Background Obesity is a global public health crisis. Obesity in adolescents tends to track into adulthood. Home dining is one of the preventive measures which can achieve some of the recommended factors that might protect against weight gain and obesity. Therefore, this study aimed to investigate the correlates of home dinner, and the association between home dinner and weight status in Hong Kong adolescent. Methods All data used in this study was adopted from a local study done by the Hong Kong Student Obesity Surveillance (HKSOS) project 2006-2007. For the association between family meal frequency and weight status, multi-nominal logistic regression was used for analysis. For further analysis, significant (p<0.05) correlates and frequency of dining at home were set as independent and dependent variables, respectively. All correlates were adopted in multivariate logistic regression, resulting in crude and mutually adjusted odds ratios for frequency of dining at home. Results In total, 65.7% of subjects had dinner at home at least 4 times per week. More frequent dining at home ( 4 - 7 vs. 0 - 3 times per week ) was correlated with female sex, lower socioeconomic status, smoking, intact family structure, no full time job mothers and her parenting styles. Subjects who had dinner at home more frequently had higher consumption of cereals, vegetables, high fat food, and snack and soft drink. They also reported watching more TV during meals and a greater feeling of fullness after meals. Adolescents with more frequent home dining were 14% ( 95% CI: 0.06 to 0.20 ) less likely to be obese. Conclusions Statistically significant correlations of frequent home dinners with adolescents’ background characteristics and dietary habits were found. Adolescents who had more dinners at home were less likely to be obese. These findings need to be confirmed by prospective studies and interventional studies. / published_or_final_version / Public Health / Master / Master of Public Health

Background: Weight misperceptions are common in adolescents and doctors’ advice may help clarify these misperceptions. Few studies have examined how common physicians assess various weight-related factors, including physical measurements, lifestyle factors, and obesity-related medical risks, based on adolescents’ reports and patient characteristics that predict such assessments. Physicians’ weight comments were associated with weight perception in overweight patients, however, such association was unclear in non-overweight adolescents. Objectives: The present study aimed to 1) examine how common adolescents received weight-related factors from private practitioners; 2) identify factors associated with these assessments; 3) assess how common adolescents received weight comments from private practitioners; 4) examine the association of body weight comments by private practitioners with weight perception in adolescents, intention to do more non-exercise physical activity (NEPA), and perceived risk of chronic disease for being overweight. Methods: In the Hong Kong Student Obesity Surveillance (HKSOS) project, 33692 students (44.9% boys; mean age 14.8, SD 1.9 years) from 42 randomly selected schools completed an anonymous questionnaire. The students were asked whether in the past 12 months any private practitioner (or their nurses) had assessed their height, weight, waist circumference (WC), blood pressure (BP), body mass index (BMI), diet, and physical activity. Students were also asked to report any weight status comments received from private practitioners. Perceived risk of chronic disease for being overweight and intention to do more NEPA were also reported. Weight status was based on self-reported weight and height. Multiple imputation was used to replace missing values. Logistic (or ordinal logistic) regression was used to assess the association between student characteristics and assessment of each weight-related factor, and the association of weight comments with adolescent weight perception, perceived risk of chronic disease, and intention to do more NEPA. Results: Among 13283 students who had doctor consultations in the past 12 months, 37.9% received physical measurements or lifestyle enquiries, with weight (20.8%), height (16.8%) and blood pressure (11.5%) being the most common, followed by diet (8.1%), BMI (6.3%), WC (4.6%), and physical activity (4.6%). In general, adolescents who were female, older, underweight or overweight/obese, had parents with higher education level, and had actively asked private practitioners for advice about weight were more likely to receive assessments of weight-related factors. Less than one-fifth (16.8%) of adolescents received height and weight or BMI assessments. Nearly 3 in 10 (28.7%) adolescents reported receiving weight status comments from private practitioners, of which 59.8% were correct. Correct weight status comments were associated with correct weight perceptions among adolescents regardless of weight status. Being told by a private practitioner that one is too fat was positively associated with perceiving higher risk of chronic disease for being overweight in normal weight and overweight adolescents, and more intention to do NEPA in all adolescents. Conclusions: Weight-related factors in adolescents were infrequently assessed by private practitioners in Hong Kong. Generally, unhealthy weight, higher parental education and advice-seeking by adolescents predicted these assessments. Receiving correct weight comments predicted correct adolescent weight perceptions. Practitioners should routinely assess and advise adolescents on weight status. / published_or_final_version / Community Medicine / Master / Master of Philosophy

Kong, Pik Shan. / Thesis (M.D.)--Chinese University of Hong Kong, 2013. / Includes bibliographical references (leaves 149-178). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web.

Childhood obesity is becoming a challenging issue in China, and parents may playa key role in the development of adolescent obesity. However, the relationships between certain parent-related factors and the development of adolescent obesity are rarely reported in China. Therefore, this study aims to investigate the relationship among Chinese parents' perception of their children's weight, parenting behaviors, parenting style, and adolescents' weight status. Two studies were performed to achieve this purpose. / Key words: adolescent obesity, parenting behaviors, parenting styles / The first study (Chapter 3) examines the validity and reliability of the questionnaires for adolescents and parents; the questionnaires are intended to measure parenting behaviors, parents' perception of their children's weight, and parenting styles in the Chinese context. Several steps were performed. First, the questionnaires were selected based on their validity and reliability, as well as their applicability to the Chinese adolescent and parenting context. Second, the questionnaires were translated into Chinese using a cross-cultural translation technique. Third, five experts were invited to evaluate the content validity and feasibility of the questionnaires for application in the Chinese population. Fourth, 15 pairs of adolescents and their parents were invited to attend a short interview after completing the experimental version of the questionnaires. They were asked to share comments on the readability and cultural relevance of the questionnaire. The questionnaires were then revised according to their feedback. Fifth, 127 pairs of adolescents (10-15 years old) and their parents (Ganzhou: 62 pairs, Shantou: 65 pairs) were recruited to examine the retest reliability and internal consistency of the questionnaires. Sixth, the data collected in the main survey were used to examine construct validity. The result showed that 10 items were excluded because of poor content validity or low intraclass correlation coefficient (&lt;0.7). The internal consistencies of the subscales (ranging from 0.61 to 0.81) were found to be acceptable (Cronbach's alpha >0.6). The goodness-of-fit statistics (RMSEA, CFI, and NNFI) also indicated acceptable fit for the theory models. The results suggest that the validity and reliability of the questionnaires are acceptable, and the questionnaires are applicable to Chinese adolescents and parents in Southern China. / The second study (Chapters 4,5,6) determines the relationships among parenting behaviors, parents' perception of their children's weight, parenting style, and adolescent weight status. A total of 2,143 adolescents and 1,869 parents were recruited from secondary schools in Ganzhou and Shantou in China. The adolescents' weights and heights were measured by trained testers. The dietary habits and physical activity level of the adolescents, as well as parenting behaviors, parenting styles, parents' perception of their children's weight, and demographic information were collected through questionnaires issued to the adolescents and parents validated in Study 1. Several parenting behaviors, including "pressure to eat" and "diet and PA monitoring," were found to be significantly related to adolescents' age and gender-specific BMI Z score (Z-BMI), although the correlation coefficients were low (r ranged from -0.23 to 0.09, p (r ranged from -0.23 to 0.09, p&lt;0.01). The results of the hierarchical multiple regression revealed that "pressure to eat" and "diet and PA monitoring" were the predictors of adolescent Z-BMI. The results of Kappa statistics showed that only a slight agreement exists between parental perception of their children's weights and the adolescents' actual weights (Kappa=0.221, p&lt;0.01). A significant difference in parenting behaviors was found between parents with correct and incorrect perceptions of their children's weight. Compared with the reference authoritative parenting style, the odds of acquiring unhealthy dietary habits were significantly higher for children with authoritarian (Father: OR=1.67, 95%CI: 1.29-2.16; Mother: OR=1.72, 95%CI: 1.31-2.26) and neglectful (Father: OR=2.17, 95%CI: 1.66-2.82; Mother: OR=2.29, 95%CI: 1.76-3.00) parents. The odds of being physically inactive for children with neglectful parents were almost twice than that for children with authoritative parents (Father: OR=2.05, 95%CI: 1.37-3.06; Mother: OR=1.77, 95%CI: 1.18-2.67). Significant differences were found in the parenting behaviors of parents with four different parenting styles. However, no association was found between parenting style and adolescent weight. The data of this study suggest that parenting behaviors are weakly but significantly associated with the development of adolescent obesity. Misclassifications of children's weight status were prevalent among Chinese parents. Parental perceptions of their children's weights were associated with some parenting behaviors related to children's weight development. The adolescents' dietary habits, physical activity, and some parenting behaviors were associated with parenting style. However, there was no direct association between parenting style and adolescent weight. / Wen, Xu. / Adviser: Stanley Sai-Chuen Hui. / Source: Dissertation Abstracts International, Volume: 73-03, Section: A, page: . / Thesis (Ph.D.)--Chinese University of Hong Kong, 2010. / Includes bibliographical references (leaves 130-163). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [201-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract also in Chinese.

by Joan, Fung-yee Chan. / Thesis (M.Phil.)--Chinese University of Hong Kong, 1998. / Includes bibliographical references (leaves 93-99). / Abstract and questionnaire also in Chinese. / ABSTRACT --- p.ii / ACKNOWLEDGEMENTS --- p.iv / TABLE OF CONTENTS --- p.v / LIST OF TABLES --- p.vii / LIST OF FIGURES --- p.viii / Chapter CHAPTER ONE - --- INTRODUCTION --- p.1 / Chapter 1.1 --- Slimness As An Updated Trend --- p.1 / Chapter 1.2 --- Physical Appearance as the Main Concern for Adolescents --- p.2 / Chapter 1.3 --- Stigma of Being Overweight --- p.3 / Chapter 1.4 --- Possible Psychological Correlates of Overweight --- p.5 / Chapter 1.5 --- Females are More Preoccupied with Appearance? --- p.10 / Chapter 1.6 --- Differences in Psychological Profiles of Boys and Girls with Diffprent Weight --- p.13 / Chapter 1.7 --- Subjective Satisfaction of Weight and Body Shape --- p.15 / Chapter 1.8 --- Related Local Findings --- p.17 / Chapter 1.9 --- Objectives of the Present Study --- p.20 / Chapter 1.10 --- The Use of EDI-2 --- p.22 / Chapter CHAPTER TWO - --- METHODOLOGY --- p.24 / Chapter 2 1 --- Subjects --- p.24 / Chapter 2.2 --- Measures / Scales --- p.24 / Chapter 2.3 --- Procedure --- p.32 / Chapter CHAPTER THREE - --- RESULTS --- p.34 / Chapter 3.1 --- Demographic Characteristics of Sample --- p.34 / Chapter 3.2 --- Prevalence of Overweight Among the Sample --- p.36 / Chapter 3.3 --- Satisfaction of Overall Body Shape --- p.38 / Chapter 3.4 --- Dissatisfaction Towards Different Body Parts --- p.39 / Chapter 3.5 --- Sex Differences --- p.41 / Chapter 3.6 --- Differences in Psychological Profile Among Different Weight Groups --- p.47 / Chapter 3.7 --- Psychological Profiles of Different Weight Groups with Different Levels of Body Shape Satisfaction --- p.53 / Chapter CHAPTER FOUR - --- DISCUSSION / Chapter 4.1 --- The Prevalence of Obesity among Chinese Adolescentsin Hong Kong --- p.68 / Chapter 4.2 --- Differences in Psychosocial Variables --- p.68 / Chapter 4.3 --- "“Normative Dissatisfaction"" Towards Own Body Shape" --- p.70 / Chapter 4.4 --- Differences in Psychological Profile between Boys and Girls --- p.73 / Chapter 4.5 --- Effect of Weight among Boys and Girls --- p.76 / Chapter 4.6 --- Effect of Subjective Satisfaction with Own Body Shape --- p.82 / Chapter 4.7 --- Conclusions --- p.87 / Chapter 4.8 --- Limitations of the Present Study --- p.89 / Chapter 4.9 --- Recommendations for Future Studies --- p.91 / REFERENCES --- p.93 / APPENDIX --- p.100

Mong, Lok Yee. / Thesis submitted in: December 2007. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2008. / Includes bibliographical references (leaves 124-145). / Abstracts in English and Chinese; some text in appendix also in Chinese. / Acknowledgements --- p.i / Abstract (English version) --- p.iii / Abstract (Chinese version) --- p.v / Table of Contents --- p.vii / List of Tables --- p.ix / List of Figures --- p.xi / List of Abbreviations --- p.xiii / Chapter Chapter 1 - --- Introduction / Chapter 1.1 --- Childhood obesity: a worldwide epidemic --- p.1 / Chapter 1.2 --- Health consequences of childhood obesity --- p.3 / Chapter 1.3 --- Determinants of childhood obesity --- p.5 / Chapter 1.4 --- Hormonal dysregulation and obesity --- p.9 / Chapter 1.5 --- Project objectives and long term significance --- p.14 / Chapter Chapter 2 - --- Research Plan and Methodology / Chapter 2.1 --- Study cohort / Chapter 2.1.1 --- Subject recruitment --- p.15 / Chapter 2.1.2 --- Ethics --- p.16 / Chapter 2.1.3 --- Measurements and blood sample collections --- p.16 / Chapter 2.1.4 --- Subgroup for dietary assessment --- p.18 / Chapter 2.1.5 --- Cohort re-visits in 2006 --- p.19 / Chapter 2.2 --- Genetic study / Chapter 2.2.1 --- Sample size estimation and research subjects --- p.21 / Chapter 2.2.2 --- DNA samples --- p.22 / Chapter 2.2.3 --- Candidate genes --- p.24 / Chapter 2.2.4 --- SNP tagging and prioritizing --- p.25 / Chapter 2.2.5 --- Genotyping methods & quality control --- p.28 / Chapter 2.2.6 --- Statistical analysis --- p.31 / Chapter 2.3 --- Dietary assessment / Chapter 2.3.1 --- Three-day 24-hour dietary recalls --- p.36 / Chapter 2.3.2 --- Lifestyle questionnaire --- p.37 / Chapter 2.3.3 --- Data management --- p.38 / Chapter 2.3.4 --- Statistical methods --- p.39 / Chapter Chapter 3 - --- Results Page / Chapter 3.1 --- Study cohort --- p.41 / Chapter 3.2 --- Genetic study / Chapter 3.2.1 --- Subjects --- p.41 / Chapter 3.2.2 --- SNPs selection --- p.41 / Chapter 3.2.3 --- Factor analysis of adiposity in the study population --- p.44 / Chapter 3.2.4 --- Genotyping and association testing in stage1 --- p.50 / Chapter 3.2.5 --- Genotyping and association testing in stage2 --- p.52 / Chapter 3.2.6 --- Association of the CART gene with adiposity --- p.55 / Chapter 3.2.7 --- Association of the GHR gene with adiposity --- p.60 / Chapter 3.2.8 --- Association of the GHRHR gene with adiposity --- p.69 / Chapter 3.2.9 --- Association of the IGFBP3 gene with adiposity --- p.75 / Chapter 3.2.10 --- Association of the POMC gene with adiposity --- p.83 / Chapter 3.2 --- Dietary assessment / Chapter 3.3.1 --- Nutrient intakes of the subgroup in2004 --- p.87 / Chapter 3.3.2 --- Nutrient intakes of the subgroup in2006 --- p.92 / Chapter 3.3.3 --- Lifestyle pattern of the cohort in2006 --- p.97 / Chapter Chapter 4 - --- Discussion / Chapter 4.1 --- The role of GH-related genes with adolescent adiposity --- p.102 / Chapter 4.2 --- Nutrient intakes and lifestyle pattern of the adolescents --- p.120 / Chapter 4.3 --- Conclusion of this study --- p.123 / References --- p.124 / Appendices / Chapter A --- Information of the SNPs selected --- p.146 / Chapter B --- Comparison of SNPs minor allele frequency (MAF) among two genotyping stages and HapMap data --- p.154 / Chapter C --- Hardy-Weinberg Equilibrium (HWE) of SNPs in two genotyping stages --- p.162 / Chapter D --- Factor score coefficient matrix --- p.170 / Chapter E --- Association of SNPs with factors scores --- p.172 / Chapter F1 --- Consent form (English version) --- p.207 / Chapter F2 --- Consent form (Chinese version) --- p.209 / Chapter G1 --- 24-hour dietary recall forms (English version) --- p.211 / Chapter G2 --- 24-hour dietary recall forms (Chinese version) --- p.218 / Chapter H --- Food photo booklet --- p.225 / Chapter I1 --- Lifestyle questionnaire (English version) --- p.236 / Chapter I2 --- Lifestyle questionnaire (Chinese version) --- p.238

Yeung, Daniel Chi Shing. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2008. / Includes bibliographical references (leaves 69-83). / Abstracts in English and Chinese; appendix B also in Chinese. / ACKNOWLEDGMENTS --- p.i / ABSTRACT --- p.ii / TABLE OF CONTENTS --- p.vi / INTRODUCTION --- p.1 / Purpose and Significance --- p.3 / Hypothesis --- p.5 / Delimitation --- p.5 / Limitation --- p.5 / Operational Definitions --- p.6 / REVIEW OF LITERATURE --- p.9 / The Epidemic of Childhood Obesity --- p.9 / Increase in Childhood Obesity Over the World --- p.9 / Factors Contribute to Childhood Obesity --- p.12 / Health Consequence --- p.14 / Childhood Obesity Interventions --- p.15 / Measurement of Body Composition in Children --- p.17 / Body Composition Models --- p.17 / Measurement Methods --- p.20 / Laboratory Methods --- p.20 / Hydrodensitometry --- p.20 / Air displacement plethysmography --- p.22 / Hydrometry --- p.23 / Dual energy X-ray absorptiometry --- p.25 / Pros and cons of body fat criterion measures --- p.26 / Field Methods --- p.27 / Bioelectric impedance analysis --- p.27 / Anthropometry --- p.28 / Skinfold thickness measurement --- p.29 / Summary --- p.33 / METHODOLOGY --- p.36 / Participants --- p.36 / Experimental Protocols and Procedures --- p.36 / Criterion Measurement --- p.36 / Field Measurements --- p.38 / Statistical A nalysis --- p.39 / RESULTS --- p.41 / Comparison of ADP and DXA in Measuring Percent Fat Criterion --- p.41 / Sample Distribution and Descriptive Statistics --- p.41 / Correlations --- p.44 / Reliability --- p.46 / Cross Validation of Slaughter Equations --- p.47 / Exploration of Alternative Equations --- p.51 / DISCUSSION --- p.59 / Limitations --- p.66 / Recommendations for Future Study --- p.67 / Conclusions --- p.68 / REFERENCES --- p.69 / APPENDIX / Chapter A --- Standardized Description of Skinfold Sites --- p.84 / Chapter B --- Informed Consent --- p.85 / Chapter C --- Data Sheet --- p.87

本研究的目的在於以電阻抗法測定的脂肪比例作為標準，評價各種兒童肥胖定義診斷脂肪過量時的診斷準確性。爲了達到這項研究目的，本研究分為三個部份。首先，研究的第一部份評價了生物電阻抗法（Bio-electrical impedance analysis, BIA）在測量中國兒童青少年身體成份時的效度。隨後，幾種被廣泛應用的電子脂肪磅測量身體脂肪比例時的測量準確度被進行了評價。最後，在大規模人群測試中，利用精確的電子脂肪磅及幾種人體測量學指標決定的脂肪水平，不同兒童肥胖定義的診診斷脂肪過量的斷準確性被進行了評價。共有255名9至19歲的中國兒童青少年參與了第一和第二部份的測試，利用雙能X光骨密度儀（Dual-energy X-ray absorptiometry, DEXA）測量的體成份作為標準，比較了通過標準電阻抗法以及幾種被廣泛電子脂肪磅測量而來的體成份。研究結果顯示，生物電阻抗法是測量中國兒童青少年體成份有效的方法，然而，所有以前研究發展的BIA預測方程均未能準確估計受試者的去脂體重（Fat-free mass, FFM）。四種商業電子脂肪磅在測量受試者的體脂有類似的診斷準確度。隨後，另外的2,134名兒童青少年參與了本研究第三部份的測試，利用經過第二部份經過調整的脂肪磅測量受試者的體脂比例，同時測量人體測量學指標。研究結果發現，現有關於兒童肥胖的定義在診斷香港兒童、青少年脂肪過量的診斷準確性不夠。此外，受試者工作特徵曲綫分析（Receiver operating characteristics, ROC）發現利用基於身高和體重的指數來定義兒童肥胖在診斷肥胖兒童時較基於腰圍的指數有更好的敏感度和特異性。因此，研究者可以通過調整這些身高和體重的指數的劃分點來獲得對兒童肥胖更好的診斷準確性。 / 研究一（第3章）的目的在於評價生物電阻抗（Bio-electrical impendence analysis, BIA）方法在預測中國兒童青少年的去脂體重（Fat-free mass, FFM）中的效度，同時，也驗證已有的利用BIA方法發展的方程預測中國兒童、青少年FFM的效度。共有255名9-19歲健康的中國兒童、青少年（127名男生、128名女生）自願參與此次測試。利用傳統的單頻（50 kHz）的手腳電阻抗儀測試人體的電阻與電抗。利用雙能X光骨密度儀（Dual-energy X-ray absorptiometry, DEXA）作為測量FFM的標準。以DEXA測試的FFM為標準，對24個已有的BIA預測FFM的方程進行交互驗證。研究結果顯示，在本研究的人群中，利用24個已有的BIA預測方程所預測FFM與DEXA測量而來FFM高度相關。然而，這24個方程都未能準確預測本研究測試人群中由DEXA測量而來的FFM。利用多元線性回歸及交互驗證的方法，本研究發展了一個預測中國兒童、青少年FFM的預測方程：FFM (kg) = 1.613 + 0.742 × 身高(cm)²/電抗 (Ω) + 0.151 × 體重 (kg); R² = 0.95; SEE = 2.45kg; CV = 6.5%。本研究的研究結果表明，已有的BIA預測FFM的方程均不能通過交互驗證，從而準確的預測本研究人群的FFM。利用本研究人群發展而來的BIA預測FFM的方程，對預測中國兒童、青少年的FFM有良好的效度。本研究證明利用BIA方法可以準確的預測中國兒童、青少年的體成份。 / 研究二（第4章）旨在驗證4種利用BIA原理發展而來的商業電子脂肪磅在測量中國兒童、青少年體脂比例時的效度，以及判斷這些脂肪磅診斷身體脂肪過量時的診斷表現。參與研究一的255名中國兒童、青少年也參與本研究。利用DEXA作為測量體成份的標準測量。同時，4種電子脂肪磅（Model A, Biodynamics-310; Model B, Tanita TBF-543; Model C, Tanita BC-545 和 Model D, InBody 520）利用製造商內置的BIA方程測量受試者的體成份。研究結果表明，採用製造商內置的BIA方程測量體脂比例時，在男性中，Model B和Model C測量的體脂比例與DEXA測量的體脂比例有明顯差異 （p < 0.05）；Model C低估了脂肪過量兒童、青少年在在受試人群中的百分比（X²=10.714, p=0.001）。在女性中，Model B、Model C和Model D測量的體脂比例與DEXA測量的體脂比例有明顯差別，脂肪過量兒童在占受試人群中的比例被這三種脂肪磅所低估。由於在這四種脂肪磅和DEXA測量的%BF有著較高的相關性，回歸分析被用於調整這四種脂肪磅所測量的體脂比例。在調整后，在男性和女性中，所有調整的脂肪磅測試的體脂比例與DEXA測量的體脂比例之間沒有分別。在男性和女性受試者中，卡方檢驗結果顯示，所有校正的脂肪磅診斷的脂肪過量兒童、青少年占受試人群中的比例與DEXA的診斷比例之間沒有發現明顯區別。 此外，在女性中，與未校正的脂肪磅的對脂肪過量兒童、青少年診斷的敏感度比較，調整后的Model B 和 ModelC 脂肪磅對脂肪過量的兒童診斷的敏感度得到明顯改善 (Model B, X²=9.818,p=0.002; Model C, X²=4.615, p=0.032)。本研究的研究結果建議在利用電子脂肪磅內置方程測量中國青少年、兒童的體脂比例時，其效度需要進行驗證。因為在脂肪磅和DEXA測量之間有較高的相關性和較小的偏差，經調整的脂肪磅可以用於在進行大規模人群測試時，測量中國青少年、兒童的體脂比例，以及作為對脂肪過量兒童、青少年的診斷工具。 / 研究三（第5章）的目的在於調查基於身高體重的指數和基於腰圍的指數在診斷香港兒童、青少年脂肪過量時的總體診斷表現；以及判斷現有兒童肥胖定義診斷香港兒童、青少年脂肪過量時的診斷表現。共有來自香港多所中小學的2134名9-19歲的受試者，包括1135名男性、999名女性參與本研究。利用研究二調整的便攜式足對足電子脂肪磅測量受試者的體脂比例。基於體脂比例的兒童肥胖，即脂肪過量，被定義為體脂比例在男性高於25%，女性高於30%。四種基於BMI的兒童肥胖定義、兩種基於香港數據利用腰圍對兒童肥胖的定義、以及香港現有的兒童肥胖定義用於此研究。受試者工作特徵曲綫分析（Receiver operating characteristics, ROC）被用於分析身高體重指數（BMI）、標準身高體重（PWH）、腰圍（WC）和腰圍身高比（WHtR）在診斷香港兒童、青少年脂肪過量時的總體診斷表現。診斷試驗的指標被用來判斷現有兒童肥胖的定義診斷香港兒童、青少年脂肪過量時的診斷表現。本研究發現，在男性中，BMI、PWH、WC和WHtR在診斷香港兒童、青少年脂肪過量時有相同的良好的診斷表現[受試者工作特徵曲綫下面積(area under the curve of ROC, AUC) = 0.909-0.923]。然而，在女性中，WC（AUC=0.840）和WHtR（AUC=0.850）診斷香港兒童、青少年脂肪過量時的診斷表現差於BMI（AUC=0.900）和 PWH （AUC=0.903）。此外，現有兒童肥胖定義在診斷香港兒童、青少年脂肪過量時診斷敏感度較低，敏感度在男性中為0.325-0.761；女性中為0.128-0.588。利用最好診斷準確度的方法來確定的BMI、PWH、WC和WHtR的劃分點在診斷脂肪過量時，在男性中有相似的診斷表現，診斷敏感度在0.816-0.868之間，診斷特異度在0.803-0.869之間；對於女性，BMI和PWH 較WC和WHtR有較高的敏感度和特異度。本研究的發現表明，在診斷脂肪過量時，基於身高和體重的指數總體診斷表現好於基於腰圍的指數；現有兒童肥胖定義在診斷香港兒童、青少年脂肪過量時的診斷表現不佳。進一步，通過調整以身高和體重為基礎指數的劃分點可以使其在診斷脂肪過量時有更好的診斷表現。 / The purpose of this study was to evaluate the diagnostic accuracy of various childhood obesity definitions using bioelectrical impedance analysis (BIA) as a criterion measure of body fat. To achieve such an objective, the study involved three phases. First, the validity of BIA in measuring body composition in Chinese children and adolescents was evaluated. Then, examination on measuring accuracy of several popular BIA scales was performed. Finally, mass testing of body fat levels using an accurate BIA scale, as well as other anthropometric measures, was conducted to evaluate the diagnostic accuracy of childhood obesity definitions. A total of 255 healthy Chinese children and adolescents aged 9 years to 19 years participated in the first and second phases of the study. Body composition was measured from BIA using a criterion device (Biodynamics 310) and four popular commercial BIA scales and compared with measurements from dual-energy X-ray absorptiometry (DEXA). BIA provided excellent predictions of body composition among Chinese children and adolescents. However, all of the previously developed BIA equations yielded biased estimation. The four commercial BIA scales had similar diagnostic accuracy in measuring body fat. Subsequently, another 2,134 boys and girls were recruited to take part in body fat measurements using the best BIA scale identified in the second phase with adjusted equations, as well as other anthropometric measurements. The diagnostic accuracy of all existing definitions of childhood obesity was poor in both genders. Moreover, Receiver Operating Characteristics (ROC) analysis found that childhood obesity definitions using weight-and-height based indices [Body mass index (BMI) and weight-for-height) had superior sensitivity and specificity in identifying obese children compared with waist circumference-based indices. Therefore, with adjusted cut-off criteria for weight-and-height indices, the diagnostic accuracy of childhood obesity would be improved. / Study I : Validity of BIA method in predicting FFM / The first study (Chapter 3) aimed to examine the validity of the BIA method in predicting fat-free mass (FFM) in Chinese children and adolescents and of various published BIA equations in estimating FFM in this particular group. A total of 255 healthy Chinese children and adolescents (127 boys and 128 girls) aged 9 years to 19 years participated in this study. BIA variables (e.g., resistance and impedance) were measured at 50 kHz between the hand and foot using a traditional BIA device. The criterion of FFM measurement was also assessed using DEXA. FFM estimated from 24 published BIA equations were cross-validated against the criterion measure from DEXA. FFM estimated from the 24 published BIA equations yielded high correlations with the directly measured FFM from DEXA. However, none of the 24 equations was statistically equivalent with the DEXA-measured FFM. Using multiple linear regression and cross-validation against the DEXA measurement, an alternative prediction equation was developed as follows: FFM (kg) = 1.613 + 0.742 × height (cm)²/impedance (Ω) + 0.151 × body weight (kg); R² = 0.95; SEE = 2.45 kg; CV = 6.5%. None of the previously developed BIA equations was able to cross-validate the FFM estimates of the present sample. An alternative BIA equation, with evidence of validation and cross-validation, was thus proposed. The method based on the BIA principle provides a valid estimation of body composition among Chinese children and adolescents. / Study II: Validity of popular BIA consumer scales in measuring body fat / The second study (Chapter 4) examined the validity in measuring body fat and the diagnostic performance of four different consumer BIA scales. The 255 Chinese children and adolescents from the first study also participated in this study. DEXA was used as the criterion measurement for %BF, which was also assessed using four BIA scales [Model A (Biodynamics 310), Model B (Tanita TBF-543), Model C (Tanita BC-545), and Model D (InBody 520)]. The validity in measuring body fat and the diagnostic performance in screening excess body fat of these BIA scales was first examined. In boys, differences in %BF between Models B, C, and DEXA were significant (p < 0.05). In girls, significant differences in %BF were observed between Models B, C, D, and DEXA (p < 0.05). The prevalence of overfat in boys was underestimated by Model C (X² = 10.714, p = 0.001). For girls, the prevalence of overfat was underestimated in Models B, C, and D. Because of the high correlation between the BIA scales and DEXA (r = 0.770.94), regression analysis was used to adjust the BIA scales in measuring %BF in this sample. After adjustment, the paired t-tests did not show differences in %BF between the adjusted BIA scales and the DEXA measurement in both genders. All adjusted BIA scales except Model A in girls showed substantial agreement with the DEXA measurement. In addition, compared with overfat classification using DEXA measurement, X² test showed that the prevalence of overfat in the present samples was classified correctly by all adjusted BIA scales in both genders. Compared with the original BIA measurements, the use of the adjusted Models B and D offered significant improvements in sensitivity for girls. These findings suggest that the embedded equations in BIA scales should be validated in assessing body compositions among Chinese children and adolescents. The adjusted BIA scales can be used in large population surveys due to the high correlation and small mean bias between the BIA scales and the DEXA measurements. In conclusion, the adjusted BIA scales can serve as diagnostic tools to classify overfat Chinese children into relevant subgroups. / Study III: Diagnostic accuracy of definitions of childhood obesity / The third study (Chapter 5) aimed to investigate the diagnostic performance of weight-and-height-based indices and waist circumference (WC-based indices as diagnostic tests to screen excess body fat in Hong Kong children and adolescents and to investigate the diagnostic accuracy of existing definitions of childhood obesity in Hong Kong. A total of 2,134 participants (1,135 boys and 999 girls) were recruited from local schools. The adjusted foot-to-foot BIA scale (Model B) in the second study was applied to assess %BF. The criterion of childhood obesity (i.e., overfat) was defined as over 25%BF for boys and over 30%BF for girls. Childhood obesity was also determined from four BMI-based references, two WC-based references, and the 1993 HK reference. The diagnostic accuracy of the existing definition for childhood obesity in screening excess body fat was evaluated using diagnostic indices. The Receiver Operating Characteristics (ROC) analysis was used to evaluate the general performance of BMI, PWH, WC, and WHtR in detecting overfat. In boys, ROC analysis showed no significant difference among the four indices in screening overfat [(area under the curve of ROC, AUC) = 0.909-0.923]. In girls, BMI and PWH performed better in detecting overfat than WC and WHtR (AUC of BMI = 0.900; AUC of PWH = 0.903; AUC of WC = 0.840 and AUC of WHtR = 0.850). All definitions for obesity showed low sensitivity (boys, 0.325-0.761; girls, 0.128-0.588) in detecting overfat. Cut-offs derived for best accuracy showed similar diagnostic performance in each index in boys but not in girls. In boys, the cut-offs of BMI, WC, WHtR, and PWH can provide similar sensitivity (0.816-0.868) and specificity (0.803-0.869) in screening overfat. In girls, BMI and PWH can provide higher sensitivity and specificity than WC and WHtR. This study’s findings demonstrate that the diagnostic performance of all existing definitions for obesity is poorer than expected in both genders. BMI and PWH are superior to use as proxy measures in screening overfat among Hong Kong Chinese children and adolescents for both genders. Moreover, the diagnostic performance of these indices can be improved by adjusting the existing cut-offs. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Wang, Lin. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2012. / Includes bibliographical references (leaves 166-197). / Abstract and appendixes also in Chinese. / ABSTRACT --- p.i / 摘要 --- p.v / ACKNOWLEDGEMENT --- p.ix / PUBLICATIONS --- p.xi / LIST OF TABLES --- p.xv / LIST OF FIGURES --- p.xvii / ABBREVIATIONS --- p.xviii / Chapter CHAPTER 1. --- INTRODUCTION --- p.1 / Chapter 1.1. --- Background --- p.1 / Chapter 1.2. --- Purposes and significance --- p.4 / Chapter 1.3. --- Operational definitions --- p.5 / Chapter 1.3.1. --- Childhood overweight and obesity --- p.5 / Chapter 1.3.2. --- Body composition --- p.6 / Chapter 1.3.3. --- Bioelectric impedance analysis (BIA) --- p.6 / Chapter 1.3.4. --- Validity --- p.6 / Chapter 1.3.5. --- Diagnostic performance --- p.6 / Chapter 1.4. --- Hypothesis --- p.6 / Chapter 1.5. --- Limitations --- p.7 / Chapter 1.6. --- Delimitations --- p.7 / Chapter CHAPTER 2. --- LITERATURE REVIEW --- p.9 / Chapter 2.1. --- The epidemic and health consequence of childhood obesity --- p.10 / Chapter 2.1.1. --- Prevalence of childhood obesity --- p.10 / Chapter 2.1.2. --- Health consequence of childhood obesity --- p.15 / Chapter 2.2. --- Contributors of Childhood obesity --- p.16 / Chapter 2.2.1. --- Genetics --- p.17 / Chapter 2.2.2. --- Dietary intake --- p.17 / Chapter 2.2.3. --- Physical activity --- p.18 / Chapter 2.2.4. --- Sedentary behaviors --- p.18 / Chapter 2.3. --- Definitions of overweight and obesity in children and adolescents --- p.19 / Chapter 2.3.1. --- General definition of obesity --- p.19 / Chapter 2.3.2. --- Definitions and prevalence of childhood obesity in different countries --- p.21 / Chapter 2.3.3. --- Methods and current practices for identifying childhood obesity --- p.21 / Chapter 2.4. --- Methods for assessing body composition --- p.42 / Chapter 2.4.1. --- Body composition models --- p.42 / Chapter 2.4.2. --- Measurements methods to estimate body composition --- p.44 / Chapter 2.4.3. --- Specific issues of body fat in childhood --- p.60 / Chapter 2.5. --- Diagnostic accuracy of different definitions of childhood obesity --- p.61 / Chapter CHAPTER 3. --- STUDY I: VALIDITY OF BIOELECTRICAL IMPEDANCE MEASUREMENT IN PREDICTING FAT-FREE MASS OF CHINESE CHILDREN AND ADOLESCENTS --- p.67 / Chapter 3.1. --- Introduction --- p.67 / Chapter 3.2.1. --- Participants --- p.69 / Chapter 3.2.2. --- Measurements --- p.70 / Chapter 3.2.3. --- Data reduction and statistic analysis --- p.72 / Chapter 3.3. --- Results --- p.78 / Chapter 3.3.1. --- Descriptive statistics --- p.78 / Chapter 3.3.2. --- Cross-validation of published BIA equations --- p.79 / Chapter 3.3.3. --- Development of alternative BIA equations --- p.84 / Chapter 3.4. --- Discussion --- p.86 / Chapter 3.5. --- Conclusion --- p.92 / Chapter CHAPTER 4. --- STUDY II: VALIDITY OF FOUR COMMERCIAL BIA SCALES IN MEASURING BODY FAT AMONG CHINESE CHILDREN AND ADOLESCENTS --- p.93 / Chapter 4.1. --- Introduction --- p.93 / Chapter 4.2. --- Methods --- p.97 / Chapter 4.2.1. --- Participants --- p.97 / Chapter 4.2.2. --- Anthropometrics measurement --- p.97 / Chapter 4.2.3. --- Measurement of body composition --- p.97 / Chapter 4.2.4. --- Statistical analysis --- p.99 / Chapter 4.3. --- Results --- p.102 / Chapter 4.3.1. --- Characteristics of participants --- p.102 / Chapter 4.3.2. --- Reliability of BIA analysis --- p.103 / Chapter 4.3.3. --- Comparison of measuring body composition between BIA commercial devices (manufacturers’ equations) and DEXA measurement-Step 1 --- p.103 / Chapter 4.3.4. --- Comparison of measuring body composition between BIA commercial devices (adjusted equations) and DEXA measurement-Step 2 --- p.110 / Chapter 4.4. --- Discussion --- p.116 / Chapter 4.5. --- Conclusion --- p.123 / Chapter CHAPTER 5. --- STUDY III: DIAGNOSTIC ACCURACY OF DIFFERENT DEFINITIONS OF CHILDHOOD OBESITY IN IDENTIFYING OVERFAT AMONG CHINESE CHILDREN AND ADOLESCENTS --- p.124 / Chapter 5.1. --- Introduction --- p.124 / Chapter 5.2. --- Methods --- p.126 / Chapter 5.2.1. --- Participants --- p.126 / Chapter 5.2.2. --- Anthropometrics measurement --- p.127 / Chapter 5.2.3. --- Body fat measurement --- p.127 / Chapter 5.2.4. --- Definition of excess fatness --- p.128 / Chapter 5.2.5. --- Classification of participants --- p.128 / Chapter 5.2.6. --- Data reduction and statistic analysis --- p.129 / Chapter 5.3. --- Results --- p.131 / Chapter 5.3.1. --- Characteristics of participants --- p.131 / Chapter 5.3.2. --- Age-adjusted correlation among the different indices of obesity --- p.133 / Chapter 5.3.3. --- Prevalence rates of overweight/obesity --- p.134 / Chapter 5.3.4. --- Diagnostic agreement in assessing excess fat between %BF and anthropometric-based definitions --- p.137 / Chapter 5.3.5. --- Sensitivity and specificity --- p.138 / Chapter 5.3.6. --- Diagnostic performance of anthropometric indices in assessing excess fat --- p.141 / Chapter 5.3.7. --- Cut-offs of the anthropometric indices for screening excess fat --- p.143 / Chapter 5.4. --- Discussion --- p.148 / Chapter 5.5. --- Conclusion --- p.157 / Chapter CHAPTER 6. --- GENERAL DISCUSSION AND CONCLUSION --- p.158 / REFERENCE --- p.166 / APPENDIX A --- p.198 / APPENDIX B --- p.202 / APPENDIX C --- p.204 / APPENDIX D --- p.206 / APPENDIX E --- p.210

Chan, Po Tai. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2011. / Includes bibliographical references (leaves 128-150). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract also in Chinese; some appendixes in Chinese.

by Wan Cheuk Wing. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2002. / Includes bibliographical references (leaves p. 166-183). / Abstracts in English and Chinese. / Acknowledgements --- p.i / Abstract --- p.ii-iii / Abstract (Chinese Version) --- p.iv / Table of Contents --- p.v-xi / List of Figures --- p.xii / List of Tables --- p.xiii-xxiii / List of Abbreviations --- p.xxiiv / Chapter CHAPTER ONE: --- INTRODUCTION / Chapter 1.1 --- "Socioeconomic, dietary and epidemiological transformation" --- p.1 / Chapter 1.1.1 --- Low breastfeeding rate --- p.3 / Chapter 1.1.2 --- Breakfast skipping --- p.6 / Chapter 1.1.3 --- Popularity of eating out --- p.8 / Chapter 1.1.4 --- Lack of school lunch surveillance or policy --- p.10 / Chapter 1.1.5 --- Frequent unhealthy snack consumption --- p.11 / Chapter 1.1.6 --- Physical inactivity --- p.12 / Chapter 1.2 --- "Childhood and Adolescent obesity determinants, trends and consequences" --- p.13 / Chapter 1.3 --- "Physiological, psychosocial and economic determinants of childhood and adolescent obesity" --- p.16 / Chapter 1.4 --- Adolescence - Critical period of habit development --- p.17 / Chapter 1.4.1 --- "Factors affecting eating and physical activity patterns: peers, television and the school environment" --- p.18 / Chapter 1.5 --- The education system in Hong Kong and United States --- p.20 / Chapter 1.5.1 --- Principles of effective nutrition curriculum development --- p.23 / Chapter 1.6 --- Study Design and Theoretical Approach of study --- p.23 / Chapter CHAPTER TWO: --- METHODOLOGY / Chapter 2.1 --- Target Population Determination --- p.28 / Chapter 2.2 --- Recruitment & Geographical Distribution of Schools --- p.28 / Chapter 2.2.1 --- Familiarization with School Background --- p.30 / Chapter 2.3 --- Focus groups --- p.31 / Chapter 2.4 --- "Questionnaire Development, Instrument Design and Pre-testing" --- p.32 / Chapter 2.4.1 --- Questionnaire Development --- p.32 / Chapter 2.4.2 --- Socio-demographic --- p.33 / Chapter 2.4.3 --- Breastfeeding --- p.33 / Chapter 2.4.4 --- "Dietary - Healthy Diet Pyramid, Healthy Breakfast, Healthy Lunch, Healthy Snack, Healthy Eating Out" --- p.33 / Chapter 2.4.5 --- Physical Activity --- p.34 / Chapter 2.4.6 --- Pretesting --- p.35 / Chapter 2.4.7 --- Sampling Method --- p.35 / Chapter 2.4.8 --- Student Helpers Training --- p.36 / Chapter 2.4.9 --- Data Collection --- p.37 / Chapter 2.4.10 --- Fun-In-Seven Logo --- p.37 / Chapter 2.5 --- Intervention Program --- p.38 / Chapter 2.5.1 --- Planning the Intervention Programs - Health Committee Establishment --- p.38 / Chapter 2.5.2 --- "Intervention Activities, Curriculum Design and Implementation" --- p.39 / Chapter 2.6 --- Evaluations --- p.45 / Chapter 2.6.1 --- Process Evaluation --- p.45 / Chapter 2.6.2 --- Outcome Evaluation --- p.45 / Chapter 2.7 --- Data Management --- p.46 / Chapter 2.7.1 --- Data Processing --- p.46 / Chapter 2.7.2 --- Statistics --- p.46 / Chapter 2.7.3 --- Data Analysis --- p.47 / Chapter CHAPTER THREE: --- RESULTS / Chapter 3.1 --- Participation rate of the study --- p.52 / Chapter 3.2 --- Pre-intervention survey results --- p.52 / Chapter 3.2.1 --- General sociodemographic characteristics of students --- p.52 / Chapter 3.2.2 --- Self-evaluated nutrition scores --- p.53 / Chapter 3.2.3 --- Breastfeeding --- p.55 / Chapter 3.2.4 --- Healthy Diet Pyramid --- p.61 / Chapter 3.2.5 --- Healthy breakfast awareness and practices --- p.64 / Chapter 3.2.6 --- "Eating out knowledge, attitudes and practices" --- p.68 / Chapter 3.2.7 --- Healthy Lunch --- p.73 / Chapter 3.2.8 --- Snack patterns --- p.77 / Chapter 3.2.9 --- Physical Activity --- p.81 / Chapter 3.2.10 --- Summary Profile of the Secondary Students in the Pre-intervention Survey --- p.92 / Chapter 3.3 --- Outcome evaluation --- p.95 / Chapter 3.4 --- Post-intervention Survey --- p.95 / Chapter 3.4.1 --- General sociodemographic characteristics of students --- p.95 / Chapter 3.4.2 --- Changes in self-rated nutrition knowledge --- p.96 / Chapter 3.4.3 --- Intervention effects on of breastfeeding knowledge and attitudes --- p.97 / Chapter 3.4.4 --- Healthy Diet Pyramid and healthy eating awareness --- p.104 / Chapter 3.4.5 --- Breakfast --- p.109 / Chapter 3.4.6 --- Eating Out --- p.113 / Chapter 3.4.7 --- Lunch --- p.117 / Chapter 3.4.8 --- Snacking --- p.121 / Chapter 3.4.9 --- Physical Activity --- p.128 / Chapter 3.4.10 --- "Changes in students' knowledge, attitude, and behavior after the intervention programme" --- p.140 / Chapter 3.5 --- Summary Profile of the Secondary Students in the Post-intervention Survey --- p.145 / Chapter CHAPTER FOUR: --- DISCUSSION / Chapter 4.1 --- Impacts of Fun-in-Seven programmes --- p.150 / Chapter 4.1.1 --- Breastfeeding --- p.150 / Chapter 4.1.2 --- Healthy Diet Pyramid --- p.151 / Chapter 4.1.3 --- Healthy Breakfast --- p.152 / Chapter 4.1.4 --- Lunch --- p.153 / Chapter 4.1.5 --- Snacking --- p.155 / Chapter 4.1.6 --- Physical Activity --- p.156 / Chapter 4.2 --- Strengths of the intervention programme --- p.157 / Chapter 4.3 --- Limitations and problems encountered --- p.159 / Chapter 4.4 --- Recommendations for further improvement --- p.161 / Chapter CHAPTER FIVE: --- CONCLUSION --- p.165 / References --- p.166-180 / Appendices / Chapter A --- Questionnaire for Teacher/Principal (English version) --- p.181-183 / Chapter B --- Secondary School Background Information (English version) --- p.184-195 / Chapter CI --- Questionnaire (Chinese version) --- p.196-209 / Chapter CII --- Questionnaire (English version) --- p.210-224 / Chapter D --- Pamphlets for seven themes (Chinese and English versions) --- p.225-257 / Chapter E --- Worksheets & Certificates (Chinese and English versions) --- p.258-283 / Chapter F --- Activities photos (English version) --- p.284-288 / Chapter G --- Summary of materials and activities of each theme in Fun-in-Seven (Chinese version) --- p.289 / Chapter HI --- Breastfeeding and Physical Activity Process Evaluation Questionnaire (Chinese version) --- p.290-291 / Chapter HII --- Breastfeeding and Healthy Diet Pyramid Process Evaluation Questionnaire (English version) --- p.292-294 / Chapter JI --- "Physical Activity, Breakfast, Lunch, Eat Out, Snack Outcome Evaluation (Chinese version) - School 1" --- p.295-299 / Chapter JII --- "Physical Activity, Breakfast, Lunch, Eat Out, Snack Outcome Evaluation (English version)" --- p.300-305 / Chapter KI --- "Physical Activity, Breakfast, Lunch, Eat Out, Snack Outcome Evaluation (Chinese version) - School 2" --- p.306-309 / Chapter KII --- "Physical Activity, Breakfast, Lunch, Eat Out, Snack Outcome Evaluation (English version) ´ؤ School 2" --- p.310-313 / Chapter LI --- "Physical Activity, Breakfast, Lunch, Eat Out, Snack Outcome Evaluation (Chinese version) ´ؤ School 3" --- p.314-317 / Chapter LII --- "Physical Activity, Breakfast, Lunch, Eat Out, Snack Outcome Evaluation (English version) ´ؤ School 3" --- p.318-322 / Chapter MI --- Teacher's Outcome Evaluation Form (Chinese version) ´ؤ School --- p.323-324 / Chapter MII --- Teacher's Outcome Evaluation Form (English version) 一 School --- p.325-327 / Chapter NI --- Teacher's Outcome Evaluation Form (Chinese version) ´ؤ School --- p.328-329 / Chapter NII --- Teacher's Outcome Evaluation Form (English version) - School --- p.330-332 / Chapter PI --- Teacher's Outcome Evaluation Form (Chinese version) - School --- p.333-334 / Chapter PII --- Teacher's Outcome Evaluation Form (English version) 一 School --- p.335-337 / Chapter QI --- Health Ambassador's Outcome Evaluation Form (Chinese version) --- p.338-339 / Chapter QII --- Health Ambassador's Outcome Evaluation Form (English version) --- p.340-341