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EATING HABITS OF CALL CENTER AGENTS IN RELATION TO THEIR HEALTH AND WORK ENVIRONMENT: BASIS FOR A HEALTH PROGRAM

A Master’s Thesis Presented to the Faculty of the Graduate School University of Perpetual Help System DALTA Las Piñas City

In Partial Fulfilment of the Requirements for the Degree Master of Arts in Nursing Major in Nursing Administration

By

JULIE SIMONETTE QUEYPO ROJO March 2012

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APPROVAL SHEET

This thesis entitled, “EATING HABITS OF CALL CENTER AGENTS IN RELATION TO THEIR HEALTH AND WORK ENVIRONMENT: BASIS FOR A HEALTH PROGRAM” prepared and submitted by JULIE SIMONETTE Q. ROJO in partial fulfilment for the degree of Master of Arts in Nursing, Major in Nursing Administration has been examined and recommended for acceptance and approval for Final Oral Examination.

YOLANDA T. CANARIA, Ph.D. Adviser ORAL EXAMINATION COMMITTEE Approved by the Committee on Oral Examination with a grade of _____________________.

FLORENCIA C. MARFIL, Ph.D. Member

AMELIA M. MENDOZA, M.A.N. Member

ALFONSO H. LORETO, Ed.D. Chairman

Accepted and approved in partial fulfillment of the requirements for the Degree of Master of Arts in Nursing, Major in Nursing Administration.

ATTY. IRINEO F. MARTINEZ JR., Ph.D. Dean, Graduate School

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ACKNOWLEDGMENT

The researcher would like to extend her utmost gratitude to the following people who contributed their significant parts in the realization of this humble piece of work: Atty. Irineo F. Martinez Jr., Dean, Graduate School, University of Perpetual Help System DALTA and Review Panel, sincerity Chairman of the Dissertation

who encouraged and inspired the researcher by his

and the unending support to all graduate students in their

earnest desire to finish and attain their degrees; Dr. Yolanda T. Canaria, Associate Dean, Level 3, College of Nursing, University of Perpetual Help System DALTA - Las Piñas and the researcher’s Thesis Adviser, for her brilliant suggestions and encouragement from the start until the end of her journey in writing; Dr. Alfonso H. Loreto, Dr. Florencia C. Marfil, and Ms. Amelia M. Mendoza, the knowledgeable members of the panel for their intelligent, clever suggestions, and honest critiquing of the study. The researcher is indebted to all of them. Dr. Jesus B. Gollayan, the brilliant statistician, who painstakingly and patiently examined the data gathered. He helped organize and analyze the data needed for the study.

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Mr. Emil Estorninos, Recruitment Supervisor, Company X, for his approval to conduct the study involving regular call center agents in the company. To Mr. Emil Estorninos and the people behind him who made this possible, the researcher is grateful.

Ms. Barbie Lim, her immediate supervisor, for her understanding, help, and support. Ms. Nina Marie M. Villa, Ms. Lailani C. Ladios, Ms. Precious Rina E. Nario, Mr. Carlo G. Almazar, Ms. Hasmin Sescar, Ms. Faye Nadine C. Garcia, Mr. Eliseo L. Tonco and Mrs. Dana Keith S. Ancheta, Ms. Emilie J. Gecale, and Ms. Samantha B. Mabanglo for their unselfish sharing of ideas and insights to make this study better, their support and encouragement will be forever cherished by the author. Ms. Jasmin L. Vita, for her help, support, and patience in giving necessary information that helped in the process of completing this study. Mr. Simon Rojo and Mrs. Juliet Rojo, her parents, for their unending support and concern. Most of all, the success of this study is greatly given back to the Lord Almighty, who bestowed enough faith, courage strength, and grace for the realization of this study. J.S.R.

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ABSTRACT

Name of the Institution Address Title

: University of Perpetual Help System DALTA : Alabang-Zapote Road, Las Piñas City : Eating Habits of Call Center Agents in Relation to their Health and Work

Environment: Basis for a Health Program Author Degree Major Date of Completion : Julie Simonette Q. Rojo : Master of Arts in Nursing : Nursing Management : March 2012

This study sought to determine the eating habits of call center agents in relation to their health and work environment. Findings of the study served as basis for a health program to improve the eating habits of call center agents. Specifically, it sought to answer the following questions: (1) What is the profile of call center agents according to: 1.1 Age; 1.2 Gender; 1.3 Educational Attainment; and 1.4 BMI?

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(2) What is the work environment of call center agents in relation to: 2.1 Time of shift; and 2.2 Number of work hours? (3) What are the eating habits of call center agents in terms of: 3.1 Restrained eating; 3.2 Disinhibited eating; 3.3 Emotional eating; and 3.4 External eating? (4) Is there a significant relationship between the profile and eating habits of call center agents? (5) Is there a significant relationship between the eating habits and work environment of call center agents? (6) What health program can be proposed based on the findings of the study?

NULL HYPOTHESES The study tested the following Null Hypotheses: There is no significant relationship between the profile and eating habits of call center agents. There is no significant relationship between the eating habits and the work environment of call center agents.

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REVIEW OF RELATED LITERATURE AND STUDIES The concepts and ideas here emphasized the importance and impact of eating habits and work environment on the weight status of a person. Some related studies also touched other health effects of eating habits and work environment on the health of a person. The development of maladaptive eating habits through the combination of factors such as stress, negative emotions, external cues, concern for body image, time constraints and food availability was also discussed.

METHODOLOGY Descriptive Research Method was used in this study as it was deemed appropriate for the study which involved the identification and exploration of relationships between the eating habits in terms of (a) restrained eating; (b) disinhibited eating; (c) emotional eating; and (d) external eating, the profile and the work environment in terms of time of shift and; number work hours of call center agents. The participating company is Company X located in Northgate Cyberzone, Alabang Muntinlupa City. The respondents were 276 regular call center agents who work full-time and are in shifting schedules.

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The researcher used a self-made questionnaire which was made up of three parts. The first part determined the profile of the respondents; the second part determined the work environment of call center agents; and the third part determined the eating habits of call center agents in terms of restrained, disinhibited, emotional, and external eating habits of call center agents. Statements that reflect each eating habit was used for part three and a Likert Scale was used to determine how frequent the respondents practice each statement which reflects a certain eating habit. The following statistical instruments were used: Frequency and Percentage for presentation of frequency distribution; mean; and Pearson correlation r.

SUMMARY OF FINDINGS The study produced the following findings: 1. The profile of call center agents according to: 1.1 Age; Majority of the respondents were at 20 to 40 years of age and the least were under 20 years of age. 1.2 Gender; There were more female respondents than males.

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1.3 Educational Attainment; and Majority of the respondents were college graduates and the least had post-baccalaureate degrees. 1.4 BMI Majority of the respondents were within the normal range of BMI, followed by overweight respondents, then the underweight respondents while the least of the respondents, are obese. 2. The work environment of call center agents in relation to: 2.1 Time of shift; and Majority of the respondents worked in graveyard shifts and the least worked in mid-shifts. 2.2 Number of work hours. Most of the respondents work for 8 to 9 hours as compared to the least that work for 10 to 11 hours. 3. The eating habits of call center agents in terms of: 3.1 Restrained eating; The highest mean value is on “I try hard not to eat a lot or try to eat less so that I will not gain weight” and the lowest mean value is on “when I feel like I have gained weight, I try hard not to eat even if I see my favorite foods and delicious looking foods”; all of the mean values fall under the description “Sometimes”.

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3.2 Disinhibited eating; The highest mean value is on “it is easy to start eating but it is hard to stop” and the lowest mean value is on “I eat all the time because I am always hungry”; all of the mean values fall under the description “Sometimes”. 3.3 Emotional eating; and The highest mean value is on “when I don’t have anything to do or if I’m bored, I want to eat”; the lowest mean value is on “when I am annoyed by anyone or anything, I want to eat”; all of the mean values fall under the description “Sometimes”. 3.4 External eating. The highest mean value is on “when I see delicious smelling and tasty foods, it makes me want to eat more”; the lowest mean value is on “seeing other people eating makes me feel hungry”; all of the mean values fall under the description “Sometimes” except for the second statement which falls under “Often”. The highest overall mean value on eating habits is with respect to external eating; while the lowest mean value is on disinhibited eating. The overall mean values for eating habits in terms of restrained, disinhibited, emotional, and external eating fall under one description “Sometimes”.

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4. The significant relationship between the profile and eating habits of call center agents. There is no significant relationship between the profile in terms of age and eating habits of call center agents. There is no significant relationship between the profile in terms of gender and eating habits of call center agents. There is no significant relationship between the profile in terms of eating habits and eating habits of call center agents. There is no significant relationship between the profile in terms of BMI and eating habits of call center agents. 5. The significant relationship between the eating habits and work environment of call center agents. There is a significant relationship between the eating habits and the work environment in terms of time of shift of call center agents. There is no significant relationship between the eating habits and the work environment in terms of working hours of call center agents. 6. The health program proposed based on the findings of the study. The health program is a consolidated plan that contains strategies that were proposed to influence the employees in the BPO Industry into having a healthy lifestyle. Specifically, its goal is to modify the eating

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habits of people working in the BPO industry and to encourage maintaining healthier weight through physical activity.

CONCLUSIONS Based on the findings of the study, the following conclusions were drawn: 1. Call center agents in Company X were mostly within 20 to 40 years of age, predominantly females and college graduates. Most of them fell under the normal range of BMI; however, almost half were underweight overweight and obese. 2. Call center agents in company X mostly worked in graveyard shifts, usually for 8 to 9 hours. 3. The eating habits of call center agents in terms of restrained eating, disinhibited eating, emotional eating, and external eating fell under one description– “Sometimes”. 4. There were no significant relationships between the profile according to age, gender, educational attainment, and BMI and the eating habits of call center agents. 5. Significant relationships were found between the eating habits of call center agents and their work environment in relation to time of shift and number of work hours.

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6. The health program is a consolidated plan that contains strategies that will be proposed to influence the employees in the BPO Industry in having a healthy lifestyle. Its goal is to modify the eating habits of people working in the BPO industry and to encourage maintaining healthier weight through physical activity. The health program is formulated based on the findings of the study.

RECOMMENDATIONS 1. The healthcare team should educate call center agents on the importance of maintaining a healthy BMI and the health effects of being overweight and obese. 2. Call center agents should be taught ways to cope with working at night. Furthermore, BPO Companies and similar companies should ensure that the workplace is conducive for the health of employees who work in shifting schedules. 3. The role of the healthcare team as an advocate of good eating habits should be emphasized and strengthened. Counseling the employees in BPO companies and similar companies regarding their eating habits is one way to help them deal with maladaptive eating habits.

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4. BPO companies and similar companies should improve or consider making adjustments with regard to the food provided for their employees in such a way that healthier food options are made more available. 5. Call center agents should learn how to perceive and depend on internal eating cues and how to modify their lifestyle and eating habits to coincide with their work schedules. 6. BPO companies and similar companies should acquire or consider adopting the health program proposed, improve or maintain, develop existing health programs to help employees cope with the work environment, have healthy eating habits, and maintain a healthy weight status. 7. Future Researchers should be encouraged to conduct similar studies that will focus on other factors affecting eating habits such as: a. Distress; b. Socio-economic status; and c. Personality type 8. Future Researchers are encouraged to conduct similar studies comparing the eating habits of call center agents to regular daytime employees.

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TABLE OF CONTENTS

PAGE TITLE PAGE APPROVAL SHEET ACKNOWLEDGMENT ABSTRACT TABLE OF CONTENTS LIST OF TABLES LIST OF FIGURES i ii iii v xv xviii xx

CHAPTER 1 THE PROBLEM AND ITS BACKGROUND Introduction Theoretical and Conceptual Framework Statement of the Problem Hypotheses Scope and Limitation Significance of the Study Definition of Terms 2 1 8 12 13 14 14 16

REVIEW OF RELATED LITERATURE AND STUDIES Related Literature 20

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Related Studies Foreign Studies Local Studies Synthesis 3 RESEARCH METHODOLOGY The Research Design Research Locale Population and Sampling Respondents of the Study The Research Instrument Validation of Instrument Data Gathering Procedure Statistical Treatment of Data 4 PRESENTATION, ANALYSIS, AND INTERPRETATION OF DATA SUMMARY, CONCLUSIONS, AND RECOMMENDATIONS Summary of Findings Conclusions Recommendations

36 36 46 49

53 54 55 56 57 59 59 60

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103 106 108

REFERENCES

110

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APPENDICES A B Questionnaire Request for the List of Call Center Agents in Company X Letter of Request to Company X for Permission to Use the Company Name and Background Letter of Request to Company X for the Distribution and Retrieval of Questionnaires Letter to Respondents Statistical Tables Certification of Statistical Treatment Certification of Editing

117 117

120

C D

121 122 123 124 132 133

E F G H

CURRICULUM VITAE

134

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LIST OF TABLES TABLE 1 2 3 4 Classification of BMI for Weight Status Number of Employees in Company X Regular Employees in Company X Interpretation of the Scale for Eating Habits in the Questionnaire Distribution of Respondents According to Age Distribution of Respondents According to Gender Distribution of Respondents According to Educational Attainment Distribution of Respondents According to BMI Distribution of Respondents According to Time of Shift Distribution of Respondents According to Number of Work Hours Distribution of Mean Responses on Eating Habits in Terms of Restrained Eating Distribution of Mean Responses on Eating Habits in Terms of Disinhibited Eating Distribution of Mean Responses on Eating Habits in Terms of Emotional Eating Distribution of Mean Responses on Eating Habits in Terms of External Eating Distribution of Mean Responses on Overall Eating Habits PAGE 35 56 57 58

5 6 7

63 64 65

8 9

66 68

10

69

11

71

12

73

13

75

14

77

15

78

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16 17

Correlation Analysis between Age and Eating Habits Correlation Analysis between Gender and Eating Habits Correlation Analysis between Educational Attainment and Eating Habits Correlation Analysis between BMI and Eating Habits Correlation Analysis between Time of Shift and Eating Habits Correlation Analysis between Number of Work Hours and Eating Habits Proposed Health Program for BPO Companies

81 83

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85

19 20

87 89

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92

22

96

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LIST OF FIGURES FIGURES 1 2 3 The Epidemiologic Triad Model Conceptual Paradigm of the Study Framework for the Health Program PAGE 8 11 98

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Chapter 1 THE PROBLEM AND ITS BACKGROUND

Introduction The World Health Organization (WHO) has predicted that there will be 2.3 billion overweight adults worldwide by 2015, and more than 700 million of them will be obese. These figures were based on the Caucasian criteria of overweight and obesity (Body Mass Index >30) with larger cut-offs than Asians (obesity defined as BMI >25). Obesity is a 21st century problem that was neither recognized as a sign of ill- health nor a risk factor 5 decades ago. Currently, however, the world has included obesity in its statistics. Obesity has reached epidemic proportions globally, with more than 1 billion adults overweight – at least 300 million of them clinically obese – and is a major contributor to the global burden of chronic disease and disability. Obesity and overweight pose a major risk for serious diet-related chronic diseases, including type 2 diabetes, cardiovascular disease, hypertension, stroke, and certain forms of cancer. The health consequences range from increased risk of premature death, to serious chronic conditions that reduce the overall quality of life (WHO, 2011).

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Studies have revealed a significant mortality risk from obesity. Because obesity is so dangerous, it is important that clinicians are aware of all the factors that contribute to weight gain. One factor that makes a unique contribution to weight gain is shift work. Shift work comprises work patterns that extend beyond the conventional 8-hour daytime work day. It includes night-shift work, rotating shift work (between the thirds of the 24-hour cycle) and/or irregular work hours. Shift work is prevalent throughout the world. In 2007, The US Bureau of Labor and Statistics reported that more than 21 million wage and salary workers, or 17.7 percent, usually worked alternate shifts that fell at least partially outside the daytime shift range. Shift work is considered to be disruptive of normal diurnal biological rhythms and has been associated with many health related problems. Obesity is among the less well-known and studied health problems associated with shift work. The reasons for the increased risk of obesity seen with shift work in past studies are still being unraveled. It is likely that there is more than one cause, including lifestyle alterations in eating and exercise, and the disruption of circadian rhythm that contribute to shift work- related weight gain. Each of these possible causes should be considered when health

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care professionals are educating patients on preventative measures (Eberly and Feldman, 2010). The World Health organization defines ‘health’ as the “state of complete physical, emotional, and social well-being, not merely the absence of disease or infirmity.” A consideration of the health and energy balance of the shift worker needs to encompass these physiological, psychological, and sociological dimensions of health. For example, shift work may influence the nutritional health of an individual by affecting individuals’ eating behavior whilst at work, through the disturbance of sleep patterns and circadian rhythms in metabolic responses to food, and/or by interacting with the social and family influences on eating habits when not at work. During shift work, meal frequency is reduced, but the prevalence of high-energy snacking is increased on the particular shift that is worked. Important factors which impinge on the dietary habits of the shift worker are the specific type of job, the work environment, and the availability of food in the work place. Availability influenced most types of foods consumed. Hence, work schedules have a greater influence than feelings of hunger in determining the timing and type of food intake. Furthermore, a shift worker’s eating habits may be restricted because traditional meal times in the home are disrupted and there may

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be a biological disruption to circadian rhythms relevant to the metabolism of food eaten during shift work. The combination of these behavioral and biological factors might lead to unhealthy consequences (Atkinson, et al., 2008). In a report by the World Health Organization as mentioned by Atkinson et al., (2008) the links between diet and nutrition on chronic diseases, such as obesity, type 2 diabetes, cardiovascular disease, cancer, dental disease, and osteoporosis, were highlighted. It was proposed that nutrition should be placed at the forefront of public health policies and programs. There is a clearly-established link between inadequate diet and the development of disease for people living a “normal” diurnal existence, but only a few researchers have been able to formulate evidence-based recommendations for shift workers. The formulation of any recommendations should be based on knowledge about the metabolic consequences of shift work. It is therefore important to know about the eating habits of shift workers to have a clear basis for recommendations and health programs. Research on eating habits has identified four main types of: restrained, disinhibited, emotional, and external eating. Restrained eaters consciously restrict food intake to control body weight and body shape. Disinhibited eating refers to overeating that occurs following

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failure of restraint. Emotional eaters consume foods to reduce and alleviate negative emotions, such as anxiety. External eating occurs in response to immediate food-related external stimuli, regardless of internal physiological cues of hunger. Eating habits may change depending on the factors that influence a person to eat. It has been clear that eating habits are affected by shift work. Factors such as stress, work hours, including the time of work, and food availability, influence one’s eating habits. One such industry that has a work environment that makes use of shift work is the BPO (Business Process Outsourcing) industry which includes call centers. It requires shift work and night work, because the United States is the biggest market of the industry. The graveyard shift has become a major source of difficulty and dissatisfaction for a lot of agents as their day-to-day routines are turned upside down (Palatino, 2009). It had been documented to cause negative impact on health such as sleep disorders, eating disturbances, and gastrointestinal diseases, mental disorders, and cardiovascular diseases (EILER, 2009). Certain occupational health risks in call centers such as graveyard shifts, long working hours, period of break time, very cool temperatures in work areas, irrational behavior of customers, and high work stress are revealed in a study in 2008. An estimated 160 million new cases of work-related diseases occur yearly in

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the world, and these diseases include cardiovascular diseases, among others (WHO, 2010; ILO, 2006). It is, therefore, important to find ways to cope with this type of work environment. The industry continues to gain more employees, but it also suffers from a high attrition rate. The attrition rate in the Philippines is 57 percent (Villafania, 2009). This high turnover rate stems from various factors among them unholy work hours, rapid burnout, and stress. Other complaints include insecurity of job tenure, the repetitive nature of certain call center jobs, punitive measures for failing to meet productivity targets, heavy workload, and sedentary lifestyles (UPPI, 2010). The media cited several instances of call center agents dying of stroke or heart disease in their 20s. ABS-CBN reported that one call center agent died because of stress due to hypertension which caused brain hemorrhage (De Guia, 2010). Attesting to these occurrences, and being employed in a call center industry for 2 years up to the present, the researcher experienced the stressful environment in call centers which greatly affected her own eating habits. The environment is a venue for stress, health risks, and unhealthy practices. Having a type of work that has rigid rules which sets time restrictions was difficult to cope with. Adjusting to these work demands resulted in physical, emotional and mental stress. Stress,

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heightened emotions; environmental stimulus, like pressure from other people; and food stimulus may lead to changes in eating habits. Negative changes in eating habits in combination with changes brought about by the work hours may result into overeating or undereating which may be the beginning of health risks. In the Philippines, there are only a few studies about eating habits, moreover, little is known about eating habits of call center agents given the difference in their routine due to their type of work. This scenario impressed on the researcher’s desire to study about the eating habits of call center agents in relation to their health and work environment. The results of this study were used as basis for a health program intended to improve the eating habits of call center agents.

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Theoretical Framework The study was anchored on the selected theories and concepts that are relevant to the problem. The model below (Friis and Thomas, 2009) comprises a susceptible host (the person at risk for the disease), a disease agent (the proximate cause), and an environmental context for the interaction between Host and Agent.

Host (Call Center Agent)

Agent (Eating Habits)

Environment (Work Setting)

Figure 1. The Epidemiologic Triad Model

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In this study, the Host is the call center agent whose health is affected by eating habits and the work environment. The Eating Habit is the Agent which may affect the health of the Host and the Environment covers the overall work-setting in a call center. The Host, Agent, and

Environment affect each other; the exchange of effects result to the health of the Host or the call center agent. The Host encompasses the biological and behavioral influences and the physiological moderators of weight change. A central concept to emerge considering these models is that, while environments are external to the person, they have a powerful influence on the person’s behaviors (Bray and Bouchard, 2004). Furthermore, the relationship of eating habits, the environment, and the call center agents can further be explained through the Drive-Reduction Theory of Motivation (Weseley and McEntarffer, 2010). The motivation of call center agents to eat is affected by environmental, physiological, and psychological factors which may cause change or certain effects on their eating habits resulting to either undereating or overeating. This theory states that our behavior is motivated by biological needs. A need is one of our requirements for survival such as food water or shelter. The impulse that causes us to act in such a way that satisfies this need is

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called drive. Our body seeks homeostasis, a balanced internal state. When we are out of homeostasis, we have a need that creates a drive.

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Conceptual Framework Based on the preceding theories and concepts, the conceptual paradigm for the study was developed to serve as a guide in the conduct of the investigation: The conceptual paradigm, adapted from the IPO (Input-ProcessOutput) Model (Littlejohn and Foss, 2008), shown in Figure 2 below was comprised of three parts: the Input, the Process, and the Output.

INPUT

PROCESS

OUTPUT

2) The profile of call center agents according to: 1.1 Age; 1.2 Gender; 1.3 Educational Attainment and 1.4 BMI. 3) Work Environment in relation to: 2.1 Time of Shift and; 2.2 Number of Working Hours. 4) The eating habits of call center agents in terms of: 3.1 Restained eating; 3.2 DIsinhibited eating; 3.3 Emotional eating and; 3.4 External eating.

Relationships of profile, eating habits, health, and work environment of call center agents Proposed Health Program for Call Center Agents

Figure 2. Conceptual Paradigm of the Study

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Under the input are the profile of call center agents according to: age, gender, educational attainment, BMI, work environment, in terms of time of shift, and number of work hours; and eating habits (restrained eating, disinhibited eating, emotional eating, and external eating). What happens in the first part is the Process, which is finding the relationships between the eating habits, health, and the work environment of call center agents. The product is the Output which contains the Health Program proposal for call center agents, which was an outcome that was yielded from the Process.

Statement of the Problem This study sought to determine the eating habits of call center agents in relation to their health and work environment. Findings of the study served as basis for a health program to improve the eating habits of call center agents. Specifically, it sought to answer the following questions: (1) What is the profile of call center agents according to: 1.5 Age; 1.6 Gender; 1.7 Educational Attainment; and 1.8 BMI?

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(2) What is the work environment of call center agents in relation to: 2.3 Time of shift; and 2.4 Number of work hours? (3) What are the eating habits of call center agents in terms of: 3.1 Restrained eating; 3.2 Disinhibited eating; 3.3 Emotional eating; and 3.4 External eating? (4) Is there a significant relationship between the profile and eating habits of call center agents? (5) Is there a significant relationship between the eating habits and work environment of call center agents? (6) What health program can be proposed based on the findings of the study?

Null Hypotheses The study tested the following Null Hypotheses: There is no significant relationship between the profile and eating habits of call center agents. There is no significant relationship between the eating habits and the work environment of call center agents.

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Scope and Limitation of the Study This study sought to determine the eating habits of call center agents in relation to their health and work environment. The study involved call center agents in Northgate Cyberzone, Alabang Muntinlupa, City who are currently employed full-time in shifting schedules and who are regular employees. The limitations perceived by the researcher involved gathering information from different companies. The researcher attempted to gather data from call center companies, When the researcher inquired from their human resource department if they could partake in the study, majority of the companies declined the request. Only Company X showed interest in participating. The Recruitment supervisor, whom the researcher spoke with, agreed to give the researcher the necessary information to conduct the study and expressed willingness in distributing the questionnaire to their employees.

Significance of the Study The results of the study would be beneficial to the following: Call Center Agents. The results of the study shall enable them to realize the importance of awareness on one's eating habits especially in the work environment that they are in. The recommendations on how

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they can improve their eating habits shall help in the reduction of health risks. BPO Industry. The results of the study shall help health professionals in this industry find ways to help call center agents have healthy eating habits despite their lifestyle changes and realize the importance of eating habits in one’s health. Specific companies could make use of this study in making health programs which would suit the needs of their employees, have necessary warnings, and in

disseminating information to their workers to ensure that the workers would be aware of the health risks following eating habits and, in the process, avoid or reduce it. In the end, the health of the people shall help in the progress and will lessen the attrition rates of the whole industry. Similar Industries. This work will increase awareness on the importance of eating habits in maintaining good health, especially that of workers’ under the same working condition. This study will reduce of health risks in such industries. Health Organizations. The results of the study shall encourage them to work harder in increasing awareness regarding alarming health effects related to maladaptive eating habits. The results of this study will emphasize the need for them to pay attention to heath issues in occupational industries such as call centers.

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Other Researchers. This work would be of use in the development of new studies and enlighten other researchers who may have similar investigations. The results of this study would serve as a basis for future research, specifically on eating habits in other industries, in relation to the nature of their work and the area where they work.

Definition of Terms Some of the terms used in the study were defined either conceptually or operationally in order to establish a common frame of reference between the researcher and the reader. Age. This refers to the length of time of existence of call center agents at the time of the study. Agent. This refers to the eating habits which affect the health of a person. Body Mass Index (BMI). This refers to the weight in kilograms divided by the square of the height in meters (kg/m 2). Business Process Outsourcing or BPO. This refers to an emerging industry in the Philippines. This industry was regarded as one of the fastest-growing industries in the world. The BPO boom is led by demand for offshore call centers (http://bpo.box.com.ph/about/).

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Call Center. Telephone service facility set up to handle a large number of (usually) both inbound and outbound calls. Some firms, however, specialize only in calls that are inbound (for assistance, help, or ordering) or outbound (for sales promotion or other messages). Most telephone orders are handled by call centers, and not by the manufacturers or suppliers of goods or services. Call Center Agent. A call center agent is the person who handles incoming or outgoing customer calls for a business. A call center agent might handle account inquiries, customer complaints, or support issues (http://searchcrm.techtarget.com/definition/call-center-agent, 2007). Disinhibited Eating. This refers to overeating that occurs following failure of restraint (Coryell, 2011). Eating Habit. This refers to a developed manner or routine of eating, which can be emotional, restrained, disinhibited, or external eating. Emotional eating. This refers to consuming foods to reduce and alleviate negative emotions, such as anxiety (Macht, 2008). Educational Attainment. This refers to the highest level of school call center agents attended. Environment. This refers to the overall work-setting which affects a person’s health and eating habits.

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External eating. This refers to what occurs in response to immediate food-related external stimuli, regardless of internal

physiological cues of hunger (Coryell, 2011). Full Time Employee. This refers to an employee who is currently employed who works for a minimum of 40 hours per week as a call center agent. Health. This refers to a state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity (World Health Organization). Health program. This refers to a consolidated plan that contains strategies that will be proposed to influence the employees in the BPO Industry in having a healthy lifestyle. Host. This refers to the person or the call center agent whose health is affected by changes in the work environment and eating habits. Intuitive eating. This refers to eating using a natural mechanism that, if allowed to function, will ensure good nutrition at a healthy weight Maladaptive eating habit. This refers to an eating habit that is the result of an attempt to cope which does not have productive or desirable outcomes. Number of working hours. This refers to the time rendered at work by an employee.

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Pre-load. This refers to the food intake prior to an Experimental study. Regular Employee. This refers to an employee who has passed the probationary status as stated by the company. Restrained eating. This refers to consciously restricting food intake to control body weight and body shape. Restrained eaters can be successful or unsuccessful in their efforts to restrict food intake (Coryell, 2011). Shifting Schedule. This refers to a type of work schedule that involves night shifts and rotational schedules rather than the traditional 8 am to 5 pm schedule for five days that goes on throughout the year. Time of Shift. This refers to the beginning of work hours until the end of work hours as scheduled.

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Chapter 2 REVIEW OF RELATED LITERATURE AND STUDIES This chapter highlights the review of literature and studies relevant to the problem. The literatures were reviewed from books, journals, the World Wide Web, theses, dissertations, and other researches relevant to this study.

Related Literature Call Centers The business process outsourcing (BPO) industry sub-sector started in the Philippines in 2001 when American Online (AOL) set-up an in-house call center at the Clark special economic zone in Pampanga. A call center is an office with many employees in cubicles answering incoming telephone calls. The calls range from people asking about their computers, to card holders inquiring about their credit card balances, to subscribers checking their phone bills, to travelers booking their flights. Being the world’s third largest English-speaking country, the Philippines attracted many college graduates to the new industry by offering higher salaries than most other jobs (Sibal, 2011). BPO employees took home 53 percent more than workers of the same age in other industries. This has led it to become the world's second biggest

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share of the market, however, staff turnover rates averaged about 30 percent annually, compared to less than 10 percent in other sectors. As a result, the International Labour Organization (ILO) called on governments, as well as companies, to protect the health and safety of BPO staff working at night, and urged call centre operators to redesign work processes so staff enjoyed more autonomy at work (ILO, 2010). Despite high turnover rates, more and more work for BPO companies overtime especially women. The BPO work force has been described as young, generally well educated and predominantly female except in India. There had been a time in the Philippines when women were not allowed to work at night. It stated that, “No woman, regardless of age, shall be employed or permitted or suffered to work, with or without compensation.” The Department of Labor and Employment (DOLE) has already issued an exemption to allow BPO companies to hire women to work in the night shift. This led to letting BPO companies hire more women. A book launched by the ILO showed that young Filipino women dominate BPO jobs by up to 59.3 percent (Santos, 2011). In addition, of the more than 500,000 call center workers nationwide, 70 percent are women (Estrada, 2011). Letting more women enter the industry in addition to the fact that most workers are young, should emphasize the importance of having

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better arrangements to make the work environment better. That is so since shift work and night work is a common practice in this industry.

Shiftwork Due to the 24/7 economy, the number of jobs, including shift work and irregular work hours, has increased substantially during the last decades (van Drongelen, et al., 2011). The BPO industry is one amongst the industries practicing shift work since most of the customers are USbased companies, which are approximately twelve hours ahead of the Philippines. This implies for workers in the call center industry that their working day starts around 9 p.m. and ends at 7 a.m. in the morning (Bird, and Ernst, 2009). There is also a so called compressed work week in the BPO, which refers to one where the normal work week is reduced to less than six days, but the total number of work hours of 48 hours per week shall remain. It is when the normal work day is increased to more than eight hours but not to exceed twelve hours, without corresponding work premium (BPAP, 2010). Employees may also be asked to work overtime to meet company goals on time. Evening and night shifts, holding multiple jobs, long work hours and excessive overtime work can be detrimental to health by causing fatigue and disturbances in circadian rhythms. Working more than 40

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hours per week has been associated with poorer perceived overall health, illness rates and increased mortality, with especially pronounced effects in conjunction with extended work shifts that are longer than 8 hours (Egerter, et al., 2008). Lowden et al., (2010) found that eating behavior might be altered by working shifts, especially when night work is involved, due to a diverse range of biological, social, and cultural factors. It has been suggested that night work causes a conflict between socially-determined meal schedules and the circadian biological rhythms in hunger, satiety, and metabolism. Nocturnal eating causes disturbances of intestinal motility, affecting the digestion, absorption, and utilization of

pharmacological drugs and nutrients. From a chronobiological point of view, the human species is diurnal (i.e., active during the day), which explains why night workers tend to have a decreased appetite during the night when the organism is programmed for restitution, fasting, and endogenous mobilization of blood glucose. From a psychosocial perspective, shift-workers

commonly experience a mismatch between their daily routines (including meal times) and those of family and friends, which may further serve to disrupt their eating habits. The extent to which eating behavior is impacted by shift working is also likely to depend on local cultural norms

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(e.g., the number and timing of daily eating events and what is typically eaten at certain times). Besides the potentially negative physiological effects of eating at night, shift workers’ eating behavior may also impact their neural functions. Short-term changes in food intake are known to affect many aspects of cognitive performance, mood, and wakefulness. For example, the cognitive-behavioral consequences of both short- and long-term restrictions of food intake (e.g., skipping meals or incomplete food composition and fasting, dieting, and malnutrition, respectively) have been observed. Short-term effects are related to (a lack of) energy supply, while long-term effects concern (a lack of) the supply of essential nutrients (i.e. vitamins, minerals, and essential amino and fatty acids that are necessary for the functioning of the senses and biochemical processes). Shift-work exposure can lead to unhealthy behavior and subsequent disturbances in gastrointestinal and psychophysiological functioning causing body weight gain and obesity. Reviews state that total energy intake seems not to be affected by shift work, although meal frequency is irregular and reduced, and that high-energy snacking seems to be increased. Food intake itself cannot fully explain possible body weight gain as a result of shift work; however, it has been clear that

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irregular meal pattern and time of day intake could contribute to negative consequences in metabolism because of the relation between circadian rhythm and food intake. During daytime, when individuals normally eat, the human body promotes glucose metabolism and fat storage, while, during the night, glucose sparing and fat metabolism is promoted. As a result, shiftworkers show a lowered glucose and lipid tolerance following the change from day to night working. Other studies reported about increased leptin and blood lipid concentrations and higher low-density lipoprotein levels (van Drongelen et al., 2011).

Eating Habits Restrained and Disinhibited Eating Eating is affected by the balance between the desire for food and the effort to resist that desire. The cognitive effort to resist that desire is referred to as restraint. Restrained eaters are individuals who report that they consciously restrict food intake in order to control body weight and body shape, and that controlling their eating requires considerable effort. Restrained eaters include successful and unsuccessful dieters.

Successful dieters are characterized by high restraint and low tendency

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toward overeating, whereas unsuccessful dieters are characterized by high restraint and high tendency toward overeating. According to the Restraint Theory, dieting can cause overeating and, therefore, a higher weight. People who diet, cognitively suppress their feeling of hunger and eat less. However, the chronic attempt to control food intake makes them prone to disinhibition of their restraint and subsequent overeating in a variety of situations. Restrained eating, or dietary restraint, has been defined as the tendency to restrict food intake in order to achieve weight loss or to prevent weight gain. When cognitions are undermined (disinhibition) by, for example, distress, intoxicants, alcohol, and the consumption of high caloric food such a preload in an experimental setting (the disinhibitors), restrained eaters are more vulnerable to overeating than non-dieting individuals; this is called “counter-regulation”. Another way to describe this proposed mechanism is the boundary model: Normally people’s food intake is regulated by hunger (lower limit) and satiety (upper limit). Restrained eaters, however, ignore their hunger limits and have replaced this by an artificial selfimposed diet limit that is above the hunger limit. If this boundary is crossed, for example after having eaten a high-calorie pre-load in an experimental setting, there is no more restriction until the lower (aversion) limit. This has also been called the “what the hell effect.”

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People overeat because their diet is spoiled. The Restraint Theory is based on experimental work by Herman et al., in which participants with obesity inadequately compensated their energy intake after a pre-load. In contrast, they ate more after they ate a high energy preload. Both experimental and epidemiological studies have further addressed these behaviors in participants of different weight status (Coryell, 2011).

Emotional Eating Psychological distress or negative emotion can lead to

disinhibited eating in restrained eaters. Emotional eating refers to eating during periods of distress or negative emotion, so, in this manner, emotional eating can overlap with restraint and disinhibition. The concept of emotional eating originates from the

Psychosomatic Theory of Obesity. This theory states that, through experiences early in life, in which food has been associated with emotional distress, distress will evoke feelings of hunger later on. In the same line, Bruch stated that experience of hunger is not innate, and body awareness needs to be learned. Emotional eaters have not learned to rely on their feelings of hunger and satiety, but rather learned to associate emotions with distress. Kaplan and Kaplan proposed that people with weight problems use food as an emotional defense to face

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negative affects, whereas normal-weight persons use other coping strategies. Greeno and Wing elaborated on the concept of emotional eating which they described in the Individual Differences Model. This model considers loss of appetite to be the normal response to emotional arousal and distress, while emotional eaters respond differently; that is, by excessive eating which consequently results in weight gain. This is in contrast to the General Effect Model which postulates that all organisms react to stress by eating more, a model that, according to Greeno and Wing, has only been supported in animal studies (Snoek, 2009).

External Eating The assumption that the overweight subjects are not responsive to internal signals led to the idea that they are more responsive to external signals. A theory, focusing on external eating, states that certain people are more sensitive to external food cues than others, and that they eat in response to a variety of external stimuli, such as time manipulations, taste, visibility, and accessibility of food. In a recent review, Polivy, Herman, and Coelho (2008) concluded that “the superabundance of food cues in our society has created a ‘toxic environment’ that promotes overeating and overweight, not under-eating and weight loss.” As unhealthy foods are usually exposed more

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frequently than healthy foods – due to the economic interests in marketing processed foods high in sugar and fat – greater sensibility to external food cues could affect food intake towards unhealthy eating and subsequent higher weight. In addition, foods high in sugar are generally perceived as more palatable, which can affect external eaters more strongly as taste is one of the aspects in external eating. In this recent review, Herman and Polivy (2008) also introduced a new perspective to the concept of external eating by differentiating between normative (i.e., indicators of appropriate intake such as portion size) and sensory (i.e., the hedonic appeal of food such as palatability) external cues. External eating is also related to restrained and disinhibited eating in that external food cues can serve as disinhibitors to restraint. External eating is also associated with emotional eating; stress can result in both emotional and external eating. With regard to stress and external eating, stress may reduce internal cues of hunger and increase external food cues. Consequently, stress might lead to increased eating in external eaters. Stress and other factors, such as external food cues, negative emotions, and pressure from the society to control food intake play a huge role in the eating habits of a person; it can result into maladaptive eating habits such as restrained eating, disinhibited eating, emotional

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eating, and external eating. This reduces the ability of the person to recognize internal cues of hunger. Instead, the person relies more on external food cues and the end result is an unhealthy weight. In turn, there will be a need to find a dieting program to reduce weight.

Intuitive Eating Standard individual level interventions that focus on dietary restraint have been ineffective and, in some cases, harmful. Intuitive eating, an anti-dieting strategy that relies on recognizing and responding to internal hunger and satiation cues, has been proposed as an alternative approach to healthy weight management at the individual level. A study evaluated the relationship between intuitive eating and various health indicators among female college students. As measured by the Intuitive Eating Scale (IES), it was found that intuitive eating was significantly correlated with lower body mass index, lower triglyceride levels, higher levels of high density lipoproteins, and improved cardiovascular risk. Findings provide tentative support for intuitive eating as a positive approach to healthy weight management at the individual level. Efforts at the individual level typically focus on dietary restraint and exercise with the goal of expending more calories than one

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consumes. However, this strategy has had disappointing results since the level of restrained eating and exercise necessary to achieve weight loss seems unsustainable for most people given the current obesigenic environment. Even more worrisome is the finding that dietary restraint may paradoxically be predictive of obesity among some groups. As an alternative to restrictive dieting and its potentially negative outcomes, an anti-dieting movement began to take shape in the 1980s and has continued to gain empirical support. This movement is based on the assertion that restrained dieting (i.e., controlled meal plans, avoidance of taboo foods, and/or restricted intake of fat grams or calories) is not sustainable and may contribute to such negative outcomes as weight recycling, altered body composition, heightened fat storage potential, decreased resting metabolism, dysfunctional

relationships with food, increased risk of eating disorders, low-self esteem, and an overall sense of failure among dieters. Proponents of the anti-dieting movement further argued that many individuals seem to be capable of achieving a healthy body weight while maintaining an unrestrained relationship with food. Informal assessments revealed that, for these individuals, food intake was based primarily on physical hunger cues, rather than on diet plans, environmental cues, emotional states, or other external factors. Such individuals came to be

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referred to as intuitive eaters, and intuitive eating has continued to grow in popularity as an alternative to restrictive dieting. In short, the concept of intuitive eating suggests that all individuals have, within themselves, a natural mechanism that if allowed to function will ensure good nutrition at a healthy weight. As individuals get in touch with this "inner guide" or access their "inner wisdom," they will be more in tune with their bodies' physical needs and will eat in a way that supports healthy weight maintenance and positive nutrition. At the same time, they will avoid overeating, obsessive food consumption, harmful dieting, or mindless nibbling. This concept of intuitive eating has come to include several key attributes. The first is the ability to clearly recognize the physical signs of hunger, satisfaction, and fullness. Second, the intuitive eater is capable of sensing the nutritional needs of the body. Since there are no taboo foods or restrictions on eating, the intuitive eater considers the full range of food possibilities and carefully weighs available choices against physical promptings. Third, for the intuitive eater, the physical effects of food consumption are carefully monitored in terms of satisfaction. Food is not consumed unconsciously while driving or watching television, but is instead fully appreciated as it satisfies the nutritional and hunger needs of the body. Fourth, as promoted in the self-help literature,

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intuitive eating has taken on a philosophical orientation that values the health and energy of the body more highly than the fashionable rewards of an attractive appearance. Theoretically, an intuitive eater is more likely to be concerned about the functional benefits of fitness and proper diet composition, rather than the social advantages of lean figure. Finally, the intuitive eating philosophy strongly continues to reject restrictive dieting as a means of weight control, but instead commits individuals to mastering the elements of intuitive eating in an open, unrestrained relationship with food that promoted healthy weight management and positive self-esteem. All of these attributes, taken together, lead to the proposition that intuitive eaters are more likely to be a healthy weight and have other positive health indicators. It has been stated that eating habits which resulted from motivations (restrained, disinhibited, emotional, and external eating), other than internal cues of hunger, often result to overeating which is associated with weight gain. It is, therefore, important that the weight status is monitored.

Body Mass Index The weight status can be assessed through the Body Mass Index. Body Mass Index (BMI) is a simple index of weight-for-height that is

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commonly used to classify underweight, overweight, and obesity in adults. It is defined as the weight in kilograms divided by the square of the height in meters (kg/m2). For example, an adult who weighs 70kg and whose height is 1.75m will have a BMI of 22.9. BMI values are ageindependent and the same for both sexes. However, BMI may not correspond to the same degree of fatness in different populations due, in part, to different body proportions. The health risks associated with increasing BMI are continuous and the interpretation of BMI gradings in relation to risk may differ for different populations. There had been two previous attempts to interpret the BMI cutoffs in Asian and Pacific populations, which contributed to the growing debates. Therefore, to shed the light on these debates, WHO convened the Expert Consultation on BMI in Asian populations (Singapore, 8-11 July, 2002). The WHO Expert Consultation concluded that the proportion of Asian people with a high risk of type 2 diabetes and cardiovascular disease is substantial at BMI's lower than the existing WHO cut-off point for overweight (= 25 kg/m2). However, the cut-off point for observed risk varies from 22 kg/m2 to 25 kg/m2 in different Asian populations and for high risk, it varies from 26 kg/m2 to 31 kg/m2 . The Consultation, therefore, recommended that the current WHO BMI cut-off points should be retained as the international classification.

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Table 1 Classification of BMI for Weight Status Classification BMI(kg/m2) Principal cut-off Additional cut-off points points <18.50 <18.50 <16.00 <16.00 16.00 - 16.99 16.00 - 16.99 17.00 - 18.49 17.00 - 18.49 18.50 - 22.99 18.50 - 24.99 23.00 - 24.99 ≥25.00 ≥25.00 25.00 - 27.49 25.00 - 29.99 27.50 - 29.99 ≥30.00 ≥30.00 30.00 - 32.49 30.00 - 34.99 32.50 - 34.99 35.00 - 37.49 35.00 - 39.99 37.50 - 39.99 ≥40.00 ≥40.00

Underweight Severe thinness Moderate thinness Mild thinness Normal range Overweight Pre-obese Obese Obese class I Obese class II Obese class III

Source: Adapted from WHO, 1995, WHO, 2000 and WHO 2004. (www.who.int/bmi/index.jsp?introPage=intro_3.html, last updated 3/27/2012) The cut-off points of 23, 27.5, 32.5 and 37.5 kg/m 2 are to be added as points for public health action. It was, therefore, recommended that countries should use all categories (i.e., 18.5, 23, 25, 27.5, 30, and 32.5 kg/m2, and, in many populations, 35, 37.5, and 40 kg/m 2) for reporting purposes, with a view to facilitating international comparisons (WHO, 2006).

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Related Studies Foreign Studies A study by Escoto et al., (2010) on associations between hours worked per week and Body Mass Index (BMI), food intake, physical activity, and perceptions of eating healthy at work were examined in a sample of transit workers. Survey data were collected from 1,086 transit workers. Participants reported hours worked per week, food choices, leisure-time physical activity, and perceptions of the work environment with regard to healthy eating. Height and weight were measured for each participant. Multivariate linear and logistic regressions were conducted to examine associations between work hours and behavioral variables. Associations were examined in the full sample and stratified by gender. Transit workers working in the highest work hour categories had higher BMI and poorer dietary habits, with results differing by gender. Working 50 or more hours per week was associated with higher BMI among men, but not women. Additionally, working 50 or more hours per week was significantly associated with higher frequency of accessing cold beverage, cold food, and snack vending machines among men. Working 40 or more hours per week was associated with higher frequency of accessing cold food vending machines among women.

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Reported frequency of fruit and vegetable intake was highest among women working 50 or more hours per week. Intake of sweets, sugar sweetened beverages, and fast food did not vary with work hours in men or women. Physical activity and perception of ease of eating healthy at work were not associated with work hours in men or women. Long work hours were associated with more frequent use of garage vending machines and higher BMI in transit workers, with associations found primarily among men. Long work hours may increase dependence upon food availability at the worksite, which highlights the importance of availability of healthy food choices. Schiavo
and

de Martino

(2010) conducted a study to

evaluate the prevalence of

obesity and weight changes in night shift workers and their relationship with sleep. Fifty night shift and twenty-six day shift workers were evaluated. They belonged to one of two groups: nurse

technicians/assistants or nurses. The night shift started at 7:00 p.m. and ended at 7:00 a.m., while the day shift was either from 7:00 a.m. to 1:00 p.m. or from 1:00 p.m. to 7:00 p.m. Data were collected using sleep diaries, personal questionnaires, scales to measure weight, and height measurement to calculate Body Mass Index (BMI). There were significant differences between the day shift and the night-shift groups in sleep latency (6m54s and 20m6s; p<0.001), wakeup call (6h25m and

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7h52m; p<0.001), sleep duration (7h12m and 8h21m; p=0.002), quality of nocturnal sleep (8.48 and 7.62; p=0.009), and total nap time (34m48s and 1h30m; p=0.001), respectively. The average BMI- 1 (24.57; p=0.015) and BMI-2 (25.63; p=0.033) values from the day shift group were lower than those of the night-shift group –BMI-1 (27.01) and BMI-2 (28.04). The frequency of physical activity was correlated with the difference in BMI (r=-0.296; p=0.0366). The night-shift workers showed a higher average BMI than day shift workers did. However, it was not possible to ascertain whether sleep alterations influenced the weight gain of night shift workers. In a study by Wong et al., (2010), shift work induces stress, disturbs family life and interrupts regular meal schedules. Few studies have addressed the association between shift duties and abnormal eating behavior among hospital nurses. The hypothesis was tested in that shift duties were independent predictors of abnormal eating. Selfadministered surveys consisting of socio-demographic data, working pattern, Perceived Organizational Support (POS) questionnaire, and the patterns of eating style, identified by the Dutch Eating Behavior Questionnaires (DEBQ), were used. The study was done in one major acute hospital in one territory of Hong Kong. All 662 nurses who worked on a full-time basis in this hospital were invited to join the study and

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among them; 378 completed surveys were collected with a response rate of 57.1%. The average age was 37.2 years; 91.5% were female; 67.3% were registered nurses; 17.9% enrolled nurses; 14.5% were ranked nursing officers or above; 39.1% worked in acute settings (medical wards, intensive care units, and emergency departments); 62.1% of the respondents had at least 11 years of clinical experience; 76.2% had shift duties; and 81.9% had at least four shift duties per month. Only 66.7% of the respondents had a normal Body Mass Index (BMI 18.5–22.9 kg/m2). Three binary logistic regression analyses were conducted with abnormal emotional, external, and restraint DEBQ as outcome variables, respectively. The proponents controlled age, gender, marital status, work setting (acute vs. non-acute), years of clinical experience, the frequency of shift duties, Body Mass Index, perception of body weight changes in the past 6 months, self-perception of recent overeating; and POS. The proportions of participants having abnormal emotional, external, and restraint DEBQ scores were 66.4%, 61.4%, and 64.0%, respectively. From multiple regression analysis, nurses having 4 or more shift duties per month were more likely to present with abnormal emotional (adjusted odds ratio aOR 2.91, 95% C.I. 1.57 –5.42, p = 0.001) and restraint (aOR 3.35, 95% C.I. 1.76–6.38, p < 0.001) DEBQ scores.

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Shift duties were positively associated with abnormal eating behavior among nurses working in hospitals. More health promotional initiatives should be targeted toward hospital nurses whose duties require frequent night shifts to enhance healthy eating. A study by Coryell (2011) was done to ascertain the Role of Psychological Distress, Eating Styles, Dietary Intake, and Gender in Cardiometabolic Risk. Four hundred sixty-four participants contributed data, which were primarily recruited from Miami-Dade and Broward counties of Florida via newspaper advertisement and chain-referral. There was a screening session followed by two assessment visits. Screening session included obtaining informed consent, family medical history, and all current and pre-existing personal medical history through self-report and a comprehensive physical examination. Data gathering was done mostly through laboratory assessments and other data were gathered through anthropometric measurements and documentation of dietary intake. The three major questionnaires used to identify the eating styles in the study were the following: Dutch Eating Behavior Questionnaire, Three-Factor Eating Questionnaire – Revised 18-item version, and the Restraint Scale. Other questionnaires were used to determine the amount of psychological distress.

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In this study, women reported more restrained, emotional, and external eating than men. Restrained eating, as measured in the past study, represented unsuccessful dieting efforts. Restrained eating was conceptualized in this way to be consistent with the Restraint Theory. The restraint theory refers to unsuccessful dieting in which attempts to regulate food intake lead to episodic overeating. In other words, restrained eating is thought to cause obesity when it is characterized by a pattern of restraint and disinhibition. The Restraint Theory posits a casual path from restrained eating to overeating, and, although previous research findings demonstrate that dieting does indeed precede overeating for some individuals, overeating was found to precede dieting for others. Whereas some restrained eaters overeat, as described by the restraint theory, other restrained eaters do successfully restrict food intake and do not overeat. The study also suggested that the restrained eating style may be more influential on actual eating and consequent weight gain than the emotional and external eating style. Coryell suggested that studies examining prevention and intervention outcomes based on type of restrained eating – flexible versus rigid – to better understand how these different restrained eating subtypes operate and how they can be altered effectively to improve health.

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A Prospective twin cohort study was conducted by KeskiRahkonen et al., (2007) to explore the association of eating styles with overweight and obesity in young adults, controlling for identical genetic background in monozygotic twins. Two-hundred and thirty-three women and 2060 men from the FinnTwin16 Study, aged 16 years at baseline, and ranging from 22 to 27 years at the time of the nutritional assessment. Eating styles (Restrictive/overeating, health-conscious, snacking, emotional, and externally induced), self-reported at 22 to 27 years, were contrasted with body mass indices at 16 years and 22 to 27 years. At 22 to 27 years, obesity (BMIX30Kg/m2) was significantly crosssectionally associated with restrictive eating, frequent snacks, eating in the evening, avoiding fatty foods and failure to maintain healthy eating patterns. These associations were independent of BMI at 16 years at baseline. Obese women self-reported more vulnerability to external eating cues and comfort eating than normal-weight women. However, in a Multivariable Model, only restrictive/overeating and health-conscious eating styles were significant correlates of obesity at 22 to 27 years at the time of the nutritional assessment, independent of gender and BMI at 16 years baseline. When genetic background restricting the analysis to the 39 female and 45 male monozygotic twin pairs discordant for obesity or overweight (BMIX25Kg/m2) was controlled, restrictive/overeating

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eating style was still statistically significantly associated with excess weight. The eating styles of obese young adults differ from their normalweight counterparts: restrictive eating, overeating, and fewer healthy food choices are associated with obesity. Different eating styles may partially explain weight differences in individuals with identical genetic background. A study by Keskitalo, et al., (2008), estimated the effects of genetic and environmental factors on cognitive and emotional aspects of dieting behavior, Body Mass Index (BMI), and responses to fatty foods and on their relations. A total of 1,326 adult twin persons (aged 17-82 ; 17% M; and 83% F) from the United Kingdom and Finland completed the revised version of the Three-Factor Eating Questionnaire (TFEQ-R18) and reported the liking and use-frequency of 4 sweet-and-fatty and saltyand-fatty food items (6 items in the United Kingdom and 5 items in Finland). Genetic modeling was done by using linear structural equations. Heritability estimates were calculated separately for the countries and sexes; they were 26-63% for cognitive restraint, 45-69% for uncontrolled eating, and 9-45% for emotional eating, respectively. Of the variation in liking and use-frequency of fatty foods, 24-54% was attributed to interindividual genetic differences. No significant

correlations were observed between BMI and fatty food use or liking.

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However, BMI was positively (mostly genetically) correlated (genetic r = 0.16-0.51) with all of the dieting behaviors, and they correlated with fatty food use and liking ratings. Uncontrolled eating was both genetically and environmentally associated with liking for salty-and-fatty foods (genetic and environmental r = 0.16), and emotional eating was genetically associated with liking for sweet-and-fatty foods (genetic r = 0.31). The relation between BMI and diet appears to be mediated through dieting behaviors. Dietary counseling should focus on unhealthy dieting behaviors rather than only on direct advice on food use. Sex differences were significant for cognitive restraint and emotional eating and the liking and use-frequency scores of salty-andfatty foods, whereas age correlated modestly and positively with BMI and cognitive restraint and negatively with uncontrolled eating. For women, the heritability estimates of cognitive restraint and uncontrolled eating were higher (54–69%) than those of emotional eating (31–45%). In men, all of the estimates were lower, and, in the case of emotional eating, the estimate was not significant. The correlation between uncontrolled eating and emotional eating implies that some of the same factors predispose a person to loss of control over eating in general (uncontrolled eating) and in emotional situations. Close consideration of the relations among BMI, dieting behaviors, and the use and liking ratings of fatty foods showed

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that the relation between diet and obesity is partly modified by dieting behaviors—i.e., dietary restraint and disinhibition of the control over eating. The results provide insight into the background mechanisms of obesity and suggest that, in dietary counseling, attention should be paid to the dieting behaviors as well as to strict control over food intake. The study of Antunes, et al., (2010) aimed to correlate shift work with body mass index (BMI), waist circumference, chronotype, and depressive symptoms. This study covered 14 shift workers and 13 day workers from the health area aged 25 to 60 years. Minor psychiatric disorders were accessed by Self Report Questionnaire (SRQ-20) and depressive symptoms by Beck Depression Inventory (BDI). Chronotype was accessed using Morningness-Eveningness Questionnaire (MEQ). Anthropometric measures were taken. Shift workers presented higher BMI (P = 0.03) and waist circumference (P = 0.004) than day workers. Years on shift work were significantly correlated to waist circumference (r = 0.43; P = 0.03) and age (r = 0.47; P = 0.02). Shift work was not correlated with depressive symptoms and chronotype. It was observed that there was a correlation between years on shift work and waist circumference. Besides this, shift workers presented a higher BMI and waist circumference than day workers. Their study suggested a role played by shift work on the development and/or the early clinic

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manifestations of metabolic disturbances, becoming a risk factor to metabolic syndrome.

Local Studies Individual motivations that prompt various eating styles can play a central role in the development of unhealthy eating habits and obesity within the context of the nutrition transition. The study by Hawks et al., (2006) was conducted to compare motivational eating styles among two convenience samples of women in the Philippines. Given the presence of very different social and cultural pressures in relation to food, it was hypothesized that individual motivations for eating would differ significantly between these two populations. The first sample consisted of urban women attending a university in Manila, while the second included working women in the rural province of Bacolod. The Motivation for Eating Scale (MFES), a 43-item self-report questionnaire, was used to assess four different motivations for eating: environmental, emotional, physical (hunger based), and social. It was found that the college sample was younger and more likely to be underweight, while the community sample was older and more likely to be overweight or obese. No differences in physical and social eating were found between the two samples, but the college females had significantly higher levels of

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environmental and emotional eating. Other research has shown that environmental and emotional eating may be associated with binge eating, weight gain, and the development of eating disorders. The potentially negative eating styles found in higher levels among the college female population in Manila need to be studied more fully and addressed through prevention and education programs before they lead to more serious and widespread eating problems such as overnutrition, weight gain, and eating disorders. A study, conducted by the Population Institute of the University of the Philippines (2010), with a total of 675 respondents from call centers in Metro Manila and Metro Cebu were involved in the study. The objectives of the study follow lifestyles and health status of young workers in call centers with those working in other industries. The results show that the age at which they started work, at about 20 years old, generally the age that coincides with graduation from college for a 4 ‐year course. It was found that the mean age at which they started working at their current jobs is 23 years, The study revealed that 47% of call center workers regularly eat 3 meals a day, 40% female call center workers skip breakfast, 20% skip lunch, and 16% skip dinner. There was a high consumption of chips, burgers, fries, and fried chicken among the workers, but there was a fewer number of them who consume instant

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noodles and street food regularly. Fried chicken was the most popular food choice among the BPO workers, 78% consume it regularly, followed by chips (54%), fries (53%), and burgers (49%). Two thirds of young workers drink coffee daily, but call center workers drink more coffee that their non-call center counterparts (2.3 cups a day for call center workers vs. 1.7 cups for the latter). More call center workers also consume tea (1/4 of respondents) compared to non-call center workers (only 1/5). The study also revealed that half of the young workers drink soda daily, at an average of 1.5 bottles/cans a day, regardless of group. However, energy drinks are not as popular: only 15% of young workers drink energy drinks daily, the study found. Meanwhile, call center agents prefer drinking over partying, karaoke gimmicks, or other leisure activities, the study revealed. The study said that, overall, there is a very high level of current drinking among workers (85% for call centers; 87% for non-call centers). Beer is the most commonly preferred drink by workers, with male call center workers (86%) having the highest number of respondents saying they prefer the said drink. The study also revealed that call center workers usually have co-workers as their companions when drinking. The study focused on young workers 18-34 years old who have at least completed sophomore year in college, who are working in shifts. The

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study dealt with lifestyle, social life, sexual relationships, and health questions.

Synthesis The presented studies and concepts have greatly contributed to this research undertaking. The compilation of these thoughts and ideas has strengthened the foundation of this research and consequently shaped a solid structure that led to conceptualizing the health program. These widened the range of the study, thus including more concerns that should necessarily be encompassed. The studies and literatures presented served as a guide in the formulation and construction of the questionnaire. The concepts and ideas presented emphasized the importance and the impact of eating habits and work environment on the weight status of a person. Some related studies also touched other health effects of eating habits and work environment on the health of a person. The development of maladaptive eating habits through the combination of factors such as stress, negative emotions, external cues, concern for body image, time constraints, and food availability was also discussed. As presented by the researcher from several reviewed studies, eating habits have affected health in many ways. On a wider range, the

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environment that the person is in has broader effects which cover eating habits. The work environment, playing a tremendous role in a person’s life, may cause changes in the lifestyle including variations in eating habits and these results in certain health effects like weight changes. The study of Coryell (2011) is a great inspiration to the researcher’s study. This study was done to ascertain the

interrelationships between cardiometabolic risks, psychological distress, eating styles, dietary intake, and gender. Similar to Coryell’s, the present study considered eating habits as being associated with the health of call center agents, although the former study delved more into finding relationships with more health risks through the use of laboratory and physical assessments. Coryell covered the relationship of gender and eating habits. This strengthened and supported the findings that were produced by this research. The studies of Keski-Rahkonen, et al., (2007) focused on weight, overeating, and eating habits. This study provided light on the results of the present undertaking especially in the relationship of weight and eating habits. Moreover, Hawks et al., (2006) delved into the effects of cultural differences to the eating motivation of a person and its effect to the weight status of a person. Though this study is more concerned with

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the effects cultural differences on eating habits, this helped support the findings of the current undertaking in terms of the work environment. In the study of Wong, et al., (2010), the negative effects of shift work toward the eating habits are emphasized. In the studies of Schiavo and de Martino (2010), Escoto, et al., (2010), and Antunes, et al. (2010), the relationships between BMI and the work environment were shown. These studies are very similar to the current study because, mainly, call center agents are on shifting schedules and this type of work as presented in both past studies do have relationships with weight changes. Such guided and supported the findings of the present undertaking. Moreover, the findings of the present undertaking, in relation to eating habits, were presented through the identification of the eating habits with the highest and lowest mean values. Considering the number of studies, not only on eating habits, but also the growing number of overweight, obese, and health risks brought about by maladaptive eating habits, there are still only a few programs made that are proven of great effect in solving this problem. There are dietary programs developed, but these only target overeating, the present research study aimed to develop a health program with the use of the results of other studies and the findings that were produced to help

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counter health risks, teach call center agents how to cope well with their situation, and also learn how to better their lives through behavior modification.

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Chapter 3 METHODOLOGY

After a thorough discussion of the background of the study and the review of related literature and studies, this chapter discusses how the research was conducted, how its respondents were chosen and how the collection of data was done. Specifically, it described the Research Design, Population and Sampling, Research Respondents, Research Instrument, and Statistical Treatment.

Research Design This undertaking utilized the Descriptive Method of Research which is a scientific method that involves observing and describing the behavior of a subject without influencing it in any way (Shuttleworth and Martyn, 2008). The overall purpose of Descriptive Method of Research is to provide a picture of a phenomenon as it naturally occurs, as opposed to studying the effects of the phenomenon or intervention. Descriptive Research can be designed to answer questions of a univariate, normative, or correlative nature—that is, describing only one variable,

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comparing the variable to a particular standard, or summarizing the relationship between two or more variables (Bickman and Rog, 2008).

Research Locale In the Philippines, majority of the BPO Companies are located in Metro Manila. Muntinlupa is also a very industrialized city where a lot of big companies are located. The researcher worked for over a year in Alabang, Northgate Cyberzone, which reflects a fast-growing area for business and is also the location for a lot of call centers.

Northgate Cyberzone is the information technology park within Filinvest Corporate City in Alabang. The 18.7 hectare, Philippine Economic Zone Authority (PEZA) registered IT zone is designed, mastered-planned and built around the needs of technology-based companies engaged in Business Process Outsourcing (BPO),

Knowledge Process Outsourcing (KPO), education, learning and firm, software design and multimedia, call centers, e-commerce, banking and financial services, as well as other IT support businesses and the like. Northgate Cyberzone houses F@stbytes, a dining center where food outlets run on a 24 hours, 7 days a week basis. F@stbytes is the dining area for a lot of call center agents because of its proximity, convenience,

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and the availability of more food centers. Within Northgate Cyberzone is the location of several call centers which includes Company X.

Founded in 1973, Company X serves as a leading provider in customer care outsourcing solutions with global BPO services. Company X’s award-winning suite of Customer Lifecycle Management Solutions (CLMS) consistently delivers increased sales, increased customer loyalty and enterprise-wide process improvements for many of the world’s most successful companies. With deep industry expertise, world-class technologies, and a proven track record, Company X expertly manages every single customer interaction. The result is customer relationships that last a lifetime, with consistently higher revenues and profits.

Population and Sampling The population included call center agents working in Company X in Northgate Cyberzone, Alabang, Muntinlupa City. The respondents constituted 20 percent of the population of regular call center agents. The researcher used Purposive Sampling. Non-Probability Sampling is often the only recourse due to the nature of the population and the constraints faced in accessing the sampling units; because of this, Purposive Sampling would suitably generate samples informative of

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the population. In Purposive Sampling, the researcher’s knowledge about the population is used to select the units to be included in the sample. In this study, Purposive Sampling is defined as Random Sampling from the most informative segment of the population (Guarte and Barrios, 2006).

Table 2 Number of Employees in Company X Employees in Northgate Cyberzone Probationary Call Center Agents Regular Call Center Agents Call Center Agents Total 507 1378 1885 Percentage % 26.90 73.10 100.00

The respondents were from Company X who were working fulltime and regular employees therein.

Respondents of the Study Using Purposive Sampling, the researcher sent copies of the questionnaire to the recruitment department of Company X. The recruitment department distributed the questionnaire; the researcher sent sufficient copies for the number of respondents which comprised 20

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percent of the total number of regular call center agents or 276. The respondents must be currently employed at the time of the study regular and full-time in shifting schedules.

Table 3 Regular Employees in Company X Call Center Agents Respondents Regular Frequency 276 1378 Percentage % 20.00 100.00

Research Instrument The main instrument of the study was a self-made questionnaire which was made up of three parts as shown in Appendix A. The first part determined the profile of the respondents. The weight status of respondents were identified though the BMI classification system (Table 1). The second part determined the working environment of call center agents; the third part determined the eating habits of call center agents in terms of restrained, disinhibited, emotional, and external eating habits of call center agents. Each statement on the third part reflected an eating habit (restrained, disinhibited, emotional, and external eating habits).

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Statements 1, 6, 9, 14, and 17 fall under restrained eating habits; 4,8,12,16, and 18 fall under disinhibited eating habits; 3,7,11,13, and 19 fall under emotional eating habits, and 2, 5, 10, 15, and 20 fall under external eating habits. The questions about eating habits were answered using the Likert scale. Likert Scales are a common ratings format for surveys. Respondents rank quality from high to low, or best to worst, using five or seven levels. These scales range from a group of categories—least to most—asking people to indicate how much they agree or disagree, approve or disapprove, or believe to be true or false. Here, the Likert Scale is categorized frequency as Very Often, Often, Sometimes, Seldom and Never (Allen and Seaman, 2007).

Table 4 Interpretation of the Scale for Eating Habits in the Questionnaire Classification 5 4 3 2 1 Statistical Limit 4.5-5 3.5-4.49 2.5-3.49 1.5-2.49 1-1.49 Word Description Very Often Often Sometimes Seldom Never

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Validation of the Instrument The copies of the questionnaire were submitted for validation by experts who were recommended by the Dean of the Graduate School. After content validation, the suggestions or recommendations were included in the questionnaire. The revised questionnaire was undertaken for a pilot study. This study considered 20 call center agents in Makati City known to the researcher to test for clarity and comprehensibility. To test the reliability of the instrument, the set of data gathered was analyzed using the Split-Half Method for Reliability Coefficient with the application of Pearson Product Moment of Coefficient of Correlation. Based on the data obtained from odd-even items, the computed r- value of 0.709, being higher than the critical r-value of 0.632 at five percent level of significance, revealed a significantly high reliability of the instrument.

Data Gathering Procedure After preparing a sufficient number of copies, the researcher sent the copies of the questionnaire to the recruitment department of Company X which were randomly distributed to regular call center agents and retrieved after the same were answered. After the retrieval of the accomplished instruments, the collected data were coded,

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tabulated, and summarized in such a way that they could be statistically treated. The researcher coded each response with a numerical figure to be statistically treated. According to the arrangement of the items in the questionnaire, the researcher had coded each item that came first with a numerical value lower than the next. In terms of gender, male is coded 1 and female is coded 2.

Statistical Treatment of Data The following statistical tools will be used to analyze the data obtained: Frequency Count. This refers to a systematic array of numerical values from the lowest to the highest, together with a count of number of times each value was obtained (Polit and Beck, 2006, as cited by Canaria, 2011). It was used to show the tally of responses for every item in the questionnaire. Percentage. This refers to proportion out of 100 that a group comprises. The beauty of a percentage is that it allows comparison of groups (Polit and Beck, 2006, as cited by Canaria, 2011). In this study, percentage was used together with frequency to describe the responses gathered.

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Mean. This refers to an average worked out by dividing the total of all participants’ scores by the number of participants. Pearson Correlation r. This refers to a statistic measuring the linear relationship between two variables in a sample. Five percent level of significance was used.

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Chapter 4 PRESENTATION, ANALYSIS, AND INTERPRETATION OF DATA

This

chapter

briefly

presents

the

results,

analysis,

and

interpretation of data gathered based on the problems presented in this research. Results and discussions were organized in terms of the

sequence of the research problems stated in the previous chapter.

Problem 1. What is the profile of call center agents according to: 1.9 Age; 1.10 1.11 1.12 Gender; Educational Attainment; and BMI?

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Table 5 Distribution of Respondents According to Age Age Below 20 20-40 Above 40 Total Frequency 2 263 11 276 Percentage 0.72 95.29 3.99 100.00

Table 5 shows that majority of the respondents, 263 or 95.29 percent of the respondents were 20 to 40 years of age while the least, 2 or 0.72 percent of the respondents were under 20 years of age. This is supported by the study by the Population Institute of the University of the Philippines which found that call center agents start working when they are at least 20 years old. It is generally the age that coincides with graduation from college for a 4-year course in the Philippines, just as the average age at which call center agents started working at their current jobs is 23 years (Population Institute of the University of the Philippines, 2010). Being a call center agent, which is the most known and largest BPO job, has somehow become a natural career path for the new

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college graduates. The apparent reasons are either they could not find a company that needs their finished college degree or, in cases when they did find one, they realized that call centers offer a relatively higher pay. Indeed, there has been a dramatic rise in the BPO workforce – from only 2,400 in 2000, the number has skyrocketed to 442,164 in 2009 or an annual expansion of about 48,863 new BPO jobs in the last nine years (Padilla, 2010).

Table 6 Distribution of Respondents According to Gender Gender Male Female Total Frequency 125 151 276 Percentage % 45.29 54.71 100.00

Table 6 shows that 151 or 54.71 percent of the respondents are female and 125 or 45.29 percent are male. The results show that 54.71 percent of the respondents were female, which is slightly more than males (45.29 percent), this could be because young Filipino women dominate BPO jobs by up to 59.3

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percent, as the International Labor Organization (ILO) revealed (Santos, 2011). The BPO work force is described as young, generally welleducated, and predominantly female (ILO, 2010).

Table 7 Distribution of Respondents According to Educational Attainment Educational Attainment Undergraduate College Graduate Post Baccalaureate Total Frequency 63 205 8 276 Percentage 22.83 74.28 2.90 100.00

Table 7 shows that majority of the respondents, 205, or 74.28, percent were college graduates, while the least, 8, or 2.90 percent of the respondents finished their post baccalaureate degrees. This is supported by a paper from the ILO stating that the share of college graduates is relatively high in call centers with the majority of companies employing between 80 percent and 90 percent college graduates. The skills requirements vary slightly between call centers, but most call centers demand from their candidates to have at least a two-year college education, besides possessing excellent oral and written English

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language skills in order to handle the job adequately (Bird, and Ernst, 2009).

Table 8 Distribution of Respondents According to BMI BMI Below 18.50 18.50-24.99 25.00-29.99 above 30.00 Total BMI Lowest BMI Highest BMI Average BMI 15.98 47.65 23.44 Classification Underweight Normal Range Overweight Obese Frequency 28 156 70 22 276 Percentage % 10.14 56.52 25.36 7.97 100.00

Table 8 presents the distribution of respondents according to BMI. It shows that most of the respondents, 156 or 56.52 percent, were within the normal range of BMI, followed by overweight respondents (70 or 25.36 percent), and then the underweight respondents (28 or 10.14

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percent), while the least of the respondents, 22, or 7.97 percent, were obese (Table 1). In addition, the lowest BMI is 15.98, while the highest BMI is 47.65, and the average BMI is 23.44. One of the reasons why only 56.52 percent were within the normal BMI range could be that night work causes a conflict between socially-determined meal schedules and the circadian biological rhythms in hunger, satiety, and metabolism (Lowden et al., 2010). Furthermore, shift-work exposure can lead to unhealthy behavior and subsequent disturbances in gastrointestinal and psychophysiological functioning causing body weight gain and obesity. It has been clear that irregular meal pattern and time of day intake could contribute to negative consequences in metabolism because of the relation between circadian rhythm and food intake, as highlighted by the findings of this study that almost half of the respondents were underweight, overweight, and obese. During daytime, when individuals normally eat, the human body promotes glucose metabolism and fat storage, while, during the night glucose sparing and fat metabolism is promoted. As a result, shift workers show a lowered glucose and lipid tolerance following the change from day to night work. Other studies reported about increased leptin and blood lipid concentrations and higher low-density lipoprotein levels (van Drongelen et al., 2011).

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Problem 2. What is the work environment of call center agents in relation to: 2.5 Time of shift; and 2.6 Number of working hours?

Table 9 Distribution of Respondents According to Time of Shift Time of Shift Day shift Mid shift Graveyard shift Total Frequency 92 58 126 276 Percentage 33.33 21.01 45.65 100.00

Table 9 presents the distribution of respondents according to time of shift; it shows that most of the respondents, 126, or 45.65 percent, worked in graveyard shifts, while the least of the respondents, 58, or 21.01 percent, are working in mid shifts. This could be attributed to the fact that most of the customers of the call centers are US-based companies, which are approximately twelve hours ahead of the Philippines (Bird, and Ernst, 2009).

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Table 10 Distribution of Respondents According to Number of Working Hours Number of Working Hours 8 to 9 hours 10 to 11 hours Total Frequency 237 39 276 Percentage 85.87 14.13 100.00

Table 10 presents the distribution of respondents according to number of work hours. It shows that most of the respondents, 237, or 85.87 percent, were working for 8 to 9 hours, while the least of the respondents, 39, or 14.13 percent, were working for 10 to 11 hours. This could be because the normal work day is composed of 8 hours. Some respondents could be working for 10 or 11 hours, because there is a socalled compressed work week in the BPO industry which is reduced to less than 6 days which allows companies to enhance productivity, competitiveness, and for employees to have a balanced work-life (BPAP, 2010). Also, others may extend their work hours to be paid for the

overtime (DOLE, 2010).

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Problem 3. What are the eating habits of call center agents in terms of: 3.1 Restrained eating; 3.2 Disinhibited eating; 3.3 Emotional eating; and 3.4 External eating?

The average mean rating was computed in order to determine the eating habits of call center agents based on the ratings of the respondents. Tables 10 to 14 present the ratings of the different eating habits in terms of restrained eating, disinhibited eating, emotional eating, and external eating.

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Table 11 Distribution of Mean Responses on Eating Habits in Terms of Restrained Eating Statement Number 1-I try hard not to eat a lot or try to eat less so that I will not gain weight. 6-I do not eat fatty foods and foods with a lot of calories because I don’t want to gain weight. 9- When I feel like I have gained weight, I try hard not to eat even if I see my favorite foods and delicious looking foods. 14- When I notice that I gained weight, I go on a diet as a response. 17- I try to eat less and skip snacks so that I will not gain weight. Overall Mean 3.35 3.05 2.97 3.09 2.99 3.09 Description Sometimes Sometimes Sometimes Sometimes Sometimes Sometimes

Table 11 presents the responses on eating habits in terms of restrained eating for each question. The highest mean value for restrained eating is on statement Number 1 “I try hard not to eat a lot or try to eat less so that I will not gain weight” (3.35) and the lowest mean value for restrained eating is on statement Number 9 “when I feel like I have gained weight, I try hard not to eat even if I see my favorite foods and delicious looking foods” (2.97), all the mean values for restrained eating, including the overall mean value (3.09) fall under one description,

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which is “Sometimes”. This means that the frequency that restrained eating is practiced by the respondents is “Sometimes”. The result that the highest mean value for restrained eating is on the first statement; this could be because experts consider eating less the key to weight loss (Park, 2010). In addition, the 2010 dietary guidelines released by the US government and the British government initiative urge people to eat less to reduce obesity (Martin & Taylor, 2011). This is supported by recent research findings that the ability of restrained eaters to control their food intake could be lessened if faced with pleasurable foods. Obese people react much more hedonistically to sweet, fat-laden food in the pleasure and reward circuits of the brain than healthy-weight people do. Simply seeing pictures of tempting food can light up the pleasure-seeking areas of obese peoples' brains (Beck, 2010).

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Table 12 Distribution of Mean Responses on Eating Habits in Terms of Disinhibited Eating Statement Number 4- It is easy to start eating but it is hard to stop. 8- When I get hungry I eat a lot and I don’t know when to stop because I don’t get full. 12- When there is still food to eat, I can’t stop eating because I am always hungry. 16- I eat a lot even if I am not hungry. 18- I eat all the time because I am always hungry. Overall Mean 3.09 2.70 2.74 2.72 2.63 2.77 Description Sometimes Sometimes Sometimes Sometimes Sometimes Sometimes

Table 12 presents the responses on eating habits in terms of disinhibited eating for each question. The highest mean value for disinhibited eating was on statement Number 4, “It is easy to start eating but it is hard to stop” (3.09) and the lowest mean value for disinhibited eating was on statement Number 18, “I eat all the time because I am always hungry” (2.63), all the mean values for disinhibited eating , including the overall mean value (2.77), fall under one description, which is “Sometimes”. This means that the frequency that disinhibited eating was practiced by the respondents was “Sometimes”. Considering the

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interrelationships between eating habits, the findings exhibit the relationship of disinhibited eating and external eating. This is supported by findings that while tempting food stimulates the release of dopamine in obese people, they actually have fewer dopamine receptors than normal weight subjects do, so they may derive less pleasure from actually eating, setting up a craving for more. In addition, people who are overweight are more vulnerable to external eating cues (Beck, 2010). This supports the result on the fourth statement having the highest mean and this could also explain failure to control eating once started. This could also explain why disinhibited eaters feel hungry most of the time of eat even if they are not hungry.

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Table 13 Distribution of Mean Responses on Eating Habits in Terms of Emotional Eating Statement Number 3- When I am worried, I want to eat. 7- When I feel bad, I eat to make myself feel better. 11- When I am upset or frustrated, I want to eat. 13- When I don’t have anything to do or if I’m bored, I want to eat. 19- When I am annoyed by anyone or anything, I want to eat. Overall Mean 3.00 2.95 2.83 3.01 2.55 2.87 Description Sometimes Sometimes Sometimes Sometimes Sometimes Sometimes

Table 13 presents the responses on eating habits in terms of emotional eating for each question. The highest mean value for emotional eating was on statement Number 13 “when I don’t have anything to do or if I’m bored, I want to eat” (3.01) and the lowest mean value for emotional eating is on statement Number 19 “when I am annoyed by anyone or anything, I want to eat” (2.55), all the mean values for emotional eating, including the overall mean value (2.87) fall under one description, which is “Sometimes”. This means that the frequency that emotional eating was practiced by the respondents was “Sometimes”.

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This could be because of the repetitive nature of certain call center jobs and sedentary lifestyles (UPPI, 2010). Respondents may have acquired this eating habit due to the type of job which may lead to boredom. In negative feelings, food temporarily alters mood and increases energy. This causes poor eating habits to develop over time, which causes a conditioning to turn to food in response to feelings of tension and low energy by eating energy generating foods. Moreover, individual differences play a role in emotional eating; most respondents could be experiencing more of certain negative emotions such as boredom and anxiety than the others (Kassem, 2009).

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Table 14 Distribution of Mean Responses on Eating Habits in Terms of External Eating Statement Number 2- When I see delicious smelling and tasty foods, it makes me want to eat more. 5- When I see someone eating something delicious, I eat more. 10- When I know that the food is delicious or when the food looks good, I eat more. 15- When I smell delicious foods or see good looking foods, it makes me hungry. 20- Seeing other people eating makes me feel hungry. Overall Mean 3.57 3.00 3.26 3.29 2.86 3.20 Description Often Sometimes Sometimes Sometimes Sometimes Sometimes

Table 14 presents the responses on eating habits in terms of external eating for each question. The highest mean value for external eating was on statement Number 2 “when I see delicious smelling and tasty foods, it makes me want to eat more” (3.57). This means that the frequency that respondents practice external eating, particularly on “when I see delicious smelling and tasty foods, it makes me want to eat more,” is often. The lowest mean value for

external eating was on statement Number 20, “seeing other people eating makes me feel hungry” (2.86), all the mean values except on statement Number 2 for external eating, including the overall mean value

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(2.87), fall under one description, which is “Sometimes”. This means that external eating was practiced by the respondents “Sometimes”. This is supported by the review done by Herman and Polivy (2008), which stated that taste is one of the aspects in external eating. Sensory external cues like the hedonic appeal of food, such as palatability, determine the external eating pattern.

Table 15 Distribution of Mean Responses on Overall Eating Habits Eating habits Restrained Disinhibited Emotional External Overall Mean 3.09 2.77 2.87 3.20 2.98 Description Sometimes Sometimes Sometimes Sometimes Sometimes

Table 15 presents the responses on eating habits in terms of restrained eating, disinhibited eating, emotional eating, external eating, and overall eating. The highest mean value for eating habits (3.20) is on external eating, while the lowest mean value on eating habits was on

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disinhibited eating (2.77), all the mean values fall under one description, which is “Sometimes”. This means that eating habits in terms of restrained eating, disinhibited eating, emotional eating, external eating, and overall eating is practiced by the respondents “Sometimes”. Lowden et al., (2010) stated that eating behavior might be altered by working shifts, especially when night work is involved, due to a diverse range of biological, social, and cultural factors; it has been suggested that night work causes a conflict between socially-determined meal schedules and the circadian biological rhythms in hunger, satiety, and metabolism. From a chronobiological point of view, the human species is diurnal (i.e., active during the day), which explains why night workers tend to have a decreased appetite during the night when the organism is programmed for restitution, fasting, and endogenous mobilization of blood glucose. From a psychosocial perspective, shift workers commonly experience a mismatch between their daily routines (including meal times) and those of family and friends, which may further serve to disrupt their eating habits. The extent to which eating behavior is impacted by shift-working is also likely to depend on local cultural norms (e.g., the number and timing of daily eating events and what is typically eaten at certain times).

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Short-term changes in food intake are known to affect many aspects of cognitive performance, mood, and wakefulness. For example, the cognitive-behavioral consequences of both short- and long-term restrictions of food intake (e.g., skipping meals or incomplete food composition and fasting, dieting, and malnutrition, respectively) have been observed. Shift-work exposure can lead to unhealthy behavior, meal frequency is irregular and reduced, and that high-energy snacking seems to be increased (van Drongelen, et al., 2011).

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Problem 4. Is there a significant relationship between the profile and eating habits of call center agents?

Table 16 Correlation Analysis between Age and Eating Habits Eating Habits Restrained Eating Disinhibited Eating Emotional Eating External Eating Overall Eating Habits r-value -0.026 -0.054 -0.065 -0.051 -0.066 Computed t-value -0.425 -0.898 -1.071 -0.841 -1.098 Significance Not Significant Not Significant Not Significant Not Significant Not Significant

Table 16 presents the results of the correlation analysis between the profile in terms of age and eating habits classified into restrained eating, disinhibited eating, emotional eating, and external eating, including the overall eating habits. The computed r-values were all negative which indicate that there is an inverse relationship between age and eating habits. It means that older respondents tend to practice either one of the eating habits or all of the eating habits less often than younger respondents do. Results of the

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t-test revealed that the relationships were all found insignificant since the computed values did not exceed the critical t-value of 1.960 at five percent level of significance. Hence, the Null Hypothesis that “there is no significant relationship between the profile, age in particular, and eating habits” is accepted. This could be because having unhealthy eating habits is linked with lower self-esteem, negative self-image, and higher rates of psychosocial difficulties experienced by an adolescent. Indeed, as people mature, they tend to overcome issues brought about by their roles in society (Ayodele, 2009).

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Table 17 Correlation Analysis between Gender and Eating Habits Eating Habits Restrained Disinhibited Emotional External Overall Eating Habits r-value 0.026 -0.137 0.045 0.025 -0.014 Computed t-value 0.433 -2.290 0.745 0.411 -0.232 Significance Not Significant Significant Not Significant Not Significant Not Significant

Table 17 presents the results of the correlation analysis between the gender and eating habits classified into restrained eating, disinhibited eating, emotional eating, and external eating, including the overall eating habits. The computed r-values for restrained, emotional and external eating are positive which indicate that there is a direct relationship between gender, and restrained, emotional, and external eating. It means that the female respondents tend to practice restrained, emotional, and external eating “More Often”. On the other hand, the computed r-values for disinhibited and the overall eating habits are negative which indicate that there is an inverse relationship between gender and disinhibited eating. It means that the male respondents tend

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to practice disinhibited eating “More Often,” which is why the proposed health program is relevant. Results of the t-test revealed that, except disinhibited, which had an inverse relationship with gender, the relationships of the restrained, emotional, and external eating habits having direct relationships with gender, and the overall eating habits having an inverse relationship with gender were found insignificant since the computed values did not exceed the critical value of 1.960 at five percent level of significance. Hence, the Null Hypothesis that “there is no significant relationship between gender and eating habits particularly restrained, emotional, and external eating habits including the overall eating habits” is accepted. On the other hand, the result of the t-test revealed that the relationship regarding disinhibited eating and gender was found to be significant since the computed values were higher than the critical value of 1.960 at five percent level of significance. Hence, the Null Hypothesis that “there is no significant relationship between gender and eating habits, particularly in disinhibited eating” is rejected, this may be due to an effort to control body weight which is why many women diet or adopt a restrained approach to eating (Rideout, and Barr, 2009). Moreover, the results that restrained, emotional, and external eating are being practiced more by women is supported by the result of a study by Coryell

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(2011) wherein women reported more restrained, emotional, and external eating than men.

Table 18 Correlation Analysis between Educational Attainment and Eating Habits Eating Habits Restrained Disinhibited Emotional External Overall Eating Habits r-value -0.038 0.044 0.015 -0.028 -0.001 Computed t-value -0.628 0.735 0.242 -0.472 -0.023 Significance Not Significant Not Significant Not Significant Not Significant Not Significant

Table 18 presents the result of the correlation analysis between the educational attainment and eating habits classified into restrained eating, disinhibited eating, emotional eating, and external eating, including the overall eating habits. The computed r-values for restrained and external eating are negative which indicate that there is an inverse relationship between educational attainment and both restrained and external eating. It means that the respondents having a lower level of education tend to practice restrained and external eating more often. On the other hand, the

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computed r-values for disinhibited and emotional eating are positive, which indicate that there is a direct relationship between educational attainment and both disinhibited and emotional eating. It means that the respondents having a higher level of education tend to practice disinhibited and emotional eating more often, this could be because most workers are either overqualified or have another qualification and thus consider BPO services from the beginning as a temporary professional activity (Bird, and Ernst, 2009). Aside from the insecurity of job tenure and repetitive nature of certain call center jobs (UPPI, 2010), the dissatisfaction related to the misuse of their educational background may add up to their stress resulting to erratic eating habits. Hence, a health program intended for behavior modification will improve these practices which can lead to the well being of call center agents.

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Table 19 Correlation Analysis between BMI and Eating Habits Eating Habits Restrained Disinhibited Emotional External Overall Eating Habits r-value 0.044 0.071 -0.026 -0.046 0.016 Computed t-value 0.728 1.185 -0.434 -0.756 0.267 Significance Not Significant Not Significant Not Significant Not Significant Not Significant

Table 19 presents the result of the correlation analysis between the BMI and eating habits classified into restrained eating, disinhibited eating, emotional eating, and external eating, including the overall eating habits. The computed r-values for restrained and disinhibited eating are positive which indicate that there is a direct relationship between the BMI and both restrained and disinhibited eating. It means that the respondents having higher BMI tend to practice restrained and disinhibited eating more often. On the other hand, the computed r-values for emotional and external eating are negative which indicate that there is an inverse relationship between BMI and both emotional and external eating. It means that the respondents having higher BMI tend to practice emotional and external eating less often, this

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maybe because people with higher BMI could be unsuccessful restrained eaters that had turned to disinhibition. As supported by the findings of Keski-Rahkonen, et al., (2007), eating habits of obese young adults differ from their normal-weight counterparts: restrained eating and overeating are associated with obesity. This can be explained by the Restraint Theory, suggesting that the key factor in producing and maintaining overeating is chronic dieting: feelings of deprivation and physical hunger associated with dieting prompt episodes of overeating and gaining weight.

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Problem 5. Is there a significant relationship between the eating habits and work environment of call center agents?

Table 20 Correlation Analysis between Time of Shift and Eating Habits

Eating Habits Restrained Disinhibited Emotional External Overall Eating Habits

r-value -0.110 -0.125 -0.117 0.004 -0.121

Computed t-value -1.827 -2.087 -1.950 0.071 -2.026

Significance Not Significant Significant Not Significant Not Significant Significant

Table 20 presents the results of correlation analysis between eating habits and work environment with respect to the time of shift. The computed r-values are mostly negative which indicate that there is an inverse relationship between eating habits as to restrained, disinhibited, emotional, including the overall eating habits, and time of shift. Only external eating had a positive r-value indicating a direct relationship with the time of shift. Inverse relationship means that respondents at earlier shifts tend to practice restrained, disinhibited, and emotional eating more often, while direct relationship means that respondents at later shifts

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tend to practice external eating more often. Results of the t-test revealed that, except disinhibited, the relationships regarding the three categories having inverse relationships were found insignificant since the computed values did not exceed the critical value of 1.960 at five percent level of significance. Hence, the Null Hypothesis that “there is no significant relationship between work environment on time of shift and eating habits, particularly restrained, emotional, and external eating habits” is accepted. On the other hand, the result of the t-test revealed that the relationships regarding disinhibited and overall eating habits were both found significant since the computed values were higher than the critical value of 1.960 at five percent level of significance. Hence, the Null Hypothesis that “there is no significant relationship between work environment on time of shift and eating habits, particularly in disinhibited and overall manner of eating” is rejected. It has been mentioned before that working shifts and night work interrupt the circadian rhythm and the normal meal patterns.

Furthermore, it had been emphasized earlier that since the night time is for restitution, there is decreased appetite at night (Lowden, et al., 2010 and van Drongelen, et al., 2011). Hence, work schedules have a greater influence than feelings of hunger in determining the timing and type of

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food intake (Atkinson, et al., 2008). Also, respondents practice external eating more during much later shifts. This could be because of the accessibility and availability of food within the work place as influenced by the urge to keep them energized and awake. The results therefore emphasize the importance of educating call center agents about the necessary changes in their lifestyle and eating habits to facilitate physiological processes necessary. In addition, they should be aware about the relationships between their eating habits, time of shift, and weight status, as reflected in the stated results on the overweight and obese respondents.

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Table 21 Correlation Analysis between Number of Work Hours and Eating Habits

Eating Habits Restrained Disinhibited Emotional External Overall Eating Habits

r-value 0.119 0.211 0.159 0.086 0.197

Computed t-value 1.978 3.571 2.674 1.434 3.326

Significance Significant Significant Significant Not Significant Significant

Table 21 presents the results of correlation analysis between eating habits and work environment with respect to the number of work hours. The computed r-values are all positive which indicate that there is a direct relationship between the eating habits and work hours. It means that respondents with more work hours tend to practice all eating habits “More Often.” This is also related to the greater tendency to become overweight and obese. Furthermore, the relationships between the stress brought about by longer work hours and its effects on eating habits will be discussed in the next page. Results of the t-test revealed that the relationships regarding external eating was found insignificant since the computed values did not exceed the critical value of 1.960 at five percent level of significance. Hence, the null hypothesis that “there is

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no significant relationship between work environment on number of work hours and external eating” is accepted. On the other hand, the result of the t-test revealed that except external eating, the relationships regarding the all categories having direct relationships were found significant since the computed values exceeded the critical value of 1.960 at five percent level of significance. Hence, the Null Hypothesis that “there is no significant relationship between work environment on number of work hours and eating habits particularly restrained, disinhibited, emotional, and overall eating habits” is rejected. This may be explained by the findings of Escoto, et al., (2010), in that eating habits of workers are affected by the number of work hours, in such a way that longer working hours influence more frequent food intake in various ways for men and women. Another study with similar findings is the study by Wong, et al., (2010). Most of the participants have abnormal restrained, emotional, and external eating habits. Participants that had more shift duties are more likely to have abnormal restrained, emotional, and external eating habits. Shift work induces stress, disturbs family life, and interrupts regular meal schedules. Shift duties were positively associated with abnormal eating behavior. Consumption of more sweet food, high fat, fast food, and snack food during night duty, in order to keep them awake and resume

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energy due to heavy workload and long shift, are common to shift workers. Furthermore, longer work hours may induce more stress which leads to maladaptive eating habits. Evening and night shifts, holding multiple jobs, long work hours, and excessive overtime work can be detrimental to health by causing fatigue and disturbances in circadian rhythms. Working more than 40 hours per week has been associated with poorer perceived overall health, illness rates, and increased mortality, with especially pronounced effects in conjunction with extended work shifts that are longer than 8 hours (Egerter, et al., 2008).

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Problem 6. What health program can be proposed based on the findings of the study?

The effects of eating habits on the health of call center agents in relation to their work environment were identified in the findings of this study. The results on overweight and obese respondents have been

alarming. Not to mention, the unexpected number of underweight among those results. It seems like the type of work and the work environment have been taking a toll on the eating habits and the health of the people in the BPO industry. This health program is conceptualized to create change and to improve the health and eating habits within the BPO industry; thus: Vision: Healthy and productive employees in the BPO Industry. General Objectives: To spread awareness about the importance of having healthy eating habits and maintaining healthy weight in the BPO industry. Target Population/Beneficiaries: The program targets employees in the BPO industry and similar industries.

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PROMOTI VE
Health education Availability of healthier food options
Health teachings on eating habits Promotion of behaviors through healthy food options

PREVENTI VE
Actions leading towards a healthy weight status

Host (Call Center Agent)

Fitness activities Annual Physical Exam

Agent (Eating Habits)
CURATIVE
Achieving a healthy weight status Coordination of activities and encouraging participation

Environment (Work Setting)
REHABILITAT IVE
Monitoring, Supervision, and Evaluation by the nurses Maintenance of improvements

Concessionaires serving healthy food options Identification of people with unhealthy eating habits Health Teachings on Stress Management

Figure 3. Framework for the Health Program

The health program, as shown in figure 3 above, contains targets for intervention (call center agent, eating habits and the work setting). In order for the lifestyle including the health practices to be modified, intervention should involve the aspects (eating habits and the work setting) in life that influences the health of the call center agent. The

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interventions of the health care team in modifying the behavior of the call center agent involve promotion, prevention, and being curative and rehabilitative. Environment interventions seek to create a supportive environment for healthier choices. Lifestyle Interventions address the common risk factors by providing lifestyle interventions for call center agents and workers in the BPO industry. Curative and Rehabilitative interventions address the capacity of the health system to treat and manage risk factors and health conditions through screening, risk factor modification, and clinical management (Department of Health, 2012).

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Chapter 5 SUMMARY OF FINDINGS, CONCLUSIONS, AND RECOMMENDATIONS

This chapter presents the summary of findings, conclusions drawn from the analysis of the information and data gathered, and the proposed recommendations to address the problems and concerns revealed by the assessment and the relationships between the profile and eating habits of call center agents, and that of their work environment vis-à-vis eating habits. The study sought to find out the eating habits of call center agents in relation to their health and work environment which served as basis for a health program. Specifically, the answered the following questions: 2) What is the profile of call center agents according to: 1.13 1.14 1.15 1.16 Age; Gender; Educational Attainment; and BMI?

3) What is the work environment of call center agents in relation to: 2.7 Time of shift; and

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2.8 Number of working hours? 4) What are the eating habits of call center agents in terms of: 3.1 Restrained eating; 3.2 Disinhibited eating; 3.3 Emotional eating; and 3.4 External eating? 5) Is there a significant relationship between the profile and eating habits of call center agents? 6) Is there a significant relationship between the eating habits and work environment of call center agents? 7) What health program can be proposed based on the findings of the study?

In the course of the investigation the following hypotheses were tested on a 0.05 level of significance: There is no significant relationship between the profile and eating habits of call center agents. There is significant relationship between the eating habits in terms of disinhibited eating and overall eating habits and the work environment in terms of time of shift, and also in number of work hours in all eating habits except external eating.

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Methodology Descriptive Research Method was used in this study as it was deemed appropriate for the study which involved the identification and exploration of relationships between the eating habits in terms of (a) restrained eating; (b) disinhibited eating; (c) emotional eating; and (d) external eating, the profile and the work environment in terms of time of shift and; number work hours of call center agents. The participating company is Company X located in Northgate Cyberzone, Alabang Muntinlupa City. The respondents were 276 regular call center agents who work full-time and are in shifting schedules. The researcher used a self-made questionnaire which was made up of three parts. The first part determined the profile of the respondents; the second part determined the work environment of call center agents; and the third part determined the eating habits of call center agents in terms of restrained, disinhibited, emotional, and external eating habits of call center agents. Statements that reflect each eating habit was used for part three and a Likert Scale was used to determine how frequent the respondents practice each statement which reflects a certain eating habit.

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The following statistical instruments were used: Frequency and Percentage for presentation of frequency distribution; mean; and Pearson correlation r.

Summary of Findings The study produced the following findings: 7. The profile of call center agents according to: 1.5 Age; Majority of the respondents were at 20 to 40 years of age and the least were under 20 years of age. 1.6 Gender; There were more female respondents than males. 1.7 Educational Attainment; and Majority of the respondents were college graduates and the least had post-baccalaureate degrees. 1.8 BMI Majority of the respondents were within the normal range of BMI, followed by overweight respondents, then the underweight respondents while the least of the respondents, are obese. 8. The work environment of call center agents in relation to: 2.1 Time of shift; and

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Majority of the respondents worked in graveyard shifts and the least worked in mid-shifts. 2.3 Number of work hours. Most of the respondents work for 8 to 9 hours as compared to the least that work for 10 to 11 hours. 9. The eating habits of call center agents in terms of: 3.1 Restrained eating; The highest mean value is on “I try hard not to eat a lot or try to eat less so that I will not gain weight” and the lowest mean value is on “when I feel like I have gained weight, I try hard not to eat even if I see my favorite foods and delicious looking foods”; all of the mean values fall under the description “Sometimes”. 3.2 Disinhibited eating; The highest mean value is on “it is easy to start eating but it is hard to stop” and the lowest mean value is on “I eat all the time because I am always hungry”; all of the mean values fall under the description “Sometimes”. 3.5 Emotional eating; and The highest mean value is on “when I don’t have anything to do or if I’m bored, I want to eat”; the lowest mean value is on “when I am

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annoyed by anyone or anything, I want to eat”; all of the mean values fall under the description “Sometimes”. 3.6 External eating. The highest mean value is on “when I see delicious smelling and tasty foods, it makes me want to eat more”; the lowest mean value is on “seeing other people eating makes me feel hungry”; all of the mean values fall under the description “Sometimes” except for the second statement which falls under “Often”. The highest overall mean value on eating habits is with respect to external eating; while the lowest mean value is on disinhibited eating. The overall mean values for eating habits in terms of restrained, disinhibited, emotional, and external eating fall under one description “Sometimes”. 10. The significant relationship between the profile and eating habits of call center agents. There is no significant relationship between the profile in terms of age and eating habits of call center agents. There is no significant relationship between the profile in terms of gender and eating habits of call center agents. There is no significant relationship between the profile in terms of eating habits and eating habits of call center agents.

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There is no significant relationship between the profile in terms of BMI and eating habits of call center agents. 11. The significant relationship between the eating habits and work environment of call center agents. There is a significant relationship between the eating habits and the work environment in terms of time of shift of call center agents. There is no significant relationship between the eating habits and the work environment in terms of working hours of call center agents. 12. The health program proposed based on the findings of the study. The health program is a consolidated plan that contains strategies that were proposed to influence the employees in the BPO Industry into having a healthy lifestyle. Specifically, its goal is to modify the eating habits of people working in the BPO industry and to encourage maintaining healthier weight through physical activity.

Conclusions: Based on the findings of the study, the following conclusions were drawn: 7. Call center agents in Company X were mostly within 20 to 40 years of age, predominantly females and college graduates. Most

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of them fell under the normal range of BMI; however, almost half were underweight overweight and obese. 8. Call center agents in company X mostly worked in graveyard shifts, usually for 8 to 9 hours. 9. The eating habits of call center agents in terms of restrained eating, disinhibited eating, emotional eating, and external eating fell under one description– “Sometimes”. 10. There were no significant relationships between the profile according to age, gender, educational attainment, and BMI and the eating habits of call center agents. 11. Significant relationships were found between the eating habits of call center agents and their work environment in relation to time of shift and number of work hours. 12. The health program is a consolidated plan that contains strategies that will be proposed to influence the employees in the BPO Industry in having a healthy lifestyle. Its goal is to modify the eating habits of people working in the BPO industry and to encourage maintaining healthier weight through physical activity. The health program is formulated based on the findings of the study.

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Recommendations: 9. The healthcare team should educate call center agents on the importance of maintaining a healthy BMI and the health effects of being overweight and obese. 10. Call center agents should be taught ways to cope with working at night. Furthermore, BPO Companies and similar companies should ensure that the workplace is conducive for the health of employees who work in shifting schedules. 11. The role of the healthcare team as an advocate of good eating habits should be emphasized and strengthened. Counseling the employees in BPO companies and similar companies regarding their eating habits is one way to help them deal with maladaptive eating habits. 12. BPO companies and similar companies should improve or consider making adjustments with regard to the food provided for their employees in such a way that healthier food options are made more available. 13. Call center agents should learn how to perceive and depend on internal eating cues and how to modify their lifestyle and eating habits to coincide with their work schedules.

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14. BPO companies and similar companies should acquire or consider adopting the health program proposed, improve or maintain, develop existing health programs to help employees cope with the work environment, have healthy eating habits, and maintain a healthy weight status. 15. Future Researchers should be encouraged to conduct similar studies that will focus on other factors affecting eating habits such as: a. Distress; b. Socio-economic status; and c. Personality type 16. Future Researchers are encouraged to conduct similar studies comparing the eating habits of call center agents to regular daytime employees.

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Bird, M., & Ernst, C., (2009). “Employment Sector Employment Working Paper No. 41 Offshoring and employment in the developing world: Business process outsourcing in the Philippines.” International Labour Organization. Retrieved in March 2012 from: http://www.ilo.org/wcmsp5/groups/public/---ed_emp/---emp_elm/--analysis/documents/publication/wcms_117922.pdf. Bray, G.A., & Bouchard, C. (2004). Handbook of obesity: clinical applications, Volume 1. Marcel Dekker, Inc. BusinessDictionary.com (2012) “Call Center.” Retrieved in March 2012 from: http://www.businessdictionary.com/definition/callcenter.html. Canaria, Y.T. (2011). “Best Practices in Selected Colleges of Nursing in the National Capital Region: Basis for a Three-Year Developmental Plan for the University of Perpetual Help System Dalta College of Nursing.” Coryell, V. T. (2011). “The Role of Psychological Distress, Eating Styles, Detary Intake, and Gender in Cardiometabolic Risk. ” University of Miami, Scholarly Repository. Retrieved in November 2011 from: http://scholarlyrepository.miami.edu/oa_dissertations/611. De Guia F.G.S. (2010). “Life after dark: Lifestyle diseases among call center employees. ” Philippine Online Chronicles. Retrieved in November 2011 from: http://www.thepoc.net/thepocfeatures/health-and-wellness/health-and-fitness-features/10158life-in-the-dark.html Department of Health (2012).“Prevention and Control of Chronic Lifestyle Related Non Communicable Diseases.”Retrived in March 2012 from: http://www.doh.gov.ph/content/prevention-and-controlchronic-lifestyle-related-non-communicable-diseases

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Department of Labor and Employment (2010). “Guidelines of the Implementation of Flexible work arrangements and the exemption from the night work prohibition for women employees in the business process outsourcing Industry.” Retrieved in March 2012 from: http://bpap.org/bpap/presentations/DOLE%20Advisory4.pdf Eberly, R., & Feldman, H. (2010). “Obesity and Shift Work in the General Population.” The Internet Journal of Allied Health Sciences and Practice Volume 8 Number 3. Retrieved in December 2011 from: http://ijahsp.nova.edu/articles/Vol8Num3/pdf/feldman.pdf. Egerter, S., Dekker, M., An, J., Grossman-Kahn, R., & Braveman, P . (2008). “Robert Wood Johnson Foundation Commission to Build a Healthier America.” Issue Brief 4: Work and Health Retrieved in December 2011 from :commissiononhealth.org. Escoto, K., French, S., Harnack, L., Toomey, T., Hannan, P., & Mitchell, N. (2010). “Work hours, weight status, and weight-related behaviors: a study of metro transit workers.” International Journal of Behavioral Nutrition and Physical Activity. Retrieved in December 2011 form: http://www.ijbnpa.org/content/7/1/91#sec4 Eysenck, W. (2004). “Research methods:Data Analysis”. Press Ltd Michael. Psychology

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body mass index, and responses to sweet and salty fatty foods: a twin study of genetic and environmental associations”. American Journal of Clinincal Nutrition. Retrieved in November 2011 from: http://www.ajcn.org/content/88/2/263.long. Keski-Rahkonen, A., Bulik, C.M., Pietila¨inen, K.H., Rose, R.J., Kaprio, J., & Rissanen, A. (2007).“Eating styles, overweight and obesity in young adult twins”.European Journal of Clinical Nutrition. Retrieved in November 2011 from: http://www.nature.com/ejcn/journal/v61/n7/full/1602601a.html. Littlejohn, S. W., & Foss, K. A. (2008) .Theories of human communication, Ninth Edition. Thomsom Wadsworth. Lowden A, Moreno C, Holmbäck U, Lennernäs M, & Tucker P. (2010). “Eating and shift work – effects on habits, metabolism and performance.” Scand J Work Environ Health. Retrieved in December 2011 from: http://www.sjweh.fi/ show_abstract. php?abstract_id=2898. Macaraig, M.( 2010). “ PH overtakes India as call center capital”. Agence France-Presse Retrieved in November 2011 from: http://globalnation.inquirer.net/news/breakingnews/view/20101206 -307374/PH-overtakes-India-as-call-center-capital. Martin, A. (2011).”Government’s Dietary Advice: Eat Less.” Retrieved in March 2012 from: http://www.nytimes.com/2011/02/01/business/01food.html. Padilla, A. (2010) “Employment prospects growing dimmer for new graduates, studies show.” Retrieved in March 2012 from: http://www.thepoc.net/thepoc-features/politi-ko/politikofeatures/5378-employment-rate.html. Pearson's correlation coefficient. (2011). Farlex, Inc. Retrieved in December 2011 from: http://www.thefreedictionary.com/ Pearson's+correlation+coefficient. Ramachandran, A. & Snehalatha, C. (2010). “Rising Burden of Obesity in Asia. ” Journal of Obesity, India Diabetes Research Foundation & Dr. A. Ramachandran's Diabetes Hospitals.

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Rideout, C. A. & Barr, S. I. (2009). “Restrained Eating vs. Trying to Lose Weight: How Are They Associated with Body Weight and Tendency to Overeat among Postmenopausal Women?.” Journal of the American Dietetic Association. Retrieved in March 2012 from: http://runels.com/restrainedeatingordiet.pdf.

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APPENDIX-A

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QUESTIONNAIRE

Part 1. Profile of the Respondents Directions: Supply the needed information either by writing it on the blank or by putting a mark (/) in the box of your corresponding answer. 1.1. Age ________ 1.2. Gender Male Female 1.3. Educational Attainment Undergraduate College Graduate Post Graduate 11in.) Part 2. Work Environment of Call Center Agents 1.4. BMI _____Weight (in pounds) _____ Height (in feet and Inches, e.g. 5 ft.

2.1 Time of Shift 4am 2pm 8pm day shift midshift graveyard

2.2 Number of Work Hours 8 or 9 hours 10 or 11 hours

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Part 3. Eating Habits Directions: Read the statements and using the 5-point rating scale given below; rate each item by putting a mark (/) in the column that indicates your answer. 5Very Often 4Often 3Sometimes 2Seldom 1Never Eating Habits 5 4 3 2 1. I try hard not to eat a lot or try to eat less so that I will not gain weight. 2. When I see delicious smelling and tasty foods, it makes me want to eat more. 3. When I am worried, I want to eat. 4. It is easy to start eating but it is hard to stop. 5. When I see someone eating something delicious, I eat more. 6. I do not eat fatty foods and foods with a lot of calories because I don’t want to gain weight. 7. When I feel bad, I eat to make myself feel better. 8. When I get hungry I eat a lot and I don’t know when to stop because I don’t get full. 9. When I feel like I have gained weight, I try hard not to eat even if I see my favorite foods and delicious looking foods. 10. When I know that the food is delicious or when the food looks good, I eat more.

1

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11. When I am upset or frustrated, I want to eat. 12. When there is still food to eat, I can’t stop eating because I am always hungry. 13. When I don’t have anything to do or if I’m bored, I want to eat. 14. When I notice that I gained weight, I go on a diet as a response. 15. When I smell delicious foods or see good looking foods, it makes me hungry. 16. I eat a lot even if I am not hungry. 17. I try to eat less and skip snacks so that I will not gain weight. 18. I eat all the time because I am always hungry. 19. When I am annoyed by anyone or anything, I want to eat. 20. Seeing other people eating makes me feel hungry.

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APPENDIX-B REQUEST FOR THE LIST OF CALL CENTER AGENTS IN COMPANY X

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APPENDIX-C LETTER OF REQUEST TO COMPANY X FOR PERMISSION TO USE THE COMPANY NAME AND BACKGROUND

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APPENDIX-D LETTER OF REQUEST TO COMPANY X FOR THE DISTRIBUTION AND RETRIEVAL OF QUESTIONNAIRES

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APPENDIX-E LETTER TO RESPONDENTS

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APPENDIX-F STATISTICAL TABLES

BMI WT (LBS) 110 120 100 120 168 130 104 100 148 120 113 100 96 110 100 110 150 150 100 130 140 130 90 143 110 128 130 120 110 160 120 HT-FT 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 6 4 5 0 7 1 2 3 4 0 7 0 HT-IN 1 3 1 6 8 11 1 2 8 1 0 1 0 2 2 2 5 5 WT(KGS) 50 54.54545 45.45455 54.54545 76.36364 59.09091 47.27273 45.45455 67.27273 54.54545 51.36364 45.45455 43.63636 50 45.45455 50 68.18182 68.18182 45.45455 59.09091 63.63636 59.09091 40.90909 65 50 58.18182 59.09091 54.54545 50 72.72727 54.54545 HT(IN) 61 63 61 66 68 71 61 62 68 61 60 61 60 62 62 62 65 65 60 66 64 65 60 67 61 62 63 64 60 67 60 HT(METERS) 1.5494 1.6002 1.5494 1.6764 1.7272 1.8034 1.5494 1.5748 1.7272 1.5494 1.524 1.5494 1.524 1.5748 1.5748 1.5748 1.651 1.651 1.524 1.6764 1.6256 1.651 1.524 1.7018 1.5494 1.5748 1.6002 1.6256 1.524 1.7018 1.524 BMI 20.82777614 21.30149248 18.93434194 19.40900451 25.59772342 18.16923076 19.69171562 18.3284824 22.55037539 22.72121033 22.11494322 18.93434194 18.78791636 20.16133065 18.3284824 20.16133065 25.01349812 25.01349812 19.57074621 21.02642155 24.08119163 21.67836504 17.61367159 22.44379628 20.82777614 23.46045748 23.07661685 20.6410214 21.52782083 25.11193989 23.48489545

cxlv
140.8 103.4 122 99 120 150 130 100 110 187 152 128 145 122 250 125 150 112.2 180 141 85.9 115 120 110 100 160 100 100 250 126 106 127 120 110 189 104 160 190 5 5 5 5 5 5 5 4 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 4 5 5 5 5 5 5 5 5 5 4 5 4 5 5 6 4 0 3 4 1 5 9 7 7 5 4 2 4 11 2 4 5 8 10 1 3 3 11 5 5 5 2 11 4 1 4 0 11 8 11 0 9 64 47 55.45455 45 54.54545 68.18182 59.09091 45.45455 50 85 69.09091 58.18182 65.90909 55.45455 113.6364 56.81818 68.18182 51 81.81818 64.09091 39.04545 52.27273 54.54545 50 45.45455 72.72727 45.45455 45.45455 113.6364 57.27273 48.18182 57.72727 54.54545 50 85.90909 47.27273 72.72727 86.36364 66 64 60 63 64 61 65 57 67 67 65 64 62 64 71 62 64 65 68 70 61 63 63 59 65 65 65 62 71 64 61 64 60 59 68 59 60 69 1.6764 1.6256 1.524 1.6002 1.6256 1.5494 1.651 1.4478 1.7018 1.7018 1.651 1.6256 1.5748 1.6256 1.8034 1.5748 1.6256 1.651 1.7272 1.778 1.5494 1.6002 1.6002 1.4986 1.651 1.651 1.651 1.5748 1.8034 1.6256 1.5494 1.6256 1.524 1.4986 1.7272 1.4986 1.524 1.7526 22.77323196 17.7856801 23.87631038 17.57373129 20.6410214 28.40151291 21.67836504 21.68503735 17.26445868 29.34957975 25.34701143 22.01708949 26.57629949 20.98503842 34.94082839 22.91060301 25.80127674 18.71009659 27.42613224 20.27369546 16.26459973 20.41393029 21.30149248 22.26376185 16.67566541 26.68106466 16.67566541 18.3284824 34.94082839 21.67307247 20.07040246 21.84508098 23.48489545 22.26376185 28.79743885 21.04937484 31.31319394 28.11676204

cxlvi
154 165 105 165 185 160 190 158.4 110 155 150 150 100 121 149.6 242 270 209 145 90 160 110 110 109 162 165 90 165 130 210 129.8 110 198 112 115 107.8 151.8 110 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 6 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 6 7 1 6 6 7.5 11 5 6 7 6 7 2 2 7 0 8 3 8 0 5 3 2 2 5 6 0 6.5 2 8 4 8 8.5 3 2 2 6 5 70 75 47.72727 75 84.09091 72.72727 86.36364 72 50 70.45455 68.18182 68.18182 45.45455 55 68 110 122.7273 95 65.90909 40.90909 72.72727 50 50 49.54545 73.63636 75 40.90909 75 59.09091 95.45455 59 50 90 50.90909 52.27273 49 69 50 66 67 61 66 66 67.5 71 65 66 67 66 67 62 62 67 72 68 63 68 60 65 63 62 62 65 66 60 66.5 62 68 64 68 68.5 63 62 62 66 65 1.6764 1.7018 1.5494 1.6764 1.6764 1.7145 1.8034 1.651 1.6764 1.7018 1.6764 1.7018 1.5748 1.5748 1.7018 1.8288 1.7272 1.6002 1.7272 1.524 1.651 1.6002 1.5748 1.5748 1.651 1.6764 1.524 1.6891 1.5748 1.7272 1.6256 1.7272 1.7399 1.6002 1.5748 1.5748 1.6764 1.651 24.90822245 25.89668802 19.88105904 26.6873812 29.92221528 24.74128904 26.55502958 26.41425401 17.79158747 24.32719177 24.26125563 23.54244365 18.3284824 22.17746371 23.4796638 32.88972627 41.13919835 37.1000994 22.09327319 17.61367159 26.68106466 19.5263681 20.16133065 19.97804582 27.01457797 26.6873812 17.61367159 26.28757589 23.82702713 31.99715427 22.32670481 16.76041414 29.72993319 19.88139298 21.07775477 19.75810403 24.5523907 18.34323195

cxlvii
180 132 148 125 101 112.2 110 191.4 130 128 102 120 105 126 130 145 140 150 130 185 185 200 175 110 120 180 90 150 99 110 112 200 151 80 115 130 110 105.6 5 5 5 5 4 4 5 6 5 5 5 5 5 4 5 6 5 5 5 5 5 5 5 5 5 5 5 5 5 5 4 5 5 4 5 5 5 5 6 3 9 5 11 11 5 2 5 6 1 0 0 9 8 1 4 7 2 7 7 11 6 1 2 3 3 2 2 4 11 5 3 11 5 1 1 2 81.81818 60 67.27273 56.81818 45.90909 51 50 87 59.09091 58.18182 46.36364 54.54545 47.72727 57.27273 59.09091 65.90909 63.63636 68.18182 59.09091 84.09091 84.09091 90.90909 79.54545 50 54.54545 81.81818 40.90909 68.18182 45 50 50.90909 90.90909 68.63636 36.36364 52.27273 59.09091 50 48 66 63 69 65 59 59 65 74 65 66 61 60 60 57 68 73 64 67 62 67 67 71 66 61 62 63 63 62 62 64 59 65 63 59 65 61 61 62 1.6764 1.6002 1.7526 1.651 1.4986 1.4986 1.651 1.8796 1.651 1.6764 1.5494 1.524 1.524 1.4478 1.7272 1.8542 1.6256 1.7018 1.5748 1.7018 1.7018 1.8034 1.6764 1.5494 1.5748 1.6002 1.6002 1.5748 1.5748 1.6256 1.4986 1.651 1.6002 1.4986 1.651 1.5494 1.5494 1.5748 29.11350676 23.43164172 21.9014778 20.84458176 20.44218134 22.70903709 18.34323195 24.6256884 21.67836504 20.70293814 19.31302878 23.48489545 20.54928352 27.32314707 19.80776217 19.17044384 24.08119163 23.54244365 23.82702713 29.0356805 29.0356805 27.95266271 28.30479824 20.82777614 21.99417889 31.95223871 15.97611936 27.49272361 18.14519758 18.92093628 22.66855752 33.35133082 26.80437803 16.1918268 19.17701522 24.61464452 20.82777614 19.35487742

cxlviii
192 136.4 130 105.6 130 220 130 120 120 150 120 110 140 135 110 108 160 132 98 115 110 117 154 190 107.8 100 118 130 168 165 165 135 160 145 150 165 160 160 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 6 5 5 5 5 5 5 5 5 4 5 5 5 5 5 5 5 5 5 5 5 6 5 2 11 4 3.5 7 9 2 0 5 3 3 6 7 6 2 1 4 1 3 3 5 9 3 4 11 2 6 3 7 6 3 4 3 6 6 5 5 87.27273 62 59.09091 48 59.09091 100 59.09091 54.54545 54.54545 68.18182 54.54545 50 63.63636 61.36364 50 49.09091 72.72727 60 44.54545 52.27273 50 53.18182 70 86.36364 49 45.45455 53.63636 59.09091 76.36364 75 75 61.36364 72.72727 65.90909 68.18182 75 72.72727 72.72727 65 62 71 64 63.5 67 69 62 60 65 63 63 66 67 66 62 73 64 61 63 63 65 69 63 64 59 62 66 63 67 66 63 64 63 66 66 65 77 1.651 1.5748 1.8034 1.6256 1.6129 1.7018 1.7526 1.5748 1.524 1.651 1.6002 1.6002 1.6764 1.7018 1.6764 1.5748 1.8542 1.6256 1.5494 1.6002 1.6002 1.651 1.7526 1.6002 1.6256 1.4986 1.5748 1.6764 1.6002 1.7018 1.6764 1.6002 1.6256 1.6002 1.6764 1.6764 1.651 1.9558 32.01727759 25.00005 18.16923076 18.16409883 22.71463631 34.52891735 19.23778456 21.99417889 23.48489545 25.01349812 21.30149248 19.5263681 22.64383859 21.18819929 17.79158747 19.794761 21.1535932 22.70512354 18.5556551 20.41393029 19.5263681 19.51052853 22.78937555 33.72736309 18.54251755 20.2397835 21.62760924 21.02642155 29.82208947 25.89668802 26.6873812 23.96417904 27.52136186 25.73930341 24.26125563 26.6873812 26.68106466 19.01290238

cxlix
160 150 186 150 110 162 138 110 116 117 130 127 125 109 128 160 260 145 160 140 130 123 127 150 120 154 109 165 142 152 143 150 121 110 160 166 165 158 6 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 6 5 5 5 5 5 5 1 6 3 3 0 7 4 2 0 7 6 7 2 3 8 0 2 7 6 3 1 3 4 5 6 2 2 4 1 0 2 1 5 3 7 8 6 4 72.72727 68.18182 84.54545 68.18182 50 73.63636 62.72727 50 52.72727 53.18182 59.09091 57.72727 56.81818 49.54545 58.18182 72.72727 118.1818 65.90909 72.72727 63.63636 59.09091 55.90909 57.72727 68.18182 54.54545 70 49.54545 75 64.54545 69.09091 65 68.18182 55 50 72.72727 75.45455 75 71.81818 73 66 63 63 60 67 64 62 60 67 66 67 62 63 68 60 62 67 66 63 61 63 64 65 66 62 62 64 61 60 62 73 65 63 67 68 66 64 1.8542 1.6764 1.6002 1.6002 1.524 1.7018 1.6256 1.5748 1.524 1.7018 1.6764 1.7018 1.5748 1.6002 1.7272 1.524 1.5748 1.7018 1.6764 1.6002 1.5494 1.6002 1.6256 1.651 1.6764 1.5748 1.5748 1.6256 1.5494 1.524 1.5748 1.8542 1.651 1.6002 1.7018 1.7272 1.6764 1.6256 21.1535932 24.26125563 33.01731334 26.62686559 21.52782083 25.42583914 23.73717461 20.16133065 22.70206561 18.36310605 21.02642155 19.93260229 22.91060301 19.34885567 19.50302737 31.31319394 47.65405425 22.75769553 25.87867268 24.85174122 24.61464452 21.83402979 21.84508098 25.01349812 19.40900451 28.2258629 19.97804582 28.38140442 26.88676556 29.74753424 26.20972984 19.83149363 20.17755515 19.5263681 25.11193989 25.29298862 26.6873812 27.17734484

cl
111 140 130 125 110 164 144 154 170 113 105 107 108 100 200 220 120 180 120 100 100 210 165 160 95 180 105 130 120 150 102 110 118 163 150 155 155 134 5 5 4 5 5 4 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 4 5 5 5 5 5 5 5 1 6 11 4 1 11 6 5 9 0 0 5 4 1 3 11 7 6 3 2 3 8 10 0 0 4.5 2 6 7 2 11 0 7 9 9 9 0 5 50.45455 63.63636 59.09091 56.81818 50 74.54545 65.45455 70 77.27273 51.36364 47.72727 48.63636 49.09091 45.45455 90.90909 100 54.54545 81.81818 54.54545 45.45455 45.45455 95.45455 75 72.72727 43.18182 81.81818 47.72727 59.09091 54.54545 68.18182 46.36364 50 53.63636 74.09091 68.18182 70.45455 70.45455 60.90909 61 66 59 64 61 59 66 65 69 60 60 65 64 61 63 71 67 66 63 62 63 68 70 60 60 64.5 62 66 67 62 59 60 67 69 69 69 60 65 1.5494 1.6764 1.4986 1.6256 1.5494 1.4986 1.6764 1.651 1.7526 1.524 1.524 1.651 1.6256 1.5494 1.6002 1.8034 1.7018 1.6764 1.6002 1.5748 1.6002 1.7272 1.778 1.524 1.524 1.6383 1.5748 1.6764 1.7018 1.5748 1.4986 1.524 1.7018 1.7526 1.7526 1.7526 1.524 1.651 21.01711955 22.64383859 26.31171855 21.50106395 20.82777614 33.19324494 23.29080541 25.68052473 25.15710288 22.11494322 20.54928352 17.84296199 18.57691926 18.93434194 35.50248746 30.74792898 18.83395492 29.11350676 21.30149248 18.3284824 17.75124373 31.99715427 23.72453724 31.31319394 18.5922089 30.4833689 19.24490653 21.02642155 18.83395492 27.49272361 20.64457917 21.52782083 18.52005567 24.12122217 22.19744372 22.93735851 30.33465663 22.34539165

cli
156 145 150 160 160 161 150 139 147 150 167 153 150 158 159 145 170 5 5 6 5 6 5 5 5 5 5 5 5 5 5 5 5 6 6 9 1 3 2 7 2 2 6 4 4 1 2 4 6 0 5 70.90909 65.90909 68.18182 72.72727 72.72727 73.18182 68.18182 63.18182 66.81818 68.18182 75.90909 69.54545 68.18182 71.81818 72.27273 65.90909 77.27273 66 69 73 63 74 67 62 62 66 64 64 61 62 64 66 60 77 1.6764 1.7526 1.8542 1.6002 1.8796 1.7018 1.5748 1.5748 1.6764 1.6256 1.6256 1.5494 1.5748 1.6256 1.6764 1.524 1.9558 25.23170586 21.45752893 19.83149363 28.40198997 20.58573743 25.26888952 27.49272361 25.47659054 23.77603052 25.80127674 28.72542144 28.96954317 27.49272361 27.17734484 25.71693097 28.37758201 20.20120877

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APPENDIX-G CERTIFICATION OF STATISTICAL TREATMENT

March 2012

This is to certify that the thesis entitled” Eating Habits of Call Center Agents in Relation to their Health and Work Environment: Basis for a Health Program” of Ms. Julie Simonette Rojo was statistically analyzed by the undersigned.

Sgd. DR. JESUS B. GOLLAYAN Statistician

Noted:

Sgd. ATTY. IRINEO F. MARTINEZ JR. Dean, Graduate School

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APPENDIX-H CERTIFICATION OF EDITING

April 2012

This is to certify that the thesis entitled” Eating Habits of Call Center Agents in Relation to their Health and Work Environment: Basis for a Health Program” of Mr / Ms. Julie Simonette Rojo was edited by the undersigned.

Sgd. MR. FRANCISCO RIVAS Editor

Noted:

Sgd. ATTY. IRINEO F. MARTINEZ JR. Dean, Graduate School

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CURRICULUM VITAE

Name Address Gender Date of Birth Place of Birth Civil Status Religion Present Position Office Address

: Julie Simonette Q. Rojo : Area H, Phase II Saballero Compound, Dasmarinas City : Female : April 11, 1988 : Las Pinas City : Single : Roman Catholic : Part-Time Customer Service Representative : Convergys, Makati City

EDUCATIONAL BACKGROUND Graduate School : Degree– Master of Arts in Nursing Major in Nursing Administration : Name of School– University of Perpetual Help System– DALTA : Address– Las Piñas City : Inclusive Years– 2010 - PRESENT Tertiary : Degree– Bachelor of Arts in Nursing : Name of School– University of Perpetual Help System– DALTA : Address– Las Piñas City : Inclusive Years– 2008 : Graduated - 2004

Secondary

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Elementary

: Name of School University of Perpetual Help Rizal : Address – Las Pinas City : Graduated - 2000 : Name of School– University of Perpetual Help Rizal : Address – Las Pinas City

EXAMINATIONS PASSED Philippine Nursing Licensure Examination Certified Basic Life Support Certified IVT WORK EXPERIENCES 2010-PRESENT Convergys, Makati City Nov 2008-Jan 2010 Process Associate in a Collections Account Genpact, LLC; Cyberzone Northgate, Alabang, Muntinlupa

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