation of the individual's communication, behavior, and developmental levels. There is also no cure for autism. Evidence does show that early intervention has a positive outcome for young children with autism. Many adaptations can be made to a classroom to ensure the least restrictive environment for and autistic child. A few of those adaptations would be: daily routines encouraged social interactions, and alone time. If you are interested in autism, the movie Rain Man is very informative. Rain Man will provide you with an insight into the life of a man with autism. Rain Man portrays the life o... ... leaving caused problems in the relationship between Charlie and his father. Charlie's father carried around this guilt for not being able to care for his son and Charlie was never able to understand him because of this secret. There were quite a few adaptations made for Raymond. Raymond refused to take an airplane so Charlie had to drive across country. There were also certain parts of Raymond's daily routine that he could not manage without. To accommodate Raymond, Charlie bought him a portable T.V. and stopped each night so that Raymond could be in bed by eleven. There were other adaptations made, Raymond's bed had to be placed in front of a window and he would not travel when it was raining. Making the adaptations for Raymond is what helped Charlie to better understand and come to love his brother and his autism.

Buad 310 Case Analysis Instruction

BUAD 310 Spring 2013 Case Due by 4PM on Friday, May 3rd (in BRI 400C) In this case you will apply statistical techniques learned in the Regression part of BUAD 310. Please read the following instructions carefully before you start: †¢ This assignment uses data from the file MagAds13S. XLS, which you can download from Blackboard. After you download the file go to Data > Load data > from file in StatCrunch to open it (you don’t need to change any of the options when loading this data. ) †¢ The entire report should be typed and clearly presented without typos and grammatical errors.Copy and paste the relevant (explained further in more detail) regression output into your document. Do not attach any graphs. †¢ You are encouraged to work in groups (maximum size is 5). Any group submits only one report, in which the first page should have all the names and USC ID of the group members. A hard copy of the report needs to be submitted (an electronic copy is NOT acceptabl e). Before May 3rd, you can also hand in the report during class. When I am not in my office (BRI 400C), please drop the report in the office through the gap between the door and floor. Very important: present the problems in exactly the same order as they are listed. †¢ A note to Mac user: you might need to hold â€Å"shift† when selecting variables for the X-variables with multiple linear regression in StatCrunch. Magazine Advertising What factors influence the price of advertisements in magazines? Suppose you are part of a team of consultants hired by a retail clothing company wishing to place advertisements in at least one magazine. They are curious about what types of costs they can expect for magazines with different readership bases so they most effectively utilize their advertising budget.Your team has collected cost data on 44 consumer magazines. In addition, your team has measured some other characteristics of the magazines and their audiences that may be usefu l in understanding the advertisement costs better. The variables are as follows, pagecost: Cost of a four-color, one-page ad (in dollars) circ: Circulation (projected, in thousands) percmale: Percent male among the predicted readership medianincome: Median household income of readership (in dollars) Some natural logarithms of the variables are also provided for your convenience.Your goal is to analyze the data with StatCrunch using Multiple Linear Regression methods and choose the best model to explain the differences in advertising costs between the different titles, and then to predict what the retail clothing company should expect to pay for advertising in the different magazines. Answer the following questions (with reasonable detail, not just â€Å"yes† or â€Å"no†, use one or two sentences per question). 1. Visually examine the scatter plots of the response variable, pagecost, versus each of the explanatory variables (circ, percmale, medianincome).In StatCrunch you can go to [Graphics( Scatter Plot] to do each plot. Describe the form and the direction of each relationship. Do not attach any graphs. 2. Perform a Regression analysis to predict pagecost using all three explanatory variables [Stat ( Regression ( Multiple Linear, then fill in the proper Response and Predictor variables, then click Next twice and under Save options select Residuals, Predicted values and 95% interval for either the mean or an individual (you will have to decide which one you need for part d! ). For he CI (or PI) to be produced you need to enter the values from part d in the row underneath the data table, in appropriate columns. Note that the value for circ has to be entered in the same units as all the values in the circ column. To produce a residual plot do a Scatter plot as in question 1, selecting Residuals as the Y variable and Predicted values as the X variable]. Include the regression output, but not the plot. a. Use the R-squared and the F-test to comment on the usefulness of the regression model you fitted (use the significance level of 5% for the test). b.Evaluate the regression assumptions by assessing the residual plot. c. Examine each of the explanatory variables individually to determine which are contributing significantly to the model. (Use the significance level of 5 %. Do NOT actually eliminate any variables from the regression at this stage. ) d. Using the same model with all the variables, provide an appropriate 95%-level interval to the retail clothing company for the amount that they would pay for a full-page ad in a magazine with a projected audience of 2,000,000 readers, 55 percent of which are male, with a median income of $30,000.Explain in one sentence and in simple terms what this interval means. 3. Rerun the regression in part 2 with circ replaced by LN_circ (the natural logarithm of the variable circ), keeping all the other variables the same. Include the relevant regression output (only the coefficient and ANOV A tables). [Stat ( Regression ( Multiple Linear, then fill in the proper Response and Predictor variables, then click Next twice and under Save options select Residuals and Predicted values. Produce a residual plot the same way as in question 2]. a.How does this model compare to the previous model using R-squared? Explain what this difference in the R-squared values means in simple terms. b. Evaluate the regression assumptions by assessing the residual plot. c. Examine each of the independent variables individually to determine which are contributing significantly to the newest model. (Use the significance level of 5 %. Do NOT actually eliminate any variables from the regression at this stage. ) 4. Rerun the regression in part 3 with LN_pagecost (the natural logarithm of pagecost) as the response (i. . the explanatory variables are LN_circ, percmale and medianincome). Include the regression output. [Stat ( Regression ( Multiple Linear, then fill in the proper Response and Predictor variables, then click Next twice and under Save options select Residuals, Predicted values and 95% interval for either the mean or an individual (you will have to decide which one you need for part d! ). For the CI (or PI) to be produced you need to enter the values from part d in the row underneath the data table, in appropriate columns.Note that the value for LN_circ has to be entered in the same units as all the values in the LN_circ column. Also note that the interval will be produced for the LN_pagecost variable. To produce a residual plot do a Scatter plot as in question 1, selecting Residuals as the Y variable and Predicted values as the X variable]. a. Evaluate the regression assumptions by assessing the residual plot. b. Examine each of the explanatory variables individually to determine which are contributing significantly to the new model. Use a significance level of 5%. . Remove the variables you find insignificant and re-run the model. Include the regression output for the new model. d. Using the new model, provide an appropriate 95% -level interval to the retail clothing company for the amount they would pay for a full-page ad in a magazine with the values given in 2. d (projected audience of 2,000,000 readers, 55 percent of which are male, with a median income of $30,000) using the newest model. Explain in one sentence and in simple terms what this interval means. EXECUTIVE SUMMARY: (roughly about ? to 1 page)You are given the task of summarizing your findings for the board of directors of the retail clothing company. Since they are not very well-versed in regression techniques, you will need to explain things in easy-to-understand, simple and practical terms. Make sure to answer the following questions within the summary: 1. Describe each of the models you considered in parts 2-4 and how these models estimate the relationship between the cost of one-page ad and each of the explanatory variables (for each of the models you will need about one se ntence per explanatory variable). . Specify which model you would recommend to best forecast the cost of one-page advertisements. Explain why this model should work well and why you picked this particular model from the ones you tried (go over the positives you see for this model and the negatives for the other models). †¢ Reminder: include only the relevant regression output in your final document. Do not attach or include any graphs.

How Spelling Diverges Between American and British English

How Spelling Diverges Between American and British English How Spelling Diverges Between American and British English How Spelling Diverges Between American and British English By Mark Nichol As George Bernard Shaw is said to have said, â€Å"England and America are two countries separated by the same language.† It’s easy enough to find books and Web sites that provide evidence to back the old boy up, detailing such transoceanic translations as elevator/lift and critical divergences such as the relative meanings of â€Å"knocked up† (British English: â€Å"called on,† â€Å"woke up,† or â€Å"worn out†: American English: â€Å"impregnated†). What you’ll find here, however, is a discussion of differences not in vocabulary but in spelling between the English language’s two primary variants. The blame for the ornery orthography of American English (which is even more annoying to its users than to those who speak other variants of the language, because we actually have to, you know, use it) is primary laid at the oft-pedestal-mounted feet of Noah Webster, a nineteenth-century writer, editor, and lexicographer who almost single-handedly created the dialect I will hereafter in this post abbreviate as AE (as opposed to BE, or British English). Webster’s impetus was nationalistic he desired a distinct language for Americans that they could feel they owned, and one that represented democratic ideals as well. The problem is, for all his meticulousness, he was maddeningly inconsistent, and the myriad successors who have added to the American word-hoard have followed suit. Here, to do my part to make amends, is a brief guide to the major distinctions in AE and BE spelling (and within AE spelling itself), with one or more examples: -ae (encyclopaedia, mediaeval) AE usually deletes the a from the diphthong ae, which is unfortunate, because the words look so cool with it. It is retained, however, in such words as aesthetic (though that word is also spelled esthetic). -ed (fitted, forecasted, knitted) AE usually drops the past-tense ending in these words. However, exceptions are made in such usages as â€Å"The tailor fitted him for a tuxedo.† -ed [irregular] (lighted, strived) AE prefers forms such as lit and strove, though the BE forms are often employed. -ement (acknowledgement, arguement, judgement) AE omits the first e from the suffix, though some writers of AE remain unaware as far as the first and third examples are concerned. -ence (defence, licence, offence) AE spells these words with an s in place of a c. -ise/-yse (analyse, criticise, memorise, realise) AE favors -ize/-yze endings. -l (enrol, fulfil, skilful) AE doubles the l that is not part of -ful/ful-; the l in that syllable is never doubled (except in inflected forms of full). -lled/-lling (cancelled/cancelling, levelled/levelling, travelled/travelling) AE omits one l in this form; some writers of AE still haven’t received the memo. -mme (diagramme, programme, telegramme) AE omits the second m and the e at the end of these words. -ogue (analogue, catalogue, dialogue, epilogue) In AE, catalog is clipped, though the full form is preferred for all its analogues. (See?) -our (colour, favour, honour, labour) In AE, the u is jettisoned in most words with -our; glamour is an exception. -oeuvre (manoeuvre) AE simplifies this ending to -euver (maneuver). -que (banque, checque) In AE, the French-influenced -que is replaced by a Germanic k. -re (centre, litre, metre, theatre) In AE, the letters in the -re ending are reversed, though the BE spelling for the first and last examples is sometimes employed in proper names for facilities to convey Old World class. -st (amidst, amongst) In AE, amid and among are preferred, though many writers of AE, professionals and amateurs alike, retain the -st ending. -t (dreamt, leapt, learnt) AE replaces -t with -ed, though some writers of AE, out of ignorance or because they prefer the more poetically pleasing appearances, use the BE form. -wards (backwards, inwards, upwards) AE omits the -s, though many writers of AE retain it (often inconsistently from one word to another). -xion (complexion, connexion) This suffix is unique to complexion, spelled identically in AE and BE, and connexion, now almost obsolete in the United Kingdom. Want to improve your English in five minutes a day? Get a subscription and start receiving our writing tips and exercises daily! Keep learning! Browse the Spelling category, check our popular posts, or choose a related post below:100 Whimsical WordsRound vs. Around5 Keys to Better Sentence Flow

Geography Ivory Coast Essay Example

Geography Ivory Coast Essay Example Geography Ivory Coast Essay Geography Ivory Coast Essay The Ivory Coast (Cote dIvoire) has a long and intense history of facing hardships. Though the citizens gained independence from the French in 1960 after being colonized for roughly 67 years, they still face a countless number of economic, social and political issues. The people of the Ivory Coast must come together with the government in order to resolve the issues and better their countrys future. Like in most developing countries, a prominent political issue that the Ivory Coast faces is corruption in the government. The leaders of the Ivory Coast are every thing but eaders. They are incompetent, not trustworthy, and genuinely do not care to govern the country in the interest of the common good of the citizens. (http:// mw. . africaw. com/) In 2011 the World Bank conducted a study with the intention of ranking the most corrupt countries in order, it was found that in Africa the Ivory Coast was ranked number 38 out of 49 African countries. In 2010, transparency International ranked it 130th out of 176 countries in 2011 in its Corruption Perceptions Index. The government has a tendency to misuse grants that are given to hem in order to better their country which contributes to the corruption that their country faces today. The Ivorians have experienced a great deal of suffering due to corruption including destroyed regions and deaths in their families. (economist. com) The media in the Ivory Coast is beginning to create advertisements in order to make everyone aware of corruption and how it is negatively affecting the citizens of Cote dIvoire. : In addition to this an American government agency committee entitled Millennium Challenge Corporation (MCC) that aids poor countries recover from overty, this committee will attempt to aid the Ivory Coast once they meet certain benchmark requirements, with one dominant requirement being to invest in the people and decrease corruption. ( economist. com/) Cote dIvoire is blessed with an abundant amount of natural resources which helps stimulate their economy, but with such a low literacy rate in their country, it is nearly impossible for everyone to prosper and benefit from these resources. The education of a nation drastically affects their progress economically, because ignorance leads to bad ecisions. By having a literacy rate of 48. 7% in males and about 38. 6% in females (africaw. com), the Ivory Coast will remain in a state of an unstable economy unless their education improves. Their low literacy rate means that they do not have a sufficient amount of people who are able to aid in creating ways to make use of their natural resources that would improve their economy with stability. Low education also hurts the Ivorians economically because most women do not use contraceptives during intercourse, which leads to many pregnancies occurring in women that are ot prepared to have children. With unprepared births comes poverty because women that are uneducated are more likely to be poor and have the responsibility of not only taking care of themselves, but their children as well. According to africaw. com The Ivory Coast is one of the poorest countries in the world with about 50% of the country living below the poverty line. Their literacy rates are worse than that of most African countries, which is why their rate of teenage pregnancy and HIW AIDS is significantly high (because they are ignorant to the negative consequences of ases in the Ivory Coast has led to many deaths among their citizens. This disease spreads to citizens in various ways: mother-to-child, unprotected sexual intercourse, and quickly occurs in key populations of individuals including men who have sex with men (MSM), sex workers and people who inject drugs. (aidsalliance. org) The Ivorians dying in large amounts from HIVI AIDS serves as a major issue because it creates an imbalance in the population pyramid. It is bottom heavy meaning there is a significant amount of young people compared to the amount of old people. This ffects the country negatively because having too many young children and not enough adults has a negative correlation with progress in the work force. coopami. rg/en/countries/countries_partners/cote_ivoire/ country _description/index. htm The rapid spread of AIDS in the Ivory Coast haphazardly occurred because there were initially two AID cases reported by the World Health Organization (WHO) in 1985 ( ncbi. nlm. nih. gov) and reached its highest point in November of 1996 when the WHO reported 31,963 case which put Cote dIvoire in the top ten as the seventh country with the highest number of eported cases of this horrific disease. (unesco. rg) Studies have shown that the adult population of citizens between ages 20 to 29 years old are the most affected by HIVI AIDS, and although it is difficult now to forecast the dynamics of the epidemic in C? ¶te dIvoire because of the multitude and complexity of factors to be taken into account (Garenne, 1996), the increase in HIV prevalence among pregnant women in Abidjan over the years is particularly worrying. These numbers are appalling in the way that they relate to the citizens in the Ivory Coast, because when affected mothers ave children, the chil dren will then be born with HIV and continue the spread of this deleterious disease. The spread of HIVI AIDS essentially serves as a gender issue primarily because the disease is more prominent in women than men. According to unaids. org the chances of women being HIV positive is eight times greater than men. This wide gender gap is prevalent in sub-Saharan Africa because of gender-based violence. Women are not economically independent from older men, therefore they must rely on them for survival which unfortunately increases their chances of getting HIV/AIDS because of their participation of sexual intercourse with these men. Older men tend to have had multiple sex partners and as a result they tend to spread HIW AIDS to women. Women are also at greater risk to having this disease because they have a greater biological susceptibility, meaning that the greater exposed surface area in the female genital tract compared to the male genital tract, higher concentrations of HIV in seminal fluids than in vaginal fluids, the larger amount of semen than vaginal fluids exchanged during intercourse, and greater potential for njury to the cell wall during intercourse for women compared to men (Moss et al. 991; Pettifor et al. 2004). (Hertog) The physical aspects and fluids of a womans vagina causes her to have a greater chance of receiving the disease through intercourse than a man would therefore women are more likely to suffer from this disease. With education, the spread of HIV/AIDS would decrease dramatically. However in the Ivory Coast most students specifically females dropout at a young age because of pregnanc y. Because the majority of citizens lack an education, in the

Critique Essay Example | Topics and Well Written Essays - 250 words - 3

Critique - Essay Example However, just like any other business, the JC Penny Department Store is one that has also gone through its demoralizing moments (Zmuda, 1). The store has been indicted not to have good deals for its clients, an aspect that makes most of the clients move to other stores for a cheaper price. Pricing strategies are indeed vital for the success of any store of JC Penny’s kind. As a departmental store, the store has endeavored to impose low prices on its goods and services, which at times would reduce the store to retail store. I would in this case argue that JC Penny Company is one that needs a lot of rebranding if it has to claim a prestigious place in America. A transformation in the company’s operation especially in reinstating the client’s confidence would be of great benefit to the management. Zmuda, Natalie. ‘JC Penney Reinvents Department-Store Retailing. Unveils Sweeping Shifts to Pricing, Promotion, Presentation, Product.’ Advertising Age. January 25, 2012. Web. Available at:

Smoking Ban Case Study Example | Topics and Well Written Essays - 500 words

Smoking Ban - Case Study Example If these laws are in acted, the majority of the society or the 80% of the adults who do not smoke will benefit as their exposure to cigarette smoke and its harmful effects will be reduced. 2. A state should have the moral as well as the legal right to decide about the areas where smokers can smoke. This is because the state has a duty of care towards its citizens. According to the ethical theory of care an individual should make decisions while taking into consideration the people they are supposed to care about (Iep.utm.edu, 2014). The state and its representative have taken oath to make rules and regulations in order to protect its citizens and thus they have a duty of care to protect the citizens. Based on these principles, the state should implement such laws in order to protect its citizens from the harmful effects of cigarette smoking. 3. One alternative to a total smoking ban as discussed in the case is the allocation of a separate area to the smokers so they can smoke without disturbing or risking the health of others. Organizations such as restaurants and bars can develop a separate area for those smokers who want to smoke and for those who do not smoke. Secondly, a total ban on smoking in enclosed areas and allowance of smoking in open areas can even be a useful option. 4. There are various steps that the law has dictated that can be taken by an organization to demotivate employees from smoking within the premises of the organization. These steps include the exhibition of signs on the entrance of the organization that state that on premises smoking is not allowed. Secondly, signs should even be placed on the door of the areas where smoking is permitted. These guidelines have been clearly stipulated in the laws of the California Indoor Clean Air Act that was enacted during the period of 1976 (Smoking.uslegal.com, 2014). 5. Cigarette smoking should not be banned completely or cigarette smoking should not be considered as an illegal act.