Essay on Perceptions of Mental Illness in Girl Interrupted

The portrayal of people being sickly creatures has been used in Hollywood film for a very long time. This has been in the endeavor of putting the viewing public in the shoes of the patient and entertain them with over the top portrayals of disease. For patients that are women in particular this has been achieved by defining them along the lines of vague terms such as them being over emotional and unstable. Despite the advancement experienced by the society, women have not yet fully seen the goal of equality realize fruition. With the expansion of the psychiatric and psychological terminologies, there now additional ways via which mental illness can be ascribed as a weakness for men and women portrayed in Hollywood film. This is best†¦show more content†¦Simply, it leaves a bad impression of sorts. The film is based on a rich memoir by Susanna Kaysen. It depicts the suffering of a fictional character referred to as Susanna. The film does not primarily give focus on true hospi tal course during the recovery process of the fictional character. Much of the focus is on the characters recovering without the aid of the hospital or staff. It is depicted as a road of self discovery and not very realistic for the conditions ascribed the characters. Recovery of an individual suffering from a mental ailment takes time and proper guidance coupled with proper coordination of counseling, medications and familial support. As such, the film provides a decent exploration of mental illness but not realistic. Though in my opinion it does portray the little resources available to women during the day in age depicted the effectiveness of the society’s mental health care system. There are some key, unique approaches to mental illness that have been inculcated into the theme of the film. One of these, and most probably the most potent, is the issue of questioning the true existence of mental illness. On repeated occasions, Susanna questions the true validity of her diag nosis. Even at the end of the film, she still questions the effectiveness of her treatmentShow MoreRelatedThe Lines Between Sanity And Insanity1064 Words   |  5 Pagescommonly tested in young adult literature. Shown to be entirely based on individual perception, sanity or insanity attempt to form a reflection of the characters’ personalities. In society, as shown in the novels, people are often too quick to write off nonconformist as crazy or insane. Girl, Interrupted and One Flew Over the Cuckoo’s Nest both illustrate how society’s stern view cause them to treat mental illness unethically and take away from individualism. Minds may be altered through prescribedRead MoreBasic Theories and Techniques of Abnormal Psychology1743 Words   |  7 Pagesaffects the behavior of a person, as opposed to the difference between normal and abnormal behavior. 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For instance, Daisy was sexually abused by her father and has serious eating issues, also known as a compulsive eating disorder. Daisy binges on rotisserie chicken from her father’s shop, in the privacy of here room. She feels uncomfortable eating in front of others. Lisa, who seems to be the leader of theRead MoreReflection Paper: Girl, Interrupted1091 Words   |  5 PagesReflection Paper: â€Å"Girl, Interrupted† 1. Based on the movie and real life, do you think we need other people to help us understand and solve our problems? Why or why not? Absolutely. Without the presence of other people, there would be no social point of reference as to what would be considered â€Å"normal†. In order for an abnormality to exist, be it physical or psychological, there must be a widely accepted concept of â€Å"normalcy†. If a certain individual is said to be suffering a problem (in thisRead MoreReflection Paper: Girl, Interrupted1076 Words   |  5 PagesPaper: â€Å"Girl, Interrupted† 1. Based on the movie and real life, do you think we need other people to help us understand and solve our problems? Why or why not? Absolutely. Without the presence of other people, there would be no social point of reference as to what would be considered â€Å"normal†. In order for an abnormality to exist, be it physical or psychological, there must be a widely accepted concept of â€Å"normalcy†. If a certain individual is said to be suffering a problem (in this case, mental or

Strike Action and Workers free essay sample

Based on what unfolds throughout the novel, it appears that Zola views Etienne’s solution as the best way to end the problems brought forth by the Industrial Revolution. The industrial revolution was the transformation of production from manufacture by hand for small markets to machine manufacture for large markets. This was a period of time in which many people started to move from rural areas to cities that were built around factories and mines, like in Germinal. Although the industrial revolution had lots of positives, it also brought about lots of problems. Perhaps the biggest problem was the low wages, and the gap between the rich and poor. As seen in Germinal, everyone who could in a family worked, and this still hardly produced enough money to put food on the table. It would be very common just to have a slice of bread with some butter on it as a meal. This was a period of time in which many people started to move from rural areas to cities that were built around factories and mines, like in Germinal. Although the industrial revolution had lots of positives, it also brought about lots of problems. Perhaps the biggest problem was the low wages, and the gap between the rich and poor. As seen in Germinal, everyone who could in a family worked, and this still hardly produced enough money to put food on the table. It would be very common just to have a slice of bread with some butter on it as a meal. As all these workers were struggling to survive, managers and especially the owners who started the company were very wealthy. However, it was not that the owners were not sympathetic towards the poor; it was more they were naive as to how bad their wages and living conditions actually were. Another one of the major problems with the industrial revolution was the conditions in which the people worked. In Germinal, the workers would have long shifts in the mines, and the work was very difficult and often very dangerous as well. The people in the mines would never know when a rock fall would be coming, or when there would be an explosion due to firedamp. Even worse, was the fact that women and children also were also forced to work in these conditions in order to give the family as much money as possible. Political figure, Karl Marx, was an important figure during this time period in the novel. Therefore, some of the characters in Germinal reflect some of his ideas, while others are opposed to them. Marx thinks that in order for the class struggle between the proletariat (miners) and bourgeoisie (owners) to end, revolution needs to be brought forth by the proletariat. After this revolution, there would be a classless society, with equal distribution of wealth and ownership. Of the main characters in the book, I think that Pluchart and Etienne most closely imitate Marx’s ideas in Germinal. Pluchart is a leader of the International, which is trying to get the support of workers everywhere to bring about revolution. Etienne is deeply influenced by Pluchart and reflects many of these same ideas, which are similar to Marx. However, when he brings about the strike it is not very organized and it does not have enough support to succeed. Rasseneur also has views like Marx. However, Rasseneur’s ideas are much less radical. He wants better working conditions, but is not for a revolution or strike. Souvarine has views that are much different from the others. He wants violence and everything to burn down with the hope that something better will arise. Etienne comes to Montsou looking for a job after he was fired from his last job. He was a mechanic, but was fired after hitting his boss when he was drunk. This was not unexpected because Etienne often becomes violent when he is drinking. Etienne quickly is hired, and works in the mine at Le Voreux. His close friend is Pluchart who shares with him the ideas of a revolution by the workers. Etienne understands this plan relatively well but continually tries to gain more knowledge by reading books and further educating himself. Etienne thinks this revolution could improve the conditions and wages in the mines, and encourages the workers to go on strike. The miners are tired of the unfair conditions, and it does not take too much time to convince them to go on strike. They rally around Etienne, seeing him as their leader. Ultimately the strike fails and the people are forced to go back to work to avoid starvation. The miners put total blame on Etienne for the failure of the strike, and for the deaths of those who died during it. Although the strike failed, Etienne is optimistic about the future. He thinks that with more preparedness, organization, and support the revolution will succeed. Rasseneur used to be a mechanic at Le Voreux, but was fired after he led a protest. He has a little bit of education and is currently an innkeeper. He thinks that the workers should negotiate for better wages, but does not agree with Plucharts’s ideas and thinks they should do it peacefully without striking. He demonstrates this view throughout the novel. â€Å"But Why? It’s not in the Company’s interest to have a strike, nor in the workers’. It would be better to come to some agreement (Zola, 177). He has seen strikes before, and they have never worked. He urges the workers to not go on strike, but they are tired of the worsening conditions and will not listen. After the strike fails, he defends Etienne telling the workers they did not have to strike and that they should have listened to him. Following the strike, Rasseneur continues his view that peaceful negotiations are the best solution to bringing about changes in the conditions and wages of the workers. Pluchart is a friend of Etienne, who is one of the leaders of the International. He is well educated, and it is his job to share the views of the international to all countries around the world. His goal is to unite all the workers in the world, and bring about a revolution. He spreads these views by traveling around the world and giving speeches urging the workers to unite and strike, promising financial aid from the International. â€Å"He delivered his set speech on how marvelous the International was and the benefits it could provide, for this was how he usually chose to present it at venues where he was speaking for the first time. He explained how its aim was the emancipation of the workers, and he described its grandiose structure, with the commune at the bottom, then the province, above that the nation, and lastly, at the very summit, humanity in general (Zola 250). † After he gave the speech to the miners in Montsou, he pushed them to the brink of striking, which would eventually happen. His speech encouraged the workers of the positive outcome that could come about from striking and joining the International. However, once the strike began the workers began to lose faith in the International when they receive little financial aid, and began to starve. Following the strikes failure, Pluchart continues to make speeches and urge revolution, and convinces Etienne to join him. Souvarine is a Russian mechanic who works during the strike. He was not very well liked at first because there is a general distrust of foreigners. However, he is friendly enough to the people of Montsou that they grow to like him. Souvarine escaped from Russia after a failed effort of assassinating the Tsar. This failed assassination attempt resulted in his lover getting killed. Since then, he has had the attitude that violence is the answer to everything. He does not think that gradual change will work, and has no hope of conditions improving. In his mind, all of society should be burnt down with the hope that something better will arise. â€Å"And as for his idea of gradual evolution, don’t make me laugh! No. Put every town and city to the torch, mow people down, raze everything to the ground, and when there’s absolutely nothing left of this rotten, stinking world, then maybe, just maybe, a better one will grow up in its place (Zola, 144). † Souvarine is for the strike, but encourages the workers to act violently. Etienne is against this approach, and as leader of the strike he does not promote this. However, as the strikers begin to get frustrated they begin acts of violence, though not directly a result from Souvarine. The workers destroys others mines, kill the shop owner Maigrat, and throw bricks at the soldiers guarding Le Voreux. When the workers go back to work, Souvarine takes matters into his own hands. He sabotages Le Voreux, causing the mine to collapse. This results in the destruction of the mine and the death of many workers. Souvarine then leave Montsou with the same views; the old society needs to be destroyed before a new one can be built in its place. The title of the book, Germinal, is the name of one of the months on the Republican calendar. Germinal was the seventh month, lasting in today’s calendar from the middle of March to the middle of April. This also happens to be the same period in which Germinal starts and ends (March of one year to April of the next). Germinal literally means germination and renewal (Pearson, xiii-xiv). These meanings are shown at the end of the novel when the characters remaining are starting a new life, renewed with new meaning. The approach that Zola seemed to favor was that of Etienne. The whole strike is brought upon by Etienne, and is what Germinal is centered around. Although the strike ends up failing, Etienne is renewed (germinal) with confidence at the end of the novel as he is on his way to join Pluchart. There is no doubt in his mind that the next time that they strike, they will be better prepared, more united, and will accomplish their goals. Zola emphasizes this in his conclusion. New men were starting into life, a black army of vengeance slowly germinating in the furrows, growing for the harvests of the century to come; and soon this germination would tear the earth apart (Zola, 532)† When Zola leaves this as the conclusion of his novel, he is pointing out that the approach in which Etienne is facing the problems of the industrial revolution is the right one, and is the solution that will eventually put an end to their problems.

The Three Objects That Represent Something Important About Me free essay sample

The Three Objects That Represent Something Important About Me Everyone must be having at least one important object in his or her life. It could be a jewelry, photograph or clothing. However, the three objects that represent something important to me are my laptop, my phone and my glasses. I really can’t live without them. They give me a hand in everything doing my school homework or connecting with my friends. My current computer is my first and only laptop I got from my parents. It was bought online October 2009, before I entered college in Malaysia. It is a red rectangular Dell studio with a 15. 6 inch widescreen and it weighs around 7 pounds. I really enjoy the big screen when I am watching a drama or movie on my laptop. Also, I use my laptop to video call my family in Malaysia. I can also read news online, listen to music and play games to relax myself when I am stressed out from my school assignments. We will write a custom essay sample on The Three Objects That Represent Something Important About Me or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page My laptop is my best companion and I can’t imagine what I would do if I lose it. Another important thing to me is my phone which is an Apple iPhone 4s. I bought myself a new phone when I came to U. S. to study. I bought myself a new phone because I lost old phone when I was in transit in Los Angeles about six months ago. I was waiting for my next flight from LA to Omaha, going through the security check, when I found out that I had lost my phone. With no contact to call, I was lost, alone and helpless in a foreign country. This experience makes me aware that my phone important tool for me to contact my friends whenever I need a hand. Now, I will always check my pocket for my phone before I go anywhere. My glasses are also important to me. I have a very serious short sightedness so I couldn’t see clearly without them. The one I am wearing now has thick rectangular frames. They are black metallic with blue strips on it. I started to wear glasses since high school. I hate them but I am blind without them. I like to play sports but unfortunately, with glasses, I can’t play well and freely. The solution is to wear contact lenses when I am playing sports but still they bug me a lot. I have come to regret of wearing glasses all the time. I plan to go for a laser eyes surgery to correct my vision so that I no longer need glasses or contact lenses. As a conclusion, I can’t live without my laptop, my phone and my glasses. My laptop is basically an all purpose tool for entertainment, social life and intellect and my phone is used to reach my friends anytime anywhere. My glasses is used to give me a clear vision to see the world. I appreciate with what I have now and I hope that I can keep them in a good condition forever.

The Color Purple essays

The Color Purple essays Celie and Nettie both went through hard times although there was an array of differences between the two. They both came out stronger and more aware of the oppression that women of that generation had to face. They were Eventually able to break away from the vicious cycle of man dominating over woman and keeping her below himself and insinuating that they were the Weaker sex. Celie and Nettie both were embarked on a spiritual journey, but both were so different in multiple ways. Celie's journey was filled with constant pain, suffering, loss, anger, and oppression. Nettie also had a hard life, too, but hers was made much easier because of Celie. She kept Nettie out of harms way ...for example, on page eight, Celie begins her journal entry by writing, I ast him to take me instead of Netter while our new mammy was sick...I duck into my room and come out wearing horsehair, feathers, and a pair of our new mammy high heel shoes...he beat me for dressing trampy but do it to me anyway. Both there journeys helped them find their gender in a different light, and also find there own strength away from men. Celias journey began when she was very young. Her father raped her constantly when her mother couldnt have sex with him (she was sick from having to many children and was crazy before that) and Celie became pregnant twice (one when her mother was still alive and one after her mothers death) Both times he got rid of the babes that Celie had. After a few years (and when he got tried of Celie) he got sold off to an abusive man with little hellants for children. She barely had any joy in her life other than from seeing Nettie. She was only being beaten, neglected, and billeted. Nettie on the other hand, she never was raped by their father, didnt have to marry Mr._______ like he originally requested. She was spared by burden by Celie. She e ...

Interpersonal Communication, Pop culture vs. analysis, Benefits of Essay

Interpersonal Communication, Pop culture vs. analysis, Benefits of Marriage - Essay Example These benefits include having increased pay and more chances of promotion simply because of being married, much more likelihood of avoiding getting into trouble with the law especially criminal, behaviour and lastly enabling the man remain in great health than their single counterparts. When individuals are married according to the research by (Horn, Xu, Beam, Turkheimer & Emery, 2012), they show lower levels of psychological distress and antisocial behaviour and this causes positive changes and significantly reduces as well as protects against the negative effects on physical health. Married individuals are better adjusted to relationship as a result if having a shared environment similar to the relationship twins who share the same environment have. Risky behaviour engagement such as excessive alcohol intake, property damage and gang fighting among other criminal activities reduces significantly when the individuals get married. According to the research results, there was reduction of such risky behavioural engagements from a 25% to a 14% as the marriage continued to advance. Cigarette smoking for example reduced from 7 cigarettes to an average of 3 of them per day (Horn, Xu, Beam, Turkheimer & Emery, 2012). The overall wellbeing of married couples is higher than that of cohabiting or simple individuals. This is indicated by their general health. The example referred to in the article by (Ducharme & Kollar, 2012) is based on homosexual relationships before and after getting married. It is found that before marriage, the lesbians even though cohabiting were generally less happy and satisfied like they became once married which is the same trend with heterosexual couples. Another indication of the general wellbeing improving is based on the increase in finances once individuals became married. Apart from the finances coming from both parties hence increasing,

Tegan as One of the Largest Educational Toys Distributor Assignment - 3

Tegan as One of the Largest Educational Toys Distributor - Assignment Example In the case of Tegan, the outsourcing offered some benefits since the company’s outsourcing partner Hrad Technica had possessed significant experience in that field. The Tegan entered into a fixed cost contract with Hrad so that Tegan can avoid further costs related to project development. The outsourcing concept has assisted Tegan to escape from the trouble of reinvesting in the technology. Figure 11.20 indicates that outsourcing process would benefit the firms to reduce the costs by approximately 40% (Developing information systems). The Tegan could also take advantages of various costs such as operational and maintenance costs and project development costs. Moreover, Tegan has not adequate expertise to develop a new A/P system itself. Therefore, it is identified that outsourcing the A/P project was the best-fitted move for Tegan when comparing with other available alternatives. From a detailed study, the outsourcing challenge â€Å"scope of a definition† was the fact or that worsened the outsourcing process. Most of the companies fail to define a specific scope for the proposed program while outsourcing their IT projects. These contractual misunderstandings raise many problems and weaken the project development. Under such circumstances, the beneficiary organization tends to believe that the required services are within the scope of the contract whereas the service provider argues that it is outside the contract and therefore the organization must pay extra fees. Same is the case happened with Tegan and Hrad. During the progress of the project, Hrad Technica identified certain system features such as â€Å"computational forecasting algorithms for selecting and ordering payments† that had not been defined in the initial scope of the contract (Staats & Upton). This situation led to time delay and the need for extra funds for the completion of Tegan’s project. There are some tradeoffs involved in having the requirements analysis for a project performed by one of the firms that would ultimately bid on the project. While performing requirements analysis, the project development firm must try to accumulate information regarding the client firm wherever it is possible. Sometimes, the firms send their official representatives to scrutinize the client’s current systems and practices even though it involves some additional costs. This practice may assist the project development team to acquire the client’s trust. Generally, outsourcing firms also give an opportunity for the client to posts feedbacks at various phases of project development. Although the client’s frequent intervention may interrupt the project development flow, it is a better strategy to provide improved services to the client firms.

Nutrition - Obesity Essay Example for Free

Nutrition Obesity Essay Objective: To assess the association between the consumption of fast food (FF) and body mass index (BMI) of teenagers in a large UK birth cohort. Methods: A structural equation modelling (SEM) approach was chosen to allow direct statistical testing of a theoretical model. SEM is a combination of confirmatory factor and path analysis, which allows for the inclusion of latent (unmeasured) variables. This approach was used to build two models: the effect of FF outlet visits and food choices and the effect of FF exposure on consumption and BMI. Results: A total of 3620 participants had data for height and weight from the age 13 clinic and the frequency of FF outlet visits, and so were included in these analyses. This SEM model of food choices showed that increased frequency of eating at FF outlets is positively associated with higher consumption of unhealthy foods (b ? 0. 29, Po0. 001) and negatively associated with the consumption of healthy foods (b ? A1. 02, Po0. 001). The SEM model of FF exposure and BMI showed that higher exposure to FF increases the frequency of visits to FF outlets (b ? 0. 61, Po0.001), which is associated with higher body mass index standard deviation score (BMISDS; b ? 0. 08, Po0. 001). Deprivation was the largest contributing variable to the exposure (b ? 9. 2, Po0. 001). Conclusions: The teenagers who ate at FF restaurants consumed more unhealthy foods and were more likely to have higher BMISDS than those teenagers who did not eat frequently at FF restaurants. Teenagers who were exposed to more takeaway foods at home ate more frequently at FF restaurants and eating at FF restaurants was also associated with lower intakes of vegetables and raw fruit in this cohort. International Journal of Obesity (2011) 35, 1325–1330; doi:10. 1038/ijo. 2011. 120; published online 28 June 2011 Keywords: fast food; overweight; ALSPAC Introduction Childhood obesity prevalence have risen dramatically in the last 30 years in the Western world with the most recent figures for England and Wales show that 17% of boys and 16% of girls are obese. 1 An increase in the availability of calorie dense foods is implicated as one of the factors in the aetiology of the obesity epidemic. Fast food (FF) is one section of the food market that has grown steadily over the last few decades and it was worth d8. 9 billion in the United Kingdom in 2005. 2 FF is typically quick, convenient, cheap and Correspondence: Dr LK Fraser, School of Geography, University of Leeds, University road, Leeds LS2 9JT, UK. E-mail: l. k. [emailprotected] ac. uk Received 6 February 2011; revised 21 April 2011; accepted 12 May 2011; published online 28 June 2011 uniform in its production,3 but FF is often high in saturated fats, energy dense and has low micronutrient content. 4–9 Studies from the United States of America have shown that children who consume FF (when compared with children who do not eat FF) have higher energy intake and higher fat intakes9,10 as well as lower vegetable and milk intake. 10,11 Therefore, the consumption of such foods could possibly result in a positive energy balance; and hence, weight gain. There is some evidence from longitudinal studies in the United States of America that consuming FF as a teenager can result in weight gain in both early12 and middle adulthood. 13 FF is often marketed to children and adolescents through television, internet and movie advertising,14–17 with brand recognition being present from an early age. 18 The addition of toys as gifts with FF meals also attracts children. There is growing body of literature that has assessed the location of FF outlets and has found that areas of higher deprivation Fast food and body mass index LK Fraser et al 1326 have more FF outlets19–21 and that FF outlets are often located close to schools. 22–24 The majority of research to date has been undertaken in the United States of America, but a study that analysed the fat content of a FF meal in McDonald’s and Kentucky Fried Chicken outlets in 35 countries showed that the amount of fat varied considerably between countries, within the same FF outlet. 25 This means that results from studies in the United States of America may not be generalisable to other countries. This study aims to assess the cross-sectional association between the consumption of FF and the body mass index (BMI) of teenagers in a large UK birth cohort. Methods The data for this study were obtained from the Avon Longitudinal Study of Parents and Children (ALSPAC),26 which is a birth cohort study where pregnant mothers who lived in the old Avon County in the United Kingdom (the Bristol region) were recruited in the early 1990s. A total of 14 541 mothers completed recruitment. Because of retrospective recruitment the total sample size was 15 224 fetuses and 14 610 live births. This paper presents data on the teenagers who attended the year 13 clinic and completed the year 13 questionnaire. Variables The food frequency data were collected from the questionnaires completed by mother (or carer) and separate questionnaires completed by the teenagers themselves at age 13 years. The data used from the carer questionnaire (collected at the same time point) referred to the questions ‘How often does s/he eat in a FF restaurant? The responses to this question were collected as never/rarely, once a month, once every 2 weeks, once or twice per week, 3–4 times a week, 5 or more times a week. The carers were also asked ‘In total, how many portions of vegetables does s/he eat in a week (do not include potatoes)’, ‘In total, how many portions of raw fruit does s/he eat in a week? ’ These were free numerical responses, which were retained as a continuous variable for analyses. In the food frequency part of the teenager completed questionnaire the teenagers were asked ‘If you ever buy food yourself from outside school, or from school vending machines, how often do you buy and eat each of the following things (include after school and weekends): chips, burger, pizza, sandwich, pies or pasties, chocolate, crisps, fruit and other food. ’ The height and weight data were collected at clinic visits at B13 years. The exact age, sex, height and weight were used to calculate a BMI standard deviation score (BMISDS) for each participant (1990 UK reference dataset). 27 The teenagers International Journal of Obesity were classified as obese if their BMISDS was greater than the 95th percentile (BMISDS41. 64). The physical activity data were collected via accelerometry at the age 13 clinic visit. 28 The participants wore an accelerometer for seven consecutive days and the measure used from this is mean counts per minute, which is a continuous variable. A deprivation score was assigned to each participant by matching the coordinates of their residential address (when carer questionnaire was completed) to the appropriate lower super output area. Each lower super output area has an index of multiple deprivation score (Index of Multiple Deprivation 2007 (IMD))29 assigned from the local census data. This is a continuous variable in which a higher number indicates an area of higher deprivation. Ethnicity was assigned as per the child’s ethnicity into a binary variable of ‘white British’ and ‘other’ ethnicity. Statistical modelling Descriptive statistics were performed in STATA version 10 (StataCorp LP, College Station, TX, USA). A structural equation modelling (SEM) approach was chosen to allow direct statistical testing of a theoretical model. SEM has many benefits over traditional regression techniques, which include the ability to model equations simultaneously and the incorporation of latent variables. 30 SEM is a combination of confirmatory factor and path analysis, which allows for the inclusion of latent (unmeasured) variables. 31 This approach was used to build two models: the effect of FF outlet visits and food choices and the effect of FF exposure on consumption and BMI. The SEM analyses were undertaken in AMOS version 17. 0 (IBM SPSS, USA). The hypothesised model for food choices is shown in the results section (Figure 2). The observed variables are displayed as boxes and latent variables as circles. Each observed variable has an associated random error term and each latent variable has an associated disturbance term, which represents the variance in the latent variable that has not been explained by the observed variables associated with that latent variable. Regression paths are shown by singleheaded arrows and covariances by double-headed curved arrows. The model fit was assessed by two indices; the comparative fit index (CFI) and the root mean square error of approximation (RMSEA). The CFI is a comparison of the hypothesised model compared with an independence model where all parameters are assumed to be independent. The RMSEA gives an indication of ‘how well would the model, with unknown but optimally chosen values, fit the population covariance matrix if it were available’. 32 A combination of CFI40. 95 and a RMSEA of o0. 50 is a sign of good model fit. The w2-test of overall fit is very sensitive to large sample size so has not been used in these models. 30 The two models were constructed a priori using previous research. The nutritional content of chips, burgers, pizza and Fast food and body mass index LK Fraser et al 1327 pies are known to be high in saturated fat and energy and therefore are ‘unhealthy’,4–9,33 whereas fruit and vegetables are known to contain fibre and vitamins and so are classified as ‘healthy’. Exposure to FF outlets is known to be higher in areas of higher deprivation. 19–21 In the food choices model, unhealthy consumption (latent variable) was modelled from the frequency of consumption of chips, burger, pizza and pies (reported by the teenagers themselves), and the healthy consumption was modelled from the number of pieces of vegetables and raw fruit consumed by the teenager (maternal report). The number of times that the teenager visited a FF outlet (maternal report) was regressed on the unhealthy and healthy consumption variables. The model for the effect of FF exposure on consumption and BMISDS is shown in Figure 3. Here exposure is a latent variable modelled from maternal and paternal takeaway frequency and deprivation score. The exposure is regressed on the number of visits to FF outlet. The BMISDS at age 13 years is the main outcome of this model. Ethical approval for the study was obtained from the ALSPAC Law and Ethics Committee and the local research ethics committees. Results A total of 3620 participants have data for height and weight from the age 13 clinic and the frequency of FF outlet visits, and were included in these analyses (SEM cannot use individuals with missing data). A total of 1711 (47. 3%) were boys and 456 (12.6%) obese. The descriptive statistics are shown in Table 1. Frequency of visiting FF outlets and food consumption frequencies are shown in Figure 1. The results of model 1 are shown in Figure 2 with regression weights shown in Table 2. This model showed that increased frequency of eating at FF outlets was positively associated with higher consumption of unhealthy foods (b ? 0. 29, Po0. 001) and negatively associated with the consumption of healthy foods (b ? A1. 02, Po0. 001). The CFI for model 1 was 0. 98 and the RMSEA was 0. 05 (90% confidence interval 0. 044, 0. 058). These represent good approximate model fit. Table 1. The results of model 2 are shown in Figure 3 with regression weight shown in Table 3. This model showed that increased exposure to FF increased the frequency of visits to FF outlets (b ? 0. 61, Po0. 001), which in turn was associated with higher BMISDS (b ? 0. 08, Po0. 001). Deprivation was the largest contributing variable to the exposure (b ? 9. 2, Po0. 001). The CFI for model 2 was 0. 98, and the RMSEA was 0. 021 (90% confidence interval 0. 009, 0. 033). These represent very good approximate model fit. Discussion This study shows that teenagers who are exposed to more unhealthy foods at home are more likely to eat at FF restaurants and have a higher BMISDS. The negative association of increased visits to FF outlets on consumption of healthy foods (fruit and vegetables) has also been demonstrated. The FF restaurant use in this analysis was reported by the mother or main carer of the teenager and showed that nearly 60% of all the teenagers ate at a FF restaurant at least once a month. This appears to be less frequently than in the United States of America, where studies showed that 60% of older children and adolescents ate FF more than once per week34 and that B30% of children ate at a FF restaurant on any typical day. 9. As one part of the SEM this study showed that eating at a FF outlet was associated with a higher BMISDS. There were no previous UK studies to compare these results with, but previous studies from the United States of America have not found consistent results. Boutelle et al. 11 found no association between frequency of FF consumption and adolescent BMI or weight status, and an Australian study Descriptive statistics Mean BMISDS Deprivation (IMD 2007)29 Physical activity (c. p. m. ) Raw fruit (portions per week) Vegetables (portions per week) s. d. Median IQR 0. 29 13. 7 541 9. 5 9. 5 1. 14 11. 4 190 7 7 0. 024 10. 6 511 8 8 A0. 47, 1. 06 5. 9, 17. 0 404, 653 5, 14 5, 12 Abbreviations: BMISDS, body mass index standard deviation score for age and sex; c. p. m. , cycles per minute; IMD 2007, Index of Multiple Deprivation 2007; IQR, interquartile range. Figure 1 Food frequency data. International Journal of Obesity Fast food and body mass index LK Fraser et al 1328 Figure 2 Results of SEM model of food choices. Table 2 Results of SEM model of food choices Regression weights a Unhealthy’fast food Healthy’fast food Chips’unhealthy Burger’unhealthy Fruit’healthy Vegetables’healthy Pizza’unhealthy Pies’unhealthy Estimate s. e. CR P 0. 285 A1. 023 1. 000 0. 732 1. 000 1. 157 0. 774 0. 530 0. 021 0. 124 13. 439 A8. 274 o0. 001 o0. 001 0. 016 45. 243 o0. 001 0. 148 0. 018 0. 016 7. 802 42. 483 32. 720 o0. 001 o0. 001 o0. 001 Abbreviations: CR, critical ratio; SEM, structural equation modeling. aAll consumption variables units: never/rarely, once a month, once every 2 weeks, once or twice per week, 3–4 times a week, 5 or more times a week. showed that FF eaten at home (but not away from home) was associated with higher BMI in adolescents (MacFarlane). Two longitudinal studies using data from the CARDIA study found that higher FF intake in adolescence was associated with higher BMI in young adulthood12 and those who ate FF more than twice a week had put on an extra 4. 5 kg of weight 15 years later. 13 The teenagers who ate more frequently at FF restaurants were more likely to eat less fruit and vegetables, as well as consume more unhealthy foods (chips, burger, pizza, pies) than those teenagers who ate at FF restaurants less frequently. This is an indication that the consumption of unhealthy foods may displace healthy food choices. This is similar to previous research in the United States of America, International Journal of Obesity which showed that children who ate FF consumed 45 g less vegetables per day than children who did not eat FF. 10 At age 13 years the food frequency data were a combination of maternal and self-report from the teenagers, but the total macro- and micronutrient values could not be assessed in this study as these data were not yet available at the time of writing. Deprivation was the largest contributor to the FF exposure variable. This could be explained by the fact that those of higher deprivation eat more FF because of the relative cheapness of FF. It has also been shown in many studies in the United Kingdom and the United States of America that areas of higher deprivation have more FF outlets than more affluent areas therefore, FF is more readily available. 35 An interesting economics paper from the United States of America showed that increasing the cost of FF by $1 could decrease BMI by 0. 78 units. 36 The increased consumption of unhealthy foods (chips, burger, pizzas and pies) by those teenagers who ate more frequently at FF outlets was not surprising, but the associated negative effect of the consumption of fruit and vegetables by these participants is important. These teenagers will not only be consuming more of the saturated fat and salt from the burgers, and so on, but at the same time they are not consuming important nutrients from fruit and vegetables. Although many FF outlets now offer more healthy alternatives such as fruit and vegetables, the consumers may still be choosing the unhealthy foods. Fast food and body mass index LK Fraser et al 1329 The FF question completed by the carer did not specify what constituted FF so some respondents may only count large franchises as FF whereas others may use a broader definition that includes independent takeaways. Although the frequency of eating at a FF restaurant was asked, the carers were not asked about the food eaten from these establishments and many FF restaurants now offer more ‘healthy’ alternatives. Although the majority of FF items do not meet the Food Standards Agency nutrient standards for total fat, saturated fat, sugar and sodium there are wide variations in similar products from different FF outlets with sodium content varying by up to four times in fried chicken products. 37 Therefore, having data on which food items were consumed from which FF outlet would further enhance future studies. There was no information on why the teenagers ate at FF restaurants, and key questions for the future include; was there no alternative eating establishments in their neighbourhood? Did they prefer FF to other meals or was the cost of food important? Conclusions This study has shown that the teenagers who ate at FF restaurants consumed more unhealthy foods and were more likely to have higher BMISDS than those teenagers who did not eat frequently at FF restaurants. Teenagers who were exposed to more takeaway foods at home ate more frequently at FF restaurants. Eating at FF restaurants was also associated with lower intakes of vegetables and raw fruit in this cohort. Figure 3 The SEM model of FF exposure and BMI. Table 3 Results of SEM model of FF exposure and body mass index Regression weights Fast food ’exposure. Maternal fast food’exposure Deprivation’exposure Paternal fast food’exposure BMISDS’fast food BMISDS’c. p. m. a Estimate s. e. CR 0. 61 1. 000 9. 20 0. 66 0. 08 0. 00 0. 07 8. 654 1. 07 0. 08 0. 02 0. 00 8. 605 8. 680 3. 586 A3. 351 P o0. 001 o0. 001 o0. 001 o0. 001 o0. 001 Abbreviations: BMISDS, body mass index standard deviation score for age and sex; c. p. m. , cycles per minute; CR, critical ratio; FF, fast food; IMD 2007, Index of Multiple Deprivation 2007; SEM, structural equation modeling. a All consumption variables units: never/rarely, once a month, once every 2 weeks, once or twice per week, 3–4 times a week, 5 or more times a week. Strengths/limitations This is a large dataset with good-quality height and weight data taken at clinic visits by trained staff using validated equipment. There were food consumption data about the teenagers available from both the teenagers and their carers, but this is a cross-sectional study so causation cannot be implied from this data. As expected in a longitudinal study there is attrition and the subcohort used in this study may not be truly representative of the whole cohort. Conflict of interest The authors declare no conflict of interest. Acknowledgements. We are extremely grateful to all the families who took part in this study, the midwives for their help in recruiting and the whole ALSPAC team, which include interviewers, computer and laboratory technicians, clerical workers, research scientists, volunteers, managers, receptionists and nurses. The UK Medical Research Council (grant ref: 74882), The Wellcome Trust (grant ref: 076467) and the University of Bristol provide core support for ALSPAC. LKF was funded by ESRC/MRC studentship. References 1 Craig RS. Health survey for England 2007, 2008. Available from http://www. natcen. ac. uk/study/health-survey-for-england-2007. 2 Keynote.UK fast food and home delivery outlets, 2006. 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