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Name: Amber Trengove

Mail ID  1 1  0  1  4  3  7  0  6

Email: trear003 @mymail.unisa.edu.au

Course code and title: BEHL 3012 Health Psychology

School: PSW Program Code: BEHL 2013

Course Coordinator: Tutor: Steph Centofanti

Day, Time, Location of Tutorial/Practical: Thursday 9:00am H-08

Assignment number: 1 Due date: Monday May 26th 2014

Assignment topic as stated in Course Outline: Practical Report

Further Information: (e.g. state if extension was granted and attach evidence of approval, Revised Submission Date)

 

I declare that the work contained in this assignment is my own, except where acknowledgement of sources is made.

I authorise the University to test any work submitted by me, using text comparison software, for instances of plagiarism. I understand this will involve the University or its contractor copying my work and storing it on a database to be used in future to test work submitted by others.

I understand that I can obtain further information on this matter at http://w3.unisa.edu.au/ltu/integrity/default.asp Note: The attachment of this statement on any electronically submitted assignments will be deemed to have the same authority as a signed statement.

Signed: Amber Trengove Date: Saturday 24th May 2014

Date received from student Assessment/grade Assessed by:

Recorded: Dispatched (if applicable):

1

Summary Information

Quality Score   An excellent report has the following qualities

Single-Slide 2 /2Completed a Single-Slide Summary for presentation in a tutorial.

Abstract 3 /3Clearly summarises the Introduction, Method, Results and Discussion sections in 500 words or less.

TOTAL 5 /5  

Comments: Good, but be sure to proof read.

Introduction

Quality Score   An excellent report has the following qualities

Logical development 4 /5

Develops a logical argument and presents ideas clearly. Premises are based on solid facts. Material is well organized and sequenced. Arguments are strong and coherent.

Subject relevance 3 /3Direct and to the point with little divergence. No superfluous information.

Use of sources and evidence 4 /4Critical use of relevant material. Evidence evaluated with respect to its theoretical and empirical rigor.

Critical evaluation leading to research questions 5 /5Well argued. Main issues understood, explored and evaluated, and research questions justified.

Statement of research aims 3 /3 Research questions/aims are clearly stated.

TOTAL 19 /20  

Comments: Really good. You have introduced the theories of behaviour change, and critically reflected on relevant material.

Method

Quality Score   An excellent report has the following qualities

Participants 4 /5Research participants are clearly described with all relevant details given.

Procedure 9 /10The procedure is outlined clearly. The reader can imagine exactly how the research was conducted.

Design/Approach 4 /5 The research design is correctly and clearly stated.

TOTAL 17 /20  

Comments: Great, very clear description of how the study was conducted.

Results

Quality Score   An excellent report has the following qualities

Research Aims addressed 5 /5The analyses presented address the research aims of the study.

Analyses conducted correctly 5 /5 Analyses are clear and correct.

Figure/table conventions 4 /5 Figures and/or tables are presented correctly.

Succinct statement of results 5 /5The results section is to the point. There is no superfluous information that does not belong in this section.

TOTAL 19 /20  

Comments: Comprehensive results, good use of trend lines on graphs.

Discussion

Quality Score   An excellent report has the following qualities

Summary of results 3 /3Results are summarized clearly without simply restating the results section.

Reference to previous research 3 /5Previous research is integrated with findings of the study.

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Critique of methodology 4 /5Limitations of the study are clearly acknowledged, and consequences of these limitations are appropriately discussed.

Implications for theory or practice 2 /3 Broader implications of the research are outlined.

Future research 2 /2Future research suggested by the study is discussed.

Conclusion 1 /2Good concluding section which draws together the various points made. A summary of the main points and relevance of these points.

TOTAL 15 /20  

Comments: Good job

Presentation

In-text references 2 /2 Appropriate in-text references.

Reference list 2 /2Thorough, clear, appropriate referencing style, easy to trace, full list of references included.

Legibility 1.5 /2 Fluent and succinct piece of writing

Spelling, Grammar and syntax 1.5 /2

No problems, appropriate spelling. Clear and well-constructed sentences, focused on single or a few points. Well written paragraphs that contain a single or a few themes. Sentences are well organized and coherent.

Style 3 /4Clear, concise, well-organized writing. A pleasure to read and easy to follow.

Length 2 /2 Reasonable length and around the set word limit

Overall presentation 1 /1Neat, legible type, appropriate spacing and layout, evidence of headings and subheadings where appropriate.

TOTAL 13 /15  

Comments: Please proof read and take note of your sentence structure. At times a little hard to follow.

Markers general comments: Overall a very good report. Despite a few legibility issues, the report included good use of evidence and clearly presented data. Well done.

Grade (%): HD 88

3

Increasing frequency of breakfast consumption: impact

on mood and energy levelsAmber R. Trengove

University of South Australia

Abstract: In this study the authors hypothesised that by increasing the regularity of breakfast

consumption by implementing a behavioural intervention program, that mood and energy levels of

the participant would also increase. A 24-year-old female recorded every item of food that she

consumed over the course of 1 week and recorded the state of her mood, the time of consumption,

the activity taking place, and if there were any other persons in her presence. After the initial week,

a behavioural intervention occurred, encouraging behaviour change by using operant conditioning

and positive reinforcement to increase the consumption of breakfast on a regular basis. The diary

was recorded for the following week, using the behavioural intervention plan. The participant was

able to increase breakfast consumption in the post-intervention week by allowing indulgences for

desirable behaviour. The mean of the mood and energy levels also increased from 6.1 in the baseline

week to 7.1 in the post-intervention week and the post-intervention mood and energy levels were

trending positively. The results indicate that the operant conditioning model of behaviour change

was successful in increasing the consumption of breakfast and that there was a correlation between

the consumption of breakfast and the positive trend of mood and energy levels.

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Skipping breakfast has been identified to result in lower energy and poor mood. What and how

we eat is an important factor in our health and well-being (Morrison, Bennet, Butow, Mullan &

White, 2012). Unhealthy diets can increase the risk of heart disease, cancer, birth defects, obesity, as

well as diseases that cause malnourishment such as anorexia and bulimia (Willett, 1994). This case

study was designed to (1) investigate the behavioural intervention on the regular consumption of

breakfast, and (2) identify any changes to mood and energy levels.

Previous studies have focused on breakfast consumption versus omitting breakfast and the

effects it has on cognitive functioning in school settings. There has been little research in to the

nutritional benefits of the consumption of breakfast on a regular basis and the impact on

psychological health, mood and energy levels, for example; previous studies have researched the

effects of missing breakfast on school students and the effects on attention and memory (Wesnes,

Pincock, Richardson, Helm & Hails, 2003). There are some limitations to the study conducted by

Wesnes, Pincock, Richardson, Helm and Hails (2003) because the study measured the consumption

of breakfast cereal against no breakfast consumption and the effects on cognitive function. The

factor of mood and energy played a small role in this study and failed to include variations between

different types of breakfast groups and their varying effects on functioning. A study by Benton and

Jarvis (2006) recognised the impact on of different serving sizes of breakfast and their effect on

cognitive functioning between the periods of breakfast and lunch. It was apparent that participants

who consumed the small breakfast of 61kcal were unable to spend a significant amount of time

concentrating on their daily tasks (Benton & Jarvis, 2006). Again, this study failed to factor the effect

of breakfast consumption on mood and energy levels. Rampersaud, Pereira, Girard, Adams, and

Metzl (2005) delve into the nutritional benefits for the regular consumption of breakfast. It is

reported that children and adolescents are able to maintain healthier weights when they are

consuming breakfast on a regular basis (Rampersaud, Pereira, Girard, Adams, & Metzl, 2005). It has

also been hypothesised in previous studies that differences in breakfast composition may also

account for variations in cognitive functioning as well as the effect on mood and energy levels, which

suggests that not only do people need to consume breakfast on a regular basis but they need to

consume the right nutritional composition of breakfast (Mahoney, Taylor, Kanarek & Samuel, 2004).

Previous research has presented evidence for the benefits of the consumption of breakfast by

using control groups. however However this is not beneficial for the participants that are omitting

breakfast. In order to maintain a healthy life-style, the participants need to identify and change the

behaviour that causes the omission so that the change in life-style is obtainable and maintainable.

Promoting health and wellness is an ongoing battle because healthy behaviours aren’t as desirable

or as easy as the alternative (Caltabianco, Sarafino, & Byrne, 2008). therefore Therefore behavioural

interventions need to take place to modify behaviour and increase the likelihood of behaviour

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change and maintenance. Operant conditioning is an effective tool to curb any unwanted behaviour

because it identifies the consequences of behaviour, and if used properly can alter the frequency of

behaviour (Powell, Symbaluk, & Honey, 2009). For example, operant conditioning is based on

reinforcements and punishments where reinforcement increases the behaviour and a punishment

reduces the likelihood of the behaviour recurring (Mazur, 2002). There has been a breakthrough in

recent years with the use of operant conditioning to modify maladaptive behaviour through the

process of learning via rewards or punishments for behaviour (Burchard & Tyler Jr, 1964). Early

theories of behaviour change include simplistic models that fail to address the complexities of

antecedents to certain undesirable behaviours (Morrison, Bennet, Butow, Mullan & White, 2012). It

was assumed that;

Information attitude change behaviour change

More advanced models, such as the transtheoretical model (TTM) account for the steps that

require preparation, action, and maintenance, however studies have shown that there are many

participants that struggle with turning preparation into action and then continuing to maintain

certain healthy behaviours; this is called the intention behaviour gap (Morrison, Bennet, Butow,

Mullan & White, 2012). The hypothesis and intention of this study is to identify behaviours or cues

that cause maladaptive eating patterns and the consequences of those unhealthy eating behaviours.

It is also the intention to investigate whether operant conditioning can affect certain behavioural

patterns to increase the likelihood of healthy eating habits and to increase the mood and energy

levels of the participant.

Method

Participants

A total of 1 Caucasian female was selected to participate. The participant was between 20 and

25 years of age and enrolled in the psychological science undergraduate program at the University of

South Australia.

Instruments

The participant received a food diary to fill out whenever they consumed a unit of food (see

appendix 1). The participant, as accurately as possible, had to fill in the date, time, quantity, specific

food item, location, company, activity, and mood at the time of consumption. The diary was

completed regularly and on a daily basis for a total of 1 week. 1 One serve of food was determined

by the CSIRO 12345 Food and Nutrition Plan (see appendix 2) and mood levels were determined on a

1 – 10 basis, 1 was identified as being low mood/energy, and 10 as high mood and energy. A

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behavioural modification program was implemented after the first baseline week to curb unwanted

healthy behaviour for an additional week.

Design

After the initial baseline week, the participant underwent an interview to establish a

behavioural modification program by focusing on behaviours or circumstances that lead to poor

food choices, which resulted in lower mood and energy levels (see appendix 3.1 and 3.2). The

interview process was designed to establish which certain triggers lead to unhealthy behaviour and

to identify which behaviours needed to be changed in order to achieve optimal health choices. Once

the target behaviour was identified, the participant and interviewer deconstructed the behaviour

into behavioural ABC which is the Antecedents to the behaviour, Behaviour that requires

modification, and Consequences of the behaviour. Based on the initial diary information, the

participant identified the cues and stimuli that lead to unhealthy behaviour and together the

interviewer and the participant discussed possible ways of modifying this behaviour by addressing

classical and operant conditioning techniques. A behaviour modification program was constructed

using stimulus control, behavioural control, and using rewards and/or punishment to curb

behaviour. If breakfast was successfully consumed prior to 11:59am, a reward was issued in either

form of TV privileges, or an indulgence for lunch or dinner. The use of positive reinforcement was

the tool to increase the desired behaviour in the post intervention week. The food diary was then

continued for 1 week using the behaviour modification program creating an AB design. ‘A’

represents the baseline week and B the post-intervention week.

Results

Breakfast Consumption Baseline Week

Thursday Friday Saturday Sunday Monday Tuesday Wednesday

Time of

Breakfast

Consumption

8:00am 10:30am 8:30am 8:00am N/A N/A N/A

The case study was designed to (1) investigate the behavioural intervention on the regular

consumption of breakfast, and (2) identify any changes to mood and energy levels. The behavioural

diary indicated that the consumption of breakfast increased due to the use of positive reinforcement

in the post intervention week, which is indicated in the table 1.2 below.

Figure 1.1

Figure 1.1 indicates the consumption of breakfast for the initial baseline food diary week. The

participant reported three days out of seven where breakfast was not consumed. This was the

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identified behaviour that was desired to be change. Figure 1.1 shows that only four days within the

week when breakfast was consumed and as a result, energy levels and mood were low (Figure 2.1).

Breakfast Consumption Post-Intervention Week

Thursday Friday Saturday Sunday Monday Tuesday Wednesday

Time of

Breakfast

Consumption

8:00am 9:30am 7:30am 7:00am 9:30am 8:30am 10:00am

Figure 1. 2

Figure 1.2 clearly indicates that the consumption of breakfast was successfully increased in the

post-intervention week. The table indicates that the participant consumed breakfast daily in the post

intervention week.

Figure 2.1 (Black Arrowed Lines Represent Nugent Trend Lines)

Figure 2.1 is indicative of the reported mood and energy levels of the participant post-breakfast

consumption in both the baseline and post-intervention week. The mood and energy was measured

on a scale from 1 – 10. The lower score on the scale indicates extremely low mood and energy, and

the highest score is indicative of optimum mood and energy. The participant was to record mood

and energy prior and post breakfast consumption. The vertical line is indicative of when the

behavioural intervention occurred. It is clear that mood and energy stabilised in the post

intervention week with an increase in the mean from 6.1 in the baseline week to an average 7.1

mood and energy in the post-intervention week (See figure 2.2). The black arrowed lines (Nugent

Method, Engel and Schutt, 2009), suggest that mood and energy levels were positively trending and

potentially would have continued to increase if the case study was to continue for consecutive

weeks. It is clear from the collated data from the participant’s food diary that there is correlation

between breakfast consumption and the increase of mood and energy levels. However it should also

be noted that on both Monday’s, regardless of breakfast consumption, the participant’s mood and

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energy levels were considerably at their lowest on this day in both the baseline and post-

intervention week, suggesting an outlying influence on the impact of energy and mood levels.

Figure 2.2

(Dotted lines represent mean lines)

Discussion

The results of the current study support the hypothesis that by implementing a behavioural

intervention designed to increase breakfast consumption will cause mood and energy levels of the

participant to also increase.

It is evident that the behavioural intervention using operant conditioning as a means of

rewarding desirable behaviour i.e. increasing breakfast consumption, the participant successfully

maintained breakfast consumption during the post-intervention week (see figure 1.1 and 1.2). The

participant was rewarded with indulgences as determined by the CSIRO 12345 Food and Nutrition

Plan (appendix 2) or extra TV privileges/Internet usage to encourage breakfast consumption on a

regular basis. The indulgences were in forms of extra servings of food, a glass of wine, or a sweet.

CSIRO 12345 Nutrition Plan suggests that up to 2 indulgences a day is the maximum allowed without

affecting or changing the diet in a negative way. This was an effective tool to encourage the

participant to increase the frequency of breakfast consumption but also to maintain the practice

over the post-intervention week.

Mood and energy levels increased in average from a mean of 6.1 in the baseline week to 7.1 in

the post-intervention week, which suggests that increasing the consumption of breakfast has an

impact on the mood and energy levels of the participant. However, the two of the lowest recordings

of mood and energy both were on a Monday regardless of breakfast consumption. which This

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suggests that there are possible outlying factors that contribute to mood and energy levels rather

than just focusing on breakfast consumption. Sleep, exercise, or work may be common variables that

cause varying results in mood and energy levels. The trend lines on the data (figure 2.1) suggest that

mood and energy levels were trending positively which further suggests that it is possible that the

increase of mood and energy levels may have continued to increase or stabilize at a higher average if

the study was continued for further weeks. Previous studies conducted by Affenito (2007), as well

as, Benton and Jarvis (2007) and Wesnes, Pincock, Richardson, Helm and Hails (2003) also support

that the consumption of breakfast plays an important role in cognitive and psychological functioning.

The students in those studies were also reported to increase in their functioning when consumption

of breakfast was consumed on a regular basis. Smith, Clark, and Gallagher (1999) specifically focused

on breakfasts that were high in carbohydrates and their impact on mood and functioning of various

individuals. It was also found that mood increased significantly earlier when consuming breakfast

cereals versus the alternative of caffeine increasing mood at a slower rate (Smith, Clark, & Gallagher,

1999).

There are certain limitations to the AB design of this case study. The AB design is limited

because it is only a snapshot of the study that needs to be investigated more thoroughly to

determine any further trends in patterns of mood and energy levels versus breakfast consumption. It

is apparent in the current data that the trend lines were trending positively in the post-intervention

week however it is impossible to determine whether this increase would continue or if it was also an

outlying factor that caused the increase in mood and energy levels. Furthermore, operant

conditioning may not be a sustainable or necessarily the healthiest way to maintain breakfast

consumption. The case study focused on rewarding positive behaviour with indulgences in food and

TV privileges however increasing indulgences into the diet on a regular basis may become harmful in

the future (Morrison, Bennet, Butow, Mullan & White, 2012).

The design is also based on one participant which limits the outcome of the results. A cross

section of randomly selected participants both male and female would be a more accurate and fairer

way to conduct a study of this nature. For future studystudies, a relevant suggestion would be to

also include various groups that measure different breakfast compositions i.e. fruit versus dairy

versus cereals to establish is there is any variation between the different types of breakfast that are

consumed by individuals and their impact on mood and energy levels among the participants.

Ingwersen, Defeyter, Kennedy, Wesnes, and Scholey (2006) as well as a study conducted by

Mahoney, Taylor, Kanarek & Samuel (2004) both suggest effects on the differences of breakfast

compositions versus energy and mood levels, however their studies aren’t an in depth when

considering a study testing various groups of food. It is evident that further research is required

when identifying the benefits of breakfast consumption and the consequences of mood and energy

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levels. It would be pertinent to assume that a study of this nature would require monitoring over

several weeks or months to achieve accurate data.

Wrap-up statement/conclusion..

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References

Affenito, S. G. (2007) Breakfast: A missed opportunity. Journal of the American Dietetic

Association. 107(4) 565 – 569

Benton, D., & Jarvis, M. (2006). The role of breakfast and a mid-morning snack on the ability of

children to concentrate at school. Physiology and Behaviour. 90(2007) 382 – 385

Burchard, J., & Tyler Jr, V. (1964). The modification of delinquent behaviour through operant

conditioning. Behaviour Research and Therapy. 2(2-4), 245 – 250

Caltabiano, M. L., Sarafino, E. P., & Byrne, D. (2008) Health psychology biopsychosocial

interactions (2nd ed.). Milton, Queensland. John Wiley and Sons Australia.

Engel and Schutt (2009). The practice of research in social work. (2nd ed). Chapter 7: Single

Subject Design, 206-246

Ingwersen, J., Defeyter, M. A., Kennedy, D. O., Wesnes, K. A., & Scholey, A. B. (2006). A low

glycaemic index breakfast cereal preferentially prevents children’s cognitive performance from

declining throughout the morning. Journal of Appetite. 49(3) 240 – 244

Mahoney, C. R., Taylor, H. A., Kanarek, R. B., & Samuel, P. (2005). Effect of breakfast

composition on cognitive processes in elementary school children. Journal of Physiology and

Behaviour. 85(3), 635 – 645

Mazur, J. E. (2002). Learning and Behaviour (5th ed.). Upper Saddle River; NJ US: Pearson

Education

Morrison, V., Bennett, P., Butow, P., Mullan, B., & White, K. (2012). Introduction to health

psychology in Australia (2nd ed.). Frenchs Forest, Australia: Pearson Education

Powell, R. A., Symbaluk, D. G., & Honey, P. L. (2009) Introduction to learning and behaviour (3rd

ed.). Davis Drive, Belmont CA USA, Wadsworth.

Rampersaud, G. C., Pereira M. A., Girard, B. L., Adams, J., & Metzl, J. D. (2005). Breakfast

habits, nutritional status, body weight, and academic performance in children and adolescents.

Journal of the American Dietetic Association. 105(4150) 743 – 760

Smith, A. P., Clark, R., & Gallagher, J. (1999). Breakfast cereal and caffeinated coffee: effects on

working memory, attention, mood, and cardiovascular function. Journal of Psychology and

Behaviour. 67(1), 9 – 17

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Wesnes, K. A., Pincock, C., Richardson, D., Helm, G., & Hails, S. (2003). Breakfast reduces

declines in attention and memory over the morning in schoolchildren. Appetite Journal. 41(2003)

329 – 331

Willett, W. C. (1994). Diet and health: What should we eat? Science Journal. 264(5158), 532 –

537. doi: 10.1126/science.8160011

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Appendix 1: Food Diary

Participants Food Diary – Baseline Week

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Time Thursday13/03/2014

Time Friday14/03/2014

Time Saturday15/03/2014

8:00am 1 serve cerealBoyfriend’s HouseAloneGetting Ready for Uni3.5/10

7:00am 1 serve blackcurrant juiceAt Parent’s houseAlonePost-Walk7/10

8:30am 1 serve cerealParent’s House with MumBreakfast7/10

9:00am 1 600mL bottle of waterIn class, at uni7/10

10:30am 1 hot cross bunParent’s House with Dad7/10

1:00pm 1 serve pumpkin soup1 slice sour dough breadAt Parent’s house with DadLunch Time8/10

12:00pm 1 serve pumpkin soupBoyfriends HouseWith LucasGetting ready for pilates4.5/10

12:00pm 1 serve pumpkin soupParent’s house with Mum and Dad7/10

1:30pm 2 x 10g malteaser easter eggsWith Dad

Watching TV8/10

3:00pm 1 hot dog with mustard, cheese and sauceIn the car, travelling2/10

2:00pm 2 fillets of battered garfish1 serve green salad1 fresh juiceAt Café Zest with Kelly and Jade7/10

7:30pm 1 serve chicken schnitzel1 serve mashed potato1 serve stir fry vegAt Parent’s house with Mum and Dad8/10

6:30pm 1 cheesymite scrollParent’s HouseWatching TV7/10

4:30pm 1 slice of pizza breadParent’s house AloneGetting ready for work6/10

7:30pm 1 serve brown rice1 serve chicken tomato casseroleAt Parent’s houseWith Parents7/10

9:00pm 2 crackers with blue cheeseat Work4/10

Time Sunday16/03/2014

Time Monday17/03/2014

Time Tuesday18/03/2014

Time Wednesday19/03/2014

8:00am 1 serve cerealParent’s HouseGetting ready for work7/10

11:00am 1 x LCM Snack Barat Boyfriend’swith Lucasgetting ready for uni5/10

12:00pm 500mL smoothieBanana, Peach, Strawberry, Spinach and Blueberry1 serve minestrone soupAt HomeStudying6/10

10:30am 1x Le Snackat HomeAloneGetting ready for Pilates7/10

12:30pm 1 cheese and bacon sausage roll1 litre waterIn car, alone7/10

1:00pm 1L waterat uniIn lecture5/10

3:30pm 1 toasted wholemeal sandwich with cheese and tomato1 600mL bottle of waterAt Uni, Alone6/10

12:00pm 50g smoked cheese10 x strawberries3x honey nut biscuits1 glass waterAt HomeWatching TV7/10

3:00pm 1 small bag of BBQ chipsAt Boyfriend’s housewith Lucaswatching TV5/10

3:00pm 2 x LCM Golden Joysat Boyfriend’s HouseAloneGetting ready for Pilates5/10

4:30pm 2 x apricot and yoghurt muesli barsat Uni, AliciaStudying7/10

2:30pm 5 x blackberries5x raspberries200mL waterAt Uni, AlonePreparing for Tute7/10

4:00pm 1 6 inch subway1x small sprite1x cookieBoyfriend’s houseWith LucasWatching TV5/10

5:00pm 20 x shapes (cheese and bacon flavour)1 glass waterLucas’ House with LucasWatching TV6/10

8:00pm 1 serve chicken cacciatore1 serve white rice1 serve white wineAt HomeWith Bec, Hugh and BradWatching TV, Dinner Time8/10

4:00pm 2x honeynut biscuits200mL waterAt UniWith Claire and CaitlynIn class7/10

6:00pm 1 serve butter chicken1 serve plain rice1 serve naan breadWith LucasWatching TV7/10

7:00pm 1 tangello1 serve tortellini with chilli rosa sauceAt Home, with BradDinner Time8/10

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Participant’s Food Diary Post-Intervention(Yellow Highlight Indicates Reward/Operant Conditioning)

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Time Thursday20/03/2014

Time Friday21/03/2014

Time Saturday22/03/2014

8:00am 5 serves of strawberries5 serves of blackberriesAt Lucas’ HouseAlone7/10

9:30am 1 150g serve passionfruit yoghurt12 strawberries1 BananaWith Lucas, at Lucas’ Housestudying8/10

7:30am 2 x crumpets with honeyAt parent’s houseGetting ready for work7/10

10:30am 1 banana8 strawberriesLucas’ HouseStudying7/10

1:30pm 1 serve beef casserole1 serve white rice1 serve vegetablesAt Lucas’ with Lucas7/10

10:30am 2x breakfast sausages1 danishAt work, with co-workers7/10

2:30pm 50g smoked cheesewater crackersat Home, AloneWatching TV7/10

5:00pm 1 slice pizza breadAt Parent’s House with MumWatching TVGetting ready for work6/10

1:30pm 1 x multigrain whole meal roll with saladAt parent’s house with dadLunch time8/10

3:30pm 1 serve minestrone soupAt Home, AloneStudying6/10

4:00pm 1 glass tonic water1 chocolate barAt Parent’s HouseWith DadWatching TV7/10

6:30pm 1 standard glass red wineAt Home, With LucasCooking Dinner7/10

7:00pm 1 serve chicken casserole1 serve brown rice1 serve vegetables1 wholemeal bunAt Parent’s House with DadWatching TV7/10

7:30pm 1 serve beef casserole1 serve white rice1 serve vegetablesAt Home, with Brad, Hugh, Bec and Lucas8/10

Time Sunday23/03/2014

Time Monday24/03/2014

Time Tuesday25/03/2014

Time Wednesday26/03/2014

7:00am 6x strawberries1 cup English BreakfastAt Parent’s House AloneGetting ready for work7/10

9:30am 1 x 150g passionfruit yoghurtat Lucas’ HouseWith LucasGetting ready for Pilates6/10

8:00am 1 banana1 glass waterLucas’ houseWith Lucas7/10

10:00am 1 cheesymite scrollAt uniStudying8/10

10:30am 2 x breakfast sausages1 DanishAt work with co-workers7/10

3:00pm 1 6inch subway1 small sprite1 cookieAt Lucas’s houseWith Lucas4/10

11:30am 2 slices banana cakeAt Lucas’ houseWith Lucas7/10

12:30pm 1 serve cheese and crackers1 muesli barAt uniStudying8/10

5:00pmOnwards

1 corona1 glass red wine15 crackers with various cheeseVarious fruit1 chocolate brownieAt Bella’s HouseFarewell Party8/10

7:30pm 2 chicken sausages 1 serve vegetables1 serve potatoesAt Lucas’ house7/10

6:00pm Tapas – Mac N Cheese Balls1 serve chicken schnitzel1 glass lemonadeAt TivoliWith Guy, Matt, Skyla, Lucas. 7/10

7:00pm 1 serve chicken breast1 serve steamed vegetablesAt Lucas’ house with his parents7/10

10:00pm 1 slice banana cakeAt SquashWith Lucas and Team Mates7/10

8:30pm 2 slices banana cakewith Lucasstudying6/10

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Appendix 2: CSIRO 12345 Food Plan

What are the food groups and serve sizes?When we talk about the various food groups and serve sizes, we mean the following....

Breads and Cereals (five or more serves a day)Most breads and cereals provide some dietary fibre, protein and a wide range of vitamins and minerals but wholegrain or wholemeal varieties provide the most. Those with lower salt and sugar content are a better choice.An allowance is made of about one level teaspoon of polyunsaturated margarine for each slice of bread. This will amount to 1-2 tablespoons of fat per day. If this is not used then a similar amount of fat or oil could be used in cooking or salad dressing.

Zinc, iron, salt, protein, complex carbohydrate,B vitamins, magnesium, folate, fibreSAMPLE SERVES1 slice bread 1 cup cooked pasta or noodles1/2 large bread roll or 1 small roll 1 cup breakfast cereal (30-40g)4-5 crispbreads 1/2 cup cooked porridge1 english muffin / scone 1/3 cup muesli

How many serves of breads or cereals should I have each day?5 serves5 serves will be adequate if you are elderly and inactive, very small and inactive or trying to lose weight. There is little room for indulgences if your energy needs are generally this low (about 1200 - 1400 calories, 5 500 - 6 000 kilojoules). The breads /cereals should be wholemeal or wholegrain.

7 - 8 serves7 - 8 serves will be needed by the average woman who is moderately active, by smaller, inactive men or by primary school children (average energy intake of 1600 - 1900 calories, 7 000 - 8 000 kilojoules a day). Most of these cereal / bread serves should be wholemeal but two or three can be refined (eg. white rice, bread or pasta).

9 -12 serves9 - 12 serves will be required for the average man who is moderately active, teenagers, and taller or highly active women (average energy intake 2 000 - 2 400 calories, 8 500 - 10 000 kilojoules). Most of the serves should be wholemeal but two or three can be refined

Vegetables (four serves a day)

This should include vegetables, raw or slightly cooked, without added fats. Frozen vegetables are fine but avoid vegetables canned in brine. At least one serve should come from each of the starchy, dark greenleafy or cruciferous, orange-yellow and other types as listed. Starchy vegetables are particularly good for complex carbohydrates. The dark green-leafy or cruciferous vegetables contain cancer-protective factors and folate (a B vitamin). The orange-yellow vegetables provide Vitamin A and other vegetables provide a range of vitamins, minerals and fibre.

Folate, vitamin A, complex carbohydrate, vitamin C, iron, fibreSAMPLE SERVES (one serve from each group) - Vegetables

Starchy1 medium potato or yam1/2 medium sweet potato1 medium parsnip

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Orange Yellow1/3 carrot or pumpkin1/2 medium sweet potato

Dark Green-Leafy orCruciferous1/2 cup cabbage, spinach, silverbeet, broccoli, cauliflower, brussels sprouts

Other Vegetables1/3 cup broad beans, peas, green beans, lettuce, zucchini, mushrooms, tomatoes,capsicum, cucumber, sweetcorn, turnips, swede, sprouts, celery, eggplantAs for all other food groups, additional serves of vegetables can be eaten as "extras".

Fruit (three serves a day)This includes raw, stewed or canned varieties. Fruit juice does not usually provide the same fibre as whole fruit and is not as filling. Dried fruits lose much of their vitamin C, so we recommend no more that one serve per day be taken as fruit juice or dried fruit. When using stewed or canned fruit, try to use those that are low in or have no added sugarsRemember that the skin on fruit can be a useful source of fibre.

Folate, vitamin C, fibre, natural sugars, magnesium, vitamin B6SAMPLE SERVES - Fruit

1 piece medium sized fruit(apple, orange, mango, mandarin, banana, pear, peach etc.)

3 pieces smaller sized fruit(apricots, plums, kiwi-fruit, figs etc)

1/4 medium sized melon(rockmelon, honeydew)

dried fruits / fruit juice(only one serve per day can count as a fruit serve)4-6 pieces of dried fruit2 tablespoons sultanas / raisins1 small glass of fruit juice (120mls)

Small fruits1 cup berry fruits (eg raspberries)20 grapes or cherries10 strawberries

Milk and milk products (two serves a day)This includes milk, cheese and yoghurt which you need for your calcium requirements, and the best choice is low fat.

Some low-fat cheeses such as cottage and ricotta are low in calcium so they cannot be counted as a milk or milk product serve but they can be used as an "extra". If you want a low-fat cheese which still has a good calcium content and therefore count as a milk serve, look for the cheddar-type cheeses with less than 10% fat.

Milk, yoghurt and cheese are the easiest way to obtain calcium, though there are other sources.If you cannot eat or are allergic to dairy foods you should seek advice from a dietitian as to alternative sources of calcium. If you simply do not like the taste, try adding milk or milk powder to soups and casseroles or eating custards, rice pudding or other milk based desserts.

Zinc, calcium, cholesterol, protein, salt, fatsSAMPLE SERVES - Dairy

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1 large glass milk (300 ml), or calcium-fortified soy milk40g (just over 1 oz) cheese200g carton yoghurt (plain or fruit)Note: Pregnant women, post menopausal women and teenagers need one extra milk serve each dayf or extra calcium and protein.

Meat and alternatives (one serve a day)The best selection from this group is lean red meat. Red meat substitutes such as poultry, fish, eggs and legume (eg. beans, chick peas and lentils) do not provide the same amount of zinc and iron as red meat.

If you want to use the alternatives to red meat regularly (ie. more than 2-3 times a week), you will need to ensure that you get enough iron and zinc in your diet by making your bread and cereal choices mainly wholegrain or wholemeal.

Iron, protein, cholesterol, zinc, vitamin B12SAMPLE SERVE60-100g (cooked weight) lean beef, lamb or pork(e.g. 1/2 cup lean mince, 2 small or 1 large lamb chop, 2 slices of roast meat)OCCASIONALLYTwo eggs2/3 cup cooked dried beans or lentils or chick peas100g fish, seafood or poultry60-100g liver or kidneyThe meat should be trimmed of fat and cooked without extra fat if possible (e.g. grilled, dry roasted or microwaved).Note: Pregnant women and teenagers need one extra meat serve each day for extra iron, zinc and protein.

Indulgences or extras (no more than two serves a day)Where do cakes, chocolate, pies and pasties fit in to all this?For most people, if you eat according to the 12345+ Food and Nutrition Plan there is still room to indulge yourself a little in some of those foods and drinks often found on the nutritionists' "forbidden" lists. We have called these "indulgences". If you prefer you can have "extra" serves from foods in the main food groups instead.Most people can have, on average, up to two indulgences a day without seriously affecting the quality of their diet.

Salt, fats, refined sugars, alcoholONE INDULGENCE (approx. equal to 150 calories; 600kj)2 standard glasses of an alcoholic drink, soft drink or cordial1 medium piece of plain cake or 1 bun1 small piece of rich cake or sweet pastry2-3 sweet biscuits30g toffee (5 toffees) or nuts (1 heaped tablespoon)60g jam, honey (1 tablespoon)40-50g processed meats or pate 30g potato crisps or similar snack (about 1 small packet)2 scoops icecream 1 meat pie = 3 indulgences1 pasty = 3 indulgences 1 sausage roll = 2 indulgences1 slice pizza (120g) = 2 indulgences 1 chocolate covered bar = 2 indulgences

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Appendix 3.1: Intervention Interview Schedule

Behaviour Modification

Classical and operant conditioning techniques can be used to develop a behaviour modification program. You can begin this process by completing a diary for a week or so and record your usual behaviour. You can then determine aspects of your behaviour that may need to be modified, and the circumstances surrounding the behaviour (i.e. where you were, who you were with, how you felt). When you reflect on your behaviour diary it may become clear that certain people, situations or feelings appear to be cues or stimuli for the target behaviour. You can then engage in stimulus control (i.e. remove or reduce the stimulus). For example, if you always smoke when you are at the pub – avoid going to the pub for a while. Using a program of reinforcement, you can strengthen your stimulus-control approach. For example, if you do not go to the pub for 1 week, you can buy yourself a present or some new clothes. Alternatively, you could set up a token economy, awarding yourself a certain amount of points per positive step, and reward yourself upon reaching a threshold amount. You can also modify a particular behaviour by changing the sequence of events that typically lead to its occurrence, disrupting the stimulus-response pattern. Another approach involves engaging in incompatible behaviour. For example, if you become aware that you usually smoke while you are watching television, arrange to do something else with your hands (e.g. knitting, holding onto a cushion). Behaviour modification goals should always be specific and attainable.

Interview Questions

Substitute “health behaviour” for your target behaviour:

1. How do you feel about your situation/health issue (ie smoking, drinking, levels of exercise etc)?2. In what situations does your health behaviour occur?3. What are you thinking/feeling/doing just before and after the health behaviour?4. What are the factors that maintain your health behaviour?5. Have you attempted to do anything about your health behaviour, if yes how and when?6. How does your social network influence your health behaviour?7. What are the benefits of you changing your behaviour?8. What are your future health goals surrounding your drinking behaviour/levels of exercise/levels

of smoking/reducing your feeling of fatigue/weight/levels of stress/negative thinking?9. What ideas do you have about how you could you work towards achieving that goal?10. How committed are you to improving your situation?11. What do you think will be the losses associated with changing your health behaviour?12. How would you maintain your health behaviour after the intervention (optional)?

Developing a Behaviour Modification Program

In pairs, using the following schedule, use the main headings to help your partner to develop a behaviour modification program using these headings as a guide.

Sections (3) and (4) are based on classical conditioning principles and section (5) is based on operant conditioning principles:

(1) Baseline data – Behavioural ABCIdentify a target behaviour that you would like to modify and describe the:Antecedents to the behaviour Behaviour requiring modificationConsequences of the behaviour

Use your diary to help you do this.

(2) Cues or Stimuli

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Based on your diary and your ABC, identify what people, situations, feelings or actions cue, or act as stimuli for, the target behaviour.

(3) Stimulus ControlAttempt to control the stimuli by reducing or removing them

(4) Behavioural ControlDisrupt the stimulus-response patternEngage in incompatible behaviour

(5) Rewards and/or punishmentsIdentify rewards and/or punishments for your behaviour

(6) EvaluationEvaluate your experience – do you feel the program was successful/unsuccessful? Why? Can you think of ways to improve your program?

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Appendix 3.2: Behaviour Modification Interview Transcript

1. How do you feel about your health issue/healthy eating?

Answer: I noticed that I eat unhealthy foods when I am tired and that I am tired because I eat unhealthy food. I also skipped breakfast 3 days out of 7 and I wish to change that.

2. What are the benefits of healthy behavior?

Answer: I will be more alert and have more energy to perform everyday tasks at optimal functioning level. I also believe that if I eat healthier in the morning, it will ward off any unwanted bad health choices later in the day.

3. What are some of the goals that you are wishing to achieve?

Answer: increase the intake of energy foods, particularly breakfast consumption instead of opting for high sugar alternatives which result in a ‘crash’. I wish to increase the frequency of my breakfast consumption in order to lower bad choices and to increase my energy levels during the day.

4. What ideas do you have about achieving these goals?

Answer: introduce high energy foods, particularly for breakfast. I think a reward system would be beneficial for me as there are some foods and activities that I enjoy doing but aren’t necessarily 100% healthy behaviors i.e. watching TV or eating an indulgence.

I am mostly at home when I skip breakfast therefore I need to ensure that I always have breakfast alternatives on hand or eat in the company of someone else.

5. What are some rewards or punishments (operant conditioning) that can be identified to increase desirable behavior or decrease undesirable behavior?

Answer: I enjoy watching TV or DVD which I try to avoid, therefore it would be a good reward for desirable behavior or I could pair the behavior of eating breakfast with watching TV. I enjoy the occasional glass of wine, chocolate bar, or delicatessen cheese. It would be beneficial if I chose to only have these novelty items if a healthy breakfast has been consumed earlier that day. A punishment would be removing these rewards if the desired behavior wasn’t achieved for that day.

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