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\title{Knowledge, Attitude and Practices Regarding Consumption of Carbonated Beverages among School Children Residing in New Delhi and Ghaziabad}
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             \author[1]{Nitya  rai}

             \author[2]{Meera  Sandhu}

             \author[3]{Vinod  Sachdev}

             \affil[1]{  ITS-CDSR Muradnagar, Ghaziabad}

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\date{\small \em Received: 7 April 2015 Accepted: 3 May 2015 Published: 15 May 2015}

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\begin{abstract}
        


The aim of the study was to assess the Knowledge, Attitude and Practices regarding consumption of carbonated drinks among school children, of different socio-economic group.Material and Method: 350 students in the age group (8-17 yrs.) were included in the study, divided into two groups based upon their socio-economic status. Self-structured objective type questionnaire containing 11 questions, were prepared and distributed.Stastical Analysis Used: The data was analysed statistically using Pearson Chi-Squares test.Results: Children of upper income group had more knowledge regarding ill effects of beverages as compared to lower income group (p<0.05). Beverages were more popular among upper income whereas milk was favorite among lower income group (p<0.001). In upper income group taste was the most influencing factor for the choice of the drink whereas in lower income friends and family were (p<0.001).

\end{abstract}


\keywords{carbonated beverages, erosion, school children.}

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\let\tabcellsep& 	 	 		 
\section[{I. Introduction}]{I. Introduction}\par
n today's world, consuming sparkling beverages has become a trend. As an undesirable increase in the ease of availability of these soft drinks its consumption has drastically taken a leap over the past few years. Fluid consumption patterns of children are now more diverse compared to the past years, as carbonated soft drinks and fruit juices have replaced the consumption of water and milk.\par
These carbonated drinks consist of water, carbon dioxide, color, additives and preservatives. In a tropical country like India, which has torrid summers, there is substantial market for aerated soft drinks. The per capita consumption of carbonated drinks in India is about \hyperref[b3]{4} bottles per year, which is less compared to the other developing countries such as Pakistan, Bangladesh, Egypt, and extremely less compared to USA where it is 350 bottles \hyperref[b0]{1} . Indian market consists of cola products and non-cola products of which the cola segment constitutes 62\%, non-cola segment is bagged with 30\% and energy drinks segment is 8\%. Furthermore, the urban areas report a dramatically high consumption of aerated drinks as compared to rural areas, where Delhi is on the top of the list for Carbonated Soft Drink consumption \hyperref[b1]{2} .\par
The excess consumption of these carbonated beverages is creating havoc in teenage population as it contains no essential nutrients and harms their general as well as oral health. Consumption of carbonated soft drinks may be a key contributor to the epidemic of obesity, as consuming more energy than the body requirement leads to weight gain due to the body storing excess energy as fat. Intake of these drinks may also lead to tooth decay 3 and dental erosion \hyperref[b3]{4} . High consumption of carbonated soft drinks during adolescence may reduce bone mineral accrual and increases fracture risk \hyperref[b4]{5} . Another observed repercussion of consumption of these empty calories is hyperacidity, leading to erosion of stomach lining, characterized by stomach ache. These symptoms are caused by caffeine and acids found in these "sweet demons" such as acetic, fumaric, gluconic and phosphoric acid \hyperref[b5]{6} .\par
It is an area of growing concern, as consumption of these drinks has markedly increased and they are capable of producing a large number of ill effects on oral and general health of the younger population. Hence, the present study was undertaken to assess the knowledge, attitude and practices (KAP) of school students toward carbonated drinks consumption. 
\section[{II. Material and Methods}]{II. Material and Methods}\par
A Self-Structured objective type questionnaire was prepared for collection of data. Approval was taken from Ethical committee of the institution.\par
This study was conducted among school going children aged between 8 and 17 years. The total number of students included were 350 (200: males and 150: females), which were divide into two groups based upon 
\section[{III. Results}]{III. Results}\par
Table  {\ref 1} : Knowledge of students regarding consumption of carbonated beverages Table  {\ref 1}: 100\% from Group I and 97.7\% from Group II had heard about carbonated beverages, but still 2.3\% in Group II were still unaware about carbonated beverages (p=0.061). 82.9\% from Group I and 71.7\% from Group II knew that consumption of these beverages is harmful for teeth and still 17.1\% from Group I and 28.3\% from Group II thought that they don't cause any harm to oral health and difference was highly significant (p=0.015). 95.4\% from Group I and 78.1\% from Group II knew that consuming these beverages is bad for general health though 4.6\% from Group I and 21.9\% from Group II considered it to be good for health(p<0.001). there socio-economic status using kuppuswamy's socio-economic status scale \hyperref[b6]{7} . Group I-175 children from upper socio economic group.\par
Group II-175 children from lower socio economic group. Sample size was calculated using Random (non-cluster) sampling. n = Z 2 P (1-P)/d 2 Z =95\%, P= 0.65 and d= 0.05 A signed consent was taken from the parents of the students who were included in the study. A questionnaire containing 11 questions was prepared for data collection. 350 questionnaires were distributed to the school students. The respondents were then asked to tick the most appropriate correct answer from the given list of answers according to them, in order to assess their knowledge, attitude and practice regarding the consumption of carbonated beverage. Questionnaire was prepared to assess whether they knew, that these carbonated beverages have ill effects on oral and general health. Did they enjoy drinking carbonated beverages and what would they choose if given choice among cold drink, fruit juice, milk and maza /slice. Factors which influenced the choice of drink such television, easy availability in the market, color and taste of the drink, or family and friends was also assessed. How much of the amount, frequency of consumption, where did they preferred to consume, and which was there favorite among those available in the market was questioned. The obtained results were subjected to statistical analysis using Pearson Chi-Square test SPSS version 16.  \hyperref[tab_2]{3}: Those belonging to Group I were more influenced by taste 52.3\% compared to other factors i.e color 17.8\%, market 8\%,T.V 7.5\%, whereas in Group II family 40.2\% and taste 21.3\% influenced choice of drink more in comparison to market 18.4\%,T.V 14.4\% (p<0.001). Children in both the Groups preferred to drink a glass 50.9\% in Group I and 76\% in group II (p=0.113). Group I students preferred to drink on a weekly basis 44\%,whereas in Group II weekly consumption was 38.6\%, and daily was 21.1\% which was high compared to Group 1 being 11.4\% (p<0.001). Coke29.3\%was the most favorite among Group 1 and thumbs-up 24.6\% among group II (p<0.001). Those in Group I preferred to drink when they were out 58.9\% as compared in Group II as they preferred to drink when at home 48.6\% (p<0.001). 
\section[{IV. Discussion}]{IV. Discussion}\par
A questionnaire study was undertaken, as it allows to collect a lot of information and data from a large number of respondents in a short span of time. Aerated beverages are an important sector in the country because it not only contributes to export earnings of the country, but also acts as a revenue driver for other industries such as glass, refrigeration, transport, paper and sugar. This segment is universal in its demand, catering to all income groups and agebrackets \hyperref[b7]{8} . Consumption of these carbonated beverages is becoming a major factor for health issues faced by the future generation.\par
In the study it was found that majority of the school children in both the groups had heard about cold drinks. But regarding knowledge of its ill effect on teeth, the upper socio-economic group had (82.9\%) more knowledge, as compared to lower socio-economic group (71.1\%) (Table  {\ref 1}). The area of concern is that their deleterious association with human teeth induces demineralization causing erosion of enamel due to their high acidic pH which ranges between 2.5-3.4. During demineralization, calcium and phosphorus are removed from the enamel which eventually leads to loss of outermost layers of the enamel causing sensitivity, other is tooth decay caused by sugar content as high as 10 tea spoons of sugar in every 250ml of this toxic elixir in the younger age group.\par
The finding of the study depicts that, carbonated drinks (34.3\%) and fruit juices (36.0\%) were more popular in the upper income group, and milk (38.3\%) and fruit juice (34.9\%) in the lower income group (Table \hyperref[tab_0]{2}). Popularity of these "sparkling beverages" is still more in upper socio-economic group, as children belonging to lower income group preferred milk and fruit juice more over the carbonated beverages.\par
Weekly consumption was common in both the group's i.e. upper socio economic group (44.0\%), and lower socio economic group (38.6\%)(Table \hyperref[tab_2]{3}). Not only the frequency, but the method of drinking also plays an important role, as holding the drink in the mouth before swallowing leads to the most pronounced pH drop followed by the long-sipping method \hyperref[b8]{9} . Most of the Volume XV Issue II Version I Year 2015 ( ) J children in the upper income group were influenced by taste (52.3\%) and color (17.8\%) of the drink, while those belonging to the lower income group were more influenced by parents (40.2\%) at young age which is in agreement with the findings of Grimm et al. (2004)  \hyperref[b9]{10} . Soft drink companies use a wide variety of marketing techniques to increase their sales. These techniques include easy accessibility in a wide variety of venues including schools, heavy media advertising as pre-teens and young adults are more vulnerable to get influenced by such factors. People who consume sugary drinks regularly i.e one to two cans a day or more have a 26\% greater risk of developing type 2 diabetes than people who rarely have such drinks \hyperref[b10]{11} . According to a study, people who increased their sugary drink consumption by one 12-ounce serving per day gained more weight over time approximately an extra pound every four years than people who did not change their intake \hyperref[b11]{12} . Surprisingly in the study it was seen that influence of parental soft drink intake is more than peer influence, which directly reflects the responsibility of the parents. Parents should be aware that their behavior regarding the consumption of beverages has a great impact on their children's intake habits as well. So, health promotion strategies should be implemented, involving both parents and children. The parents can be helpful in exposing children to healthier drinks available in the market. Studies have shown that the frequent consumption of soft drinks can lead to change in body mass index (Ludwig et al. 2001  \hyperref[b12]{13} , Striegel Moore et al. 2004 \hyperref[b13]{14} . and increase the frequency of obesity in children (Welsh et al. 2005  \hyperref[b14]{15} ), which is becoming a common health issue in children nowadays. This concern is growing by each passing day, as the population of upper income group is adapting to a western lifestyle thereby more affected by adverse health conditions as a consequence. In contrast, the low income group is still fascinated by the traditional Indian diet which is rich in nutrients and has less harmful contents.\par
In the present study, not every student was aware about the hazardous effects of carbonated beverages on general and oral health. Government strategies should be implemented in promoting healthier drinks at a low cost in the market, reducing production of soda drinks and encouraging the future of our nation to adapt to a healthier living as a well-known proverb is "An ounce of prevention is worth a pound of cure" consuming carbonated beverages when they came to know about the hazardous effect of fizzy drinks. Most influencing factors for the choice of their drink were taste (52.3\%) in upper socio economic group and (40.2\%) family in lower socio economic group. So there is a need to, spread awareness among children at a younger age and their parents about the adverse effects of soft drinks, so as to inculcate good oral practices. As the concern is growing, thus it is necessary to provide data to the concerned planning authority, so as they can implement an integrated approach to overcome the plight associated with consumption of carbonated beverages.  
\section[{Volume XV Issue II Version I}]{Volume XV Issue II Version I}\begin{figure}[htbp]
\noindent\textbf{2} \par 
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\caption{\label{tab_0}Table 2 :}\end{figure}
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\begin{longtable}{P{0.03359683794466403\textwidth}P{0.2200592885375494\textwidth}P{0.04535573122529644\textwidth}P{0.05543478260869565\textwidth}P{0.06383399209486165\textwidth}P{0.2385375494071146\textwidth}P{0.15118577075098813\textwidth}P{0.04199604743083004\textwidth}}
Year 2015\tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep \\
Volume XV Issue II Version I\tabcellsep Questions Have you heard about cold-drinks Do you have any idea if it has Bad Effects On Teeth Do you think having these cold-drinks is\tabcellsep \multicolumn{2}{l}{Responses Yes No Yes No Good for health Bad for health}\tabcellsep \multicolumn{2}{l}{Group I N (\%) 175(100\%) 0(0\%) 145(82.9\%) 30(17.1\%) 8(4.6\%) 167(95.4\%)}\tabcellsep Group II N (\%) 170(97.7\%) 4(2.3.\%) 124(71.7\%) 49(28.3\%) 37(21.9\%) 132(78.1\%)\tabcellsep p-value 0.061 0.015 < .001\\
( )\tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep \\
\tabcellsep Questions\tabcellsep \tabcellsep Responses\tabcellsep \tabcellsep Group I\tabcellsep Group II\tabcellsep P-value\\
\tabcellsep \multicolumn{2}{l}{Do you enjoy having Cold-}\tabcellsep Yes\tabcellsep \tabcellsep 158(90.8\%)\tabcellsep 140(81.4\%)\tabcellsep 0.013\\
\tabcellsep drinks\tabcellsep \tabcellsep No\tabcellsep \tabcellsep 16(9.2\%)\tabcellsep 32(18.6\%)\\
\tabcellsep \multicolumn{2}{l}{If Asked To, Would You Stop}\tabcellsep Yes\tabcellsep \tabcellsep 41(23.4\%)\tabcellsep 65(38.9\%)\tabcellsep < .001\\
\tabcellsep Drinking Cold-drinks\tabcellsep \tabcellsep No\tabcellsep \tabcellsep 53(30.3\%)\tabcellsep 66(39.5\%)\\
\tabcellsep \tabcellsep \tabcellsep May-be\tabcellsep \tabcellsep 81(46.3\%)\tabcellsep 36(21.6\%)\\
\tabcellsep \multicolumn{2}{l}{What Would you choose out}\tabcellsep Fruit Juice\tabcellsep \tabcellsep 63(36\%)\tabcellsep 61(34.9\%)\tabcellsep < .001\\
\tabcellsep of these drinks\tabcellsep \tabcellsep \multicolumn{2}{l}{Carbonated Drink}\tabcellsep 60(34.3\%)\tabcellsep 6(3.4\%)\\
\tabcellsep \tabcellsep \tabcellsep Maza/Slice\tabcellsep \tabcellsep 41(23.4\%)\tabcellsep 41(23.4\%)\\
\tabcellsep \tabcellsep \tabcellsep Milk\tabcellsep \tabcellsep 11(6.3\%)\tabcellsep 67(38.3\%)\\
\tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep \multicolumn{2}{l}{they might when asked to (p<0.001). 36\% preferred fruit}\\
\tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep \multicolumn{2}{l}{juice and 34.3\% carbonated beverages in group I while}\\
\tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep \multicolumn{2}{l}{those in group II preferred 38.3\% milk over 34.9\%}\\
\tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep \multicolumn{2}{l}{carbonated beverages(p<0.001)}\end{longtable} \par
  {\small\itshape [Note: J © 2015 Global Journals Inc. (US)other hand in Group II 38.9\% said that they will quit drinking, 39.5\% said they won't, and 21.6\% said that]} 
\caption{\label{tab_1}Table 2 :}\end{figure}
 \begin{figure}[htbp]
\noindent\textbf{3} \par 
\begin{longtable}{P{0.1685820203892493\textwidth}P{0.24184430027803522\textwidth}P{0.19142724745134382\textwidth}P{0.1882761816496756\textwidth}P{0.028359592215013902\textwidth}P{0.03151065801668211\textwidth}}
Questions\tabcellsep Responses\tabcellsep Group I\tabcellsep Group II\tabcellsep P-value\tabcellsep \\
How Do You make the choice\tabcellsep T.V\tabcellsep 13(7.5\%)\tabcellsep 25(14.4\%)\tabcellsep < .001\tabcellsep \\
of Your cold-drink\tabcellsep Easy availability in market\tabcellsep 14(8.0\%)\tabcellsep 32(18.4\%)\tabcellsep \tabcellsep \\
\tabcellsep Colour\tabcellsep 31(17.8\%)\tabcellsep 5(2.9\%)\tabcellsep \tabcellsep \\
\tabcellsep Family \& friends\tabcellsep 18(10.3\%)\tabcellsep 70(40.2\%)\tabcellsep \tabcellsep \\
\tabcellsep Taste\tabcellsep 91(52.3\%)\tabcellsep 37(21.3\%)\tabcellsep \tabcellsep \\
\tabcellsep Other\tabcellsep 7(4.0\%)\tabcellsep 5(2.9\%)\tabcellsep \tabcellsep \\
At a time how much of these\tabcellsep A Glass (100ml)\tabcellsep 89(50.9\%)\tabcellsep 133(76.0\%)\tabcellsep < .001\tabcellsep \\
drinks do you prefer having\tabcellsep A Glass Bottle(200ml)\tabcellsep 36(20.6\%)\tabcellsep 33(18.9\%)\tabcellsep \tabcellsep \\
\tabcellsep Pet Bottle (500ml)\tabcellsep 32(18.3\%)\tabcellsep 5(2.9\%)\tabcellsep \tabcellsep \\
\tabcellsep >500ml\tabcellsep 18(10.3\%)\tabcellsep 4(2.3\%)\tabcellsep \tabcellsep \\
How often Do You Consume Cold-drinks\tabcellsep Daily Every alternate days Weekly Monthly\tabcellsep 20(11.4\%) 18(10.3\%) 77(44.0\%) 60(34.3\%)\tabcellsep 36(21.1\%) 17(9.9\%) 66(38.6\%) 52(30.4\%)\tabcellsep >0.05\tabcellsep Year 2015\\
Which is Your Favourite Drink\tabcellsep Pepsi\tabcellsep 38(21.8\%)\tabcellsep 33(19.3\%)\tabcellsep =0.001\tabcellsep \\
\tabcellsep Coke\tabcellsep 51(29.3\%)\tabcellsep 21(12.3\%)\tabcellsep \tabcellsep \\
When do you like having these drinks Table\tabcellsep Sprite Mirinda Mountain Dew Thumps Up When at home with friends \& family When out with family \& friends When I Feel Thirsty\tabcellsep 26(14.9\%) 21(12.1\%) 18(10.3\%) 20(11.5\%) 53(30.3\%) 103(58.9\%) 19(10.9\%)\tabcellsep 31(18.1\%) 22(12.9\%) 22(12.9\%) 42(24.6\%) 84(48.6\%) 53(30.6\%) 36(20.8\%)\tabcellsep < .001\tabcellsep Volume XV Issue II Version I\\
\tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep )\\
\tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep J\\
\tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep (\end{longtable} \par
 
\caption{\label{tab_2}Table 3 :}\end{figure}
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