1 JPJO 6 (1) (2021) 1-9 Jurnal Pendidikan Jasmani dan Olahraga Available online at: https://ejournal.upi.edu/index.php/penjas/article/view/6-1-01 DOI: https://doi.org/10.17509/jpjo.v6i1.30438 Nutrition Education on Sedentary Activity for Adolescent Hurry Mega Insani 1 *, Lilik Kustiyah 2 , Cesilia Meti Dwiriani 2 , Ayu Mutiara Santanu 1 1 Program Studi Gizi, Fakultas Pendidikan Olahraga dan Kesehatan, Universitas Pendidikan Indonesia, Indonesia 2 Ilmu Gizi, Fakultas Ekologi Manusia,Institut Pertanian Bogor, Bogor, Indonesia Article Info Article History : Received December 2020 Revised December 2020 Accepted January 2021 Available online April 2021 Keywords : nutrition education, screen time, sedentary activity Abstract Adolescents are prone to nutrition problems, such as the lack of nutrition, overweight, and obesity caused by sedentary behaviours. Adolescents’ activities are influenced by their surrounding environment, such as family, friends, and the duration of gadget use. Nutrition Education is a method to help increasing the adolescent’s knowledge about the importance of increasing physical activity and the consequence of sedentary behav- iours for adolescents. Knowing the most effective method was the purpose of the study. This study used a quasi-experimental method with control group pre-test post- test design. The study was carried on three groups of adolescents, namely the lecture group, website group, and control group, for two months on school days. The instru- ment used was ASAQ (Adolescents Sedentary Activity Questionnaire) analysed by one-way ANOVA. The subjects of this study were adolescents aged 15-16 years old in Bandung. This study used purposive sampling to select the subjects. The results showed that Nutrition Education using the interpersonal lecture method could increase 23.7 points of adolescent knowledge compared to Nutrition Education using the web- site method (6.2 points). Nutrition Education could increase the adolescent’s knowledge but it did not have a significant effect on adolescent’s physical activities on school days. Some activities of the adolescents were quite high, especially the learning activities of the lecture group (471.7 ± 53.5) and the website group (471.7 ± 53.5). The sleep activity also increased significantly in the lecture group (p = 0.040), website group (p = 0.003), and control group (p = 0.015). Meanwhile, the screen time activity decreased significantly (p = 0.011) in the lecture group due to various factors. Further research related to the factors affecting the duration of adolescent’s screen time on school days needs to be conducted.  Correspondence Address : Jln. Dr. Setiabudhi 229. Bandung. Indonesia E-mail : hurimega@upi.edu https://ejournal.upi.edu/index.php/penjas/index 2 INTRODUCTION Adolescence (aged 11-21 years) is a period of deep biological, emotional, social, and cognitive chang- es from childhood to adulthood (Brown 2011). Adoles- cent nutritional needs are influenced by psychological and social factors, hence cases of adolescents experi- encing nutritional problems are often found (Susetyowati et al. 2017). WHO says that more than 1.9 billion adults, 18 years and older, were overweight in 2016. Over 650 million of them were obese. 39% of adults, aged 18 years and over, were overweight, while 13% of them were obese. The worldwide prevalence of obesity nearly tripled from 1975 to 2016. The preva- lence of overweight and obesity among children and adolescents aged 5-19 had risen dramatically from 4% in 1975 to over 18% in 2016. The rise occurred similar- ly among both boys and girls. In 2016, 18% of girls and 19% of boys were overweight. While only under 1% of children and adolescents aged 5-19 years were obese in 1975, more than 124 million children and adolescents (6% of girls and 8% of boys) were obese in 2016. Over 340 million children and adolescents, aged 5-19, were overweight or obese in 2016 (WHO 2016). The sub- stantial increase in childhood overweight and obesity poses a major public health problem worldwide (Lobstein, 2015). The increase in childhood overweight and obesity is a public health concern in developed countries (Kuk, 2006). Weight problems in childhood and adolescence are common in Western countries with overweight rates estimated at 17-25% in West-Europe, Australia, and the United States (Olds, 2010). In 2013, approximately 23.0% and 14.0% of Chinese boys and girls aged 2–19 years were overweight or obese (Ng M, 2014). One of the nutritional problems in adolescents, with a high prevalence and continues increase in Indo- nesia every year, is obesity and overweight. The case of overweight in adolescents aged 10-18 years in Indone- sia had increased 5.9% or five times in the last three years from 2010 (1.4%) to 2013 (7.3%) (Kementerian Kesehatan RI 2013). Central obesity in adolescents con- tinued to increase every year until reaching 31.0% in 2018 (Kementerian Kesehatan RI 2018). Based on the 2018 Basic Health Research data, the prevalence of obesity in Indonesia, over the age of 18, was around 21.8%. The highest prevalence was found in North Su- lawesi (30.2%), DKI Jakarta (29.8%), East Kalimantan (28.7%), West Papua (26.4%), Riau Islands (26.2%), and followed by other provinces. This data tended to increase from 10.5% in 2007 to 11.5% in 2013 and in- creased to 21.8% in 2018. (Kementerian Kesehatan RI 2018). Main Results of the Ministry of Health Basic Health Research in 2018 showed that the obesity rate had increased compared to the previous year data. The Basic Health Research data is made every 5 years. In Basic Health Research 2018, the proportion of over- weight and obesity in adults, aged over 18 years from 2007 to 2018, was 8.6% in 2007, which increased to 11.5% in 2013 and 13.6% in 2018. Meanwhile, the number of obesity in 2007 was 10.5%, which increased to 14.8% in 2013 and 21.8% in 2018. The indicator of an adult overweight is the Body Mass Index (BMI) which is more than or equal to 25.0 to 27.0. The United States Department of Health and Gen- eral Surgery has made recommendations of physical activity for health; Each individual, whether overweight or not, needs to accumulate moderate physical activity for 30 minutes per day with brisk walking approximate- ly five days per week (Carr and Descheemaeker 2002). However, due to the high case of obesity in 2002, American and Canadian scientists from the Institute of Medicine of the National Academy of Scientists in- creased their recommended time for physical activity to 60 minutes per day. Adolescents who do physical activ- ity for 60 minutes or more per day will have a well and happy development and participate in various kinds of activities (Strong et al. 2005). Walking, reducing televi- sion viewing, and engaging in active hobbies, such as gardening, can increase energy expenditure. The physical activity of adolescents in Indonesia is still quite low. The Indonesian Ministry of Health (2018) stated that more than 33.5% of adolescents aged over 15 in West Java have a low level of physical activ- ity. A study revealed that physical activity in urban are- as is very low (51.6%), which becomes the cause of the increasing prevalence of overweight and obesity in ado- lescents (Rizkiriani, 2014). Research from different researchers mention that the associated health risks and health care costs of childhood and adolescent obesity are considerable, the consequences include metabolic disorders, early puberty and menarche in girls, type 2 diabetes, hypertension, sleep apnea, adulthood obesity, and higher rates of mortality in young adults (Zheng, Biro, Arens, 2010). Overweight and obesity have a risk Copyright © 2021, authors, e-ISSN : 2580-071X , p-ISSN : 2085-6180 Hurry Mega Insani et al./ Jurnal Pendidikan Jasmani dan Olahraga 6 (1) (2021) 3 of developing diabetes (44%), ischemic heart disease (23%), and cancer (7-41%) (Pedum Gentas Kemenkes RI, 2016). Physical activity is recognized as a positive out- come of physical and mental health, social and cogni- tive well-being, and good academic performance (Matiba 2015). Individuals who exercise and eat healthy foods have the opportunity to live a healthy lifestyle and reduce the risk of developing diseases, such as diabetes mellitus 2, depression, and cardiovas- cular diseases related to the lack of physical activity and lifestyle choices (Matiba 2015). The amount of physical activity taken by individual is related to the quality of health and life rate; the severity of physical activity has a greater effect on bone mass in childhood and adolescence compared to adults (Muros et al. 2016; Edelstein 2015). Physical activity plays an important role in preventing overweight and obesity in young peo- ple. Adolescence is a particularly vulnerable time for the development of obesity because of the decrease of physical activity levels (Daniels, 2006). For that reason, overweight adolescents have a higher risk of becoming overweight adults (Diets, 2004). Thus, engaging young people in physical activity remains a behavioural target for obesity prevention. Studies show that a person usually spends 9.5 hours/day doing sedentary activities (Bankoski et al. 2011). The examples of sedentary activities include watching television, playing gadgets, playing games or computers, sitting around, and chatting (Guimaraes et al. 2012). Gadgets, such as smartphones, are tools used for communication, learning, and entertainment which are mostly owned by adolescents. Excessive smartphone use can affect the duration of physical ac- tivity of adolescents (Lepp et al 2013). Excessive sed- entary activities and passive behavior will lead to over- weight and obesity in adolescents. Sedentary behavior and the increasing incidence of obesity should be taken into account to reduce the prevalence and morbidity due to obesity. Nutrition education is an effort that can be taken to reduce sedentary activities and the prevalence of obe- sity in adolescents. Nutrition education for adolescents is an effort to educate adolescents to behave in accord- ance with nutritional principles (Emilia 2009). Nutrition education can be carried out using various methods, including the lecture method, discussion method, or online method. Educational programs are obliged to change and modify factors related to unhealthy life- styles, which focus on sports activities, health, nutri- tion, and development of special facilities for the selec- tion of healthy lifestyle behaviors in adolescents (Golmakani et al. 2013). Health-related education pro- grams need to be implemented to change and modify the factors associated with an unhealthy lifestyle that focuses on exercise, health, and nutrition (Golmakani et al. 2013). Mahan (2017) explains that the key to chang- ing behavior and nutritional awareness is to show that change and motivation are needed for a better change. Sutrisno and Siswanto (2016) revealed that there are several factors influencing student learning outcomes, including how to convey the material, the methods used, and the tools. This study was aimed at providing nutrition educa- tion as an effort to reduce the sedentary behaviour and prevalence of obesity in adolescents, as well as finding out a more effective method between lectures and online nutrition education through website to increase adolescent knowledge about nutrition education. METHODS Participants This study used a quasi-experimental control group pre-post test design which was conducted in three different senior high schools in urban areas. This re- search was conducted for 6 weeks and had obtained Ethical Approval from the Research Ethics Commission involving Human Subjects, Bogor Agricultural Univer- sity No. 040/IT3.KEPMSM-IPB/SK/2018. The subjects were determined using the minimum number of research samples of 30 people who can represent the population of the study (Cohen et al. 2007). Thus, for three treatment groups, a minimum sample size was 90 people. The subjects of this study were high school stu- dents. This study used purposive sampling to select the subject. The inclusion criteria of the subjects were: (1) second grade high school students, (2) having a smartphone with a sufficient capacity to open a website, and (3) willing to participate in the research proven by signing an informed consent. The exclusion criteria of the subjects were: (1) rarely attending the school, (2) did not have a device/smartphone, and (3) participating Hurry Mega Insani et al./ Jurnal Pendidikan Jasmani dan Olahraga 6 (1) (2021) Copyright © 2021, authors, e-ISSN : 2580-071X , p-ISSN : 2085-6180 4 in other studies. Subjects in each school were chosen by randomizing the class. Materials and Apparatus Knowledge of nutrition and health was collected from a questionnaire. The subjects filled out the ques- tionnaire guided by the researchers. Physical activity data were collected by interviewing the subjects using the activity questionnaire (ASAQ). Procedures Nutrition education was carried out by dividing the subjects into two treatment groups (lecture group and website group) and one control group. Nutrition educa- tion with the lecture method (group I) was conducted 6 times for 6 weeks. The lecture was held for 30 minutes followed by 30 minutes of discussion. Nutrition educa- tion using the website (group II) began with uploading nutrition education materials on the ipbnutri- teen.ipb.ac.id website. After received an explanation about how to use the website, the subjects studied the nutrition education material available on the website for six weeks. Subjects were asked to read the nutrition education material at least six times in six weeks. In the control group (group III), subjects received a leaflet containing nutrition education material every two weeks. The subjects had six weeks to study the materi- al. Table 1 shows the implementation of nutrition edu- cation based on the type of treatment. Data Analysis The obtained data were processed and analyzed using Microsoft Excel 2010 and SPSS 16.0 software. Nutritional knowledge and physical activity data were presented descriptively. Difference tests were carried out using the oneway ANOVA test. Before analyzing the data, researchers used Wilcoxon test and One- sample Kolmogorov-smirnov test to see the normality and homogeneity of the data (Table 5). Researchers used paired t-test to see the difference before and after nutrition education was carried out. RESULT Balanced Nutrition Knowledge Level Table 2 shows that, before nutrition education was carried out, more than half of the subjects in the control group (54.3%) and 48.5% of the subjects in the lecture group had low levels of nutritional knowledge. Mean- while, more than half of the website group subjects (60.6%) had a sufficient level of knowledge. After nutrition education was carried out, the knowledge of nutrition in the lecture group subjects (63.6%) increased significantly (p <0.05) into the high (63.6%) and moderate (36.4%) categories. In the web- site group, the nutritional knowledge of the subjects increased significantly (p <0.05). Most of them were in Table 1. The Steps of Nutrition Education Implementation based on The Type of Treatment Group type 1st Week 2nd Week 3rd Week 4th Week 5th Week 6th Week Lecture group • Pre-test • 1 st Leaflet Distribution • Theory 1 • Review • Quiz • Theory 1 • 2 nd Leaflet Distribution • Review • Quiz • Theory 2 • Review • Quiz • Theory 2 • 3 rd Leaflet Distribution • Review • Quiz • Theory 3 • Review • Quiz • Theory 3 • Post-test Website group • Pretest • Leaflet Distribution • Website Identification • Website monitoring • 2 nd Leaflet Distribution • Website monitoring • Website monitoring • 3 rd Leaflet Distribution • Website monitoring • Post-test Control group • Pretest • Leaflet • Distribution - 2nd Leaflet Distribution - • 3rd Leaflet Distribution • Post-test Hurry Mega Insani et al./ Jurnal Pendidikan Jasmani dan Olahraga 6 (1) (2021) Copyright © 2021, authors, e-ISSN : 2580-071X , p-ISSN : 2085-6180 5 the moderate category (51.5%). More than half of the subjects in the control group (60.0%) had a sufficient nutritional knowledge, but it did not differ significantly. There was a significant change in nutritional knowledge in the lecture group after nutrition education, covering a value change (23.7) when compared to the website group (6.2) and the control group (4.3). Sedentary Activity The results showed that the duration of sedentary activities of adolescents in this study were screen time, casual time, learning and doing homework, travel to Table 2. Distribution of Subjects based on The Level of Nutritional Knowledge Before and After Nutrition Education Nutrition Knowledge Lecture Website Control p value 1 n (%) n (%) n (%) Baseline 61.8 ± 10.2 69.0 ± 12.8 57.0 ± 15.1 0.001 Deficient 16 (48.5) 7 (21.2) 19 (54.3) Sufficient 15 (45.4) 20 (60.6) 14 (40.0) Superior 2 (6.1) 6 (18.2) 2 (5.7) End line 85.5 ± 11.1 75.3 ± 13.1 61.3 ± 20.1 0.000 Deficient 0 (0.0) 5 (15.2) 9 (25.7) Sufficient 12 (36.4) 17 (51.5) 21 (60.0) Superior 21 (63.6) 11 (33.3) 5 (14.3) Transformation (Baseline-End line) 23.7 6.2 4.3 0.000 p-value 2 0.000 0.024 0.130 1 significant if p <0.05 with one-way ANOVA test among lecture, website, and control groups 2 significant if p <0.05 with paired t-test difference test before and after nutrition education Table 3. Average Time Allocation (Minutes/Day) of Physical Activity of Adolescents on School Days Sedentary Activity Lecture (mean ± SD) Website (mean ± SD) Control (mean ± SD) P-value Baseline Endline Baseline Endline Baseline Endline Baseline Δ Screen time (watching television/ movie, playing video/computer games/ gadgets) 140.7 ± 91.3 94.8 ± 63.4 152.2 ± 122.4 150.6 ± 93.0 135.4 ± 87.4 127.1 ± 88.1 0.785 0.133 P-value 0.0111 0.822 0.922 Casual activities (reading, playing musical instruments, sitting around) 116.0 ± 57.9 108.5 ± 42.3 91.5 ± 34.3 102.3 ± 38.8 129.3 ± 70.3 122.0 ± 63.7 0.242 0.117 P-value 0.590 0.065 0.374 Learning and doing homework 445.8 ± 62.5 471.7± 53.5 418.5 ± 84.1 471.7 ± 53.5 346.6 ± 76.5 394.4 ± 55.0 0.0002 0.466 P-value 0.164 0.000 1 0.0011 Travel to school or other places (public transportation, motorbike) 60.7 ± 31.4 83.0 ± 65.2 39.5 ± 21.3 38.9 ± 31.4 80.7 ± 53.1 60.0 ± 52.4 0.0002 0.0082 P-value 0.150 0.955 0.0161 Personal activities (grooming, bath- ing, and praying) 42.4 ± 16.8 63.6 ± 30.8 70.9 ± 29.2 63.7 ± 29.8 60.4 ± 41.7 63.7 ± 42.3 0.0012 0.0062 P-value 0.0041 0.104 0.574 Sleeping 444.8 ± 81.6 479.3 ± 68.0 441.3 ± 111.3 513.3 ± 127.7 473.8 ± 84.8 544.5 ± 141.0 0.289 0.392 P-value 0.0401 0.0031 0.0151 Hurry Mega Insani et al./ Jurnal Pendidikan Jasmani dan Olahraga 6 (1) (2021) Copyright © 2021, authors, e-ISSN : 2580-071X , p-ISSN : 2085-6180 6 school or another places, personal activities, and sleep- ing. Table 3 shows the average change of the activity time allocation of a teenager in minutes during the school day. Meanwhile, Table 4 shows the average change of time allocation. Adolescents have a high du- ration of learning and doing homework than screen time or casual activity during school days. Their sleep activ- ity increased after the intervention and had a higher du- ration than other activities. A lecture group had a low duration of personal activities than other groups. Meanwhile, the website group has a low duration of travel to school or another place than other groups. DISCUSSION Balanced Nutrition Knowledge Level On the given nutrition education topic, the average of the lecture group subjects who answered correctly increased higher than the website group and control group. It could be because the subjects could easily un- derstand the material through the lecture method (direct learning method). Supriati (2016) argues that nutrition education using the lecture method can increase knowledge. Education using a lecture method provides the subject with a better understanding, discussion, and opportunities to ask questions directly to peers, teach- ers, and nutritionists. Nutrition education using the lec- ture method can increase adolescent knowledge (Safitri 2016). Oneway ANOVA test showed that there was a significant difference (p <0.05) in the mean score be- fore and after the intervention. There was also a change in values of the three nutrition education subjects. Sedentary Activity Physical activity of friends, parents, and the social environment of adolescents is related to the level of physical activity of the adolescents themselves (Cheng 2014). An active environment can help teens reduce their sedentary activity and become more active. Table 3 shows the average change of the activity time alloca- tion of a teenager in minutes during school days. Activities related to monitors or screen time of the lecture group subjects (Table 3) on school days de- creased significantly (p <0.05) from 140.7 minutes to 94.8 minutes. Research data from 2002-2010 stated that television viewing duration had decreased in 30 coun- tries (Bucksch et al. 2010). Decreasing the subject's screen time activity can help increase the subject's moderate and vigorous activ- ities so that they can meet the physical activity recom- mendations of the Ministry of Health. Adolescents who have a high screen time duration can be caused by their dissatisfaction with the school environment (Cao et al, 2011). The increasing activity of adolescent screen time will certainly affect their health. Morales-Ruan (2009) states that high screen duration can lead to overweight and obesity in adolescents. Meanwhile, the subject's personal activity (42.4 minutes to 63.6 minutes) and sleep time (444.8 minutes to 479.3 minutes) increased significantly (p <0.05). The increased sleep time could be caused by the amount of moderate and vigorous physical activity the subject did at school. Physical ac- tivity is closely related to the quality of a person’s sleep. The harder the activity, the better the quality of sleep (Apriana 2015). A good quality sleep can increase the academic score of the subject. Table 4. Average Time Allocation (Minutes/Day) Changes of Activities during School Days Sedentary Activity Transformation (mean ± SD) P-value Lecture Website Control 1. Screen time (watching television/movie, playing video/computer games/gadgets) -45.8 ± 109.9 -1.6 ± 91.2 -8.3 ± 84.8 0.133 2. Casual activities (reading, playing musical instruments, sitting around) -7.5 ± 56.5 -50.0 ± 131.5 -7.3 ± 84.6 0.117 3. Learning and doing homework 25.9 ± 91.5 53.2 ± 92.4 47.8 ± 100.1 0.466 4. Travel to school or other places (public trans- portation, motorbike) 22.3 ± 68.4 -0.6 ± 34.3 -20.6 ± 58.2 0.0081 5. Personal activities (grooming, bathing, and praying) 21.2 ± 36.9 -7.3 ± 25.5 3.3 ± 41.3 0.0061 6. Sleeping 34.5 ± 100.9 72.1 ± 127.2 70.7 ± 145.2 0.392 Hurry Mega Insani et al./ Jurnal Pendidikan Jasmani dan Olahraga 6 (1) (2021) Copyright © 2021, authors, e-ISSN : 2580-071X , p-ISSN : 2085-6180 7 In the website group and control group, learning and sleeping activities increased significantly (p <0.05). The physical activity of adolescents is influenced by the socio-demographic factors and lifestyle of the adoles- cents (Cheah 2018). The data collection was carried out in the midterm exam days for all subjects. It resulted in the increase of the duration of the subject's learning and the decrease of the duration of the subject's screen time. Therefore, the decrease and increase of the activity du- ration might not be the result of nutritional knowledge. The one-way ANOVA test results, before the nu- trition education was carried out, showed that there were significant differences (p <0.05) on activities of the subjects, including studying, trips to school or other places, and personal activities on school days. After nutrition education was carried out, there was a signifi- cant difference (p <0.05) in activities, ranging from trips to school or other places and personal activities, on school days. These changes were not the results of nu- trition education. It could be caused by other factors, such as the environment or lifestyle. It was because sig- nificant values had been obtained before nutrition edu- cation was carried out, which means that the duration of these activities were different among the groups before nutrition education was carried out. The subject characteristic data that were not homo- geneous, which resulted in changes of the physical ac- tivity duration, were not necessarily caused by nutrition education, but other factors, such as the influence of the subject's parents, peers, and other demographic factors. This is a drawback of this study. Meanwhile, the strength of this research is that researchers could use website media as a more attractive and accessible meth- od to deliver nutrition education to adolescents. CONCLUSION Adolescents have a high nutritional knowledge, especially adolescents in the lecture group, after the nutrition education was carried out. The physical activi- ty of adolescents was relatively low and had not met the recommendations of the Ministry of Health. Nutrition education could significantly increase nutrition knowledge in the lecture group and website group, but the effect on the physical activity of adolescents was not significant. 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