Document Type : Original Article
Authors
- . Zabihollah Gharlipour
- . Mohtasham Ghaffari 1
- . Zahra Hoseini 2
- . Akbar Babaei Heidarabadi 1
- . Elahe Tavassoli 3
- . Mohammad Hozuri
- . Shahram Arsang Jang
- . Mahnoush Reisi 4
- . Maryam Sahraiyan 5
1 Department of Public Health, School of Health, Shahid Beheshti University of Medical Sciences,
2 Department of Public Health, School of Health, Tehran University of Medical Sciences, Tehran,
3 Department of Public Health, School of Health, Shahid Beheshti University of Medical Sciences, Department of Public Health, School of Health, Shahrekord University of Medical Sciences, Shahrekord
4 Department of Public Health, School of Health, Bushehr University of Medical Sciences, Bushehr, Iran
5 Department of Public Health, Research Deputy, Qom University of Medical Sciences, Qom
Abstract
Background: Eating breakfast is crucial for adolescents to be healthy. It also improves
students’ capacity of learning and doing school homework. Although healthy habits such as
eating breakfast, weight control, and regular sleep increase the lifespan in adults, the effects of
healthy habits on school‑age children have not been studied much. The present study aimed at
investigating the impact of an educational program based on Theory of Planned Behavior (TPB)
on eating breakfast among middle school students. Materials and Methods: This interventional
study was conducted on sixth‑grade students in Qom City during the academic year 2012–2013.
First, 97 students were randomly assigned to the experimental group and 97 other students
were assigned to the control group. Then, a questionnaire was developed on eating breakfast
by the researchers according to the TPB. A pilot study was conducted to assess the reliability
of the questionnaire. To assess the validity of the questionnaire, advice by a panel of experts
was sought. To carry out a pre‑test, both groups answered the questions. After analyzing the
pre‑test results, the required content was developed for the experimental group. Educational
methods included delivering speech, discussion groups, pamphlets, and posters. The required
educational content was provided for students during five sessions and for parents in one session.
To determine the effect of educational intervention, a post‑test study was carried out 2 months
after the intervention. Collected data were analyzed using independent t‑test, χ,
[2] and repeated
measures. Results: In the experimental group, 36.7% of students were eating breakfast at least in
a day of a week, before educational intervention. After implementation of the educational program,
only 32.7% of them were continuing their past habit. There was a significant difference between the
mean scores of attitudes, perceived behavioral control, intention, and practice of eating breakfast in
the experimental and control groups (P < 0.05), while there was no significant difference between
the mean scores of subjective norms after
implementing the educational program in both
groups (P < 0.26). Conclusion: Using the TPB
improved students’ intentions and behavior
of eating breakfast. Thus, it seems necessary
to consider all effective environmental factors
on the subjective norms in the education
of healthy eating behaviors or improving
breakfast‑eating practice among students.
Keywords
Food, nutrition and diet therapy. 11th ed. Philadelphia: Saunders
Company; 2004. p. 257‑70.
2. Juzwiak CR, de Castro PM, Batista SH. The experience of the
permanent workshop on health and nutrition education‑OPEAS:
Training of professionals for the promotion of healthy nutrition in
schools. Cien Saude Colet 2013;18:1009‑18.
3. Cooper SB, Bandelow S, Nevill ME. Breakfast consumption and
cognitive function in adolescent schoolchildren. Physiol Behav
2011;103:431‑9.
4. Veltsista A, Laitinen J, Sovio U, Roma E, Marjo RJ, Bakoula C.
Relationship between eating behavior, breakfast consumption, and
obesity among finnish and Greek adolescents. J Nutr Educ Behav
2010;42:417‑21.
5. Bruening M, Larson N, Story M, Neumark‑Sztainer D, Hannan P.
Predictors of adolescent breakfast consumption: Longitudinal
findings from project EAT. J Nutr Educ Behav 2011;43:390‑5.
6. O’Dea JA, Wagstaff S. Increased breakfast frequency and nutritional
quality among schoolchildren after a national breakfast promotion
campaign in Australia between 2000 and 2006. Health Educ Res
2011;26:1086‑96.
7. Kukulu K, Sarvan S, Muslu L, Yirmibesoglu SG. Dietary habits,
economic status, academic performance and body mass index
in school children: A comparative study. J Child Health Care
2010;14:355‑66.
8. Mahoney CR, Taylor HA, Kanarek RB, Samuel P. Effect of breakfast
composition on cognitive processes in elementary school children.
Physiol Behav 2005;85:635‑45.
9. Murata M. Secular trends in growth and changes in eating patterns
of Japanese children. Am J Clin Nutr 2000;72:1379‑83.
10. Bellisle F. Effects of diet on behaviour and cognition in children.
Br J Nutr 2004;92:227‑32.
11. Kleinman RE, Hall S, Green H, Korzec‑Ramirez D, Patton K,
Pagano ME, et al. Diet, breakfast, and academic performance in
children. Ann Nutr Metab 2002;46(Suppl 1):24‑30.
12. Cueto S. Breakfast and performance. Public Health Nutr
2001;4:1429‑31.
13. Thompson‑McCormick JJ, Thomas JJ, Bainivualiku A, Khan AN,
Becker AE. Breakfast skipping as a risk correlate of overweight and
obesity in school‑going ethnic Fijian adolescent girls. Asia Pac J Clin
Nutr 2010;19:372‑82.
14. Herbold NH, Ferate SE. Update of nutrition guidelines for teen:
Trends and concerns. Curr Open Pediatrer 2000;12:303‑9.
15. Mahan LK and Escott‑stumps S. Krause’s food, nutrition and diet
therapy. University of Michigan. Philadelphia: Saunders; 2004.
16. Karimi B, Sadat Hashemi M, Habibian H. Study of the breakfast
habits and its relationship with some factors in Semnan (Iran) pupils.
Koomesh 2008;9:285‑92.
17. Vahedi H, Pourabdollahi P, Biglarian A, Shekarzadeh Lemoki M,
Kabirzadeh A, Sadeghi R, et al. Study of awareness towards
and the pattern of milk consumption in 7‑12 year old elementary
school students in the city of Sari and their mothers (2005‑2006).
J Mazandaran Univ Med Sci 2007;17:94‑102.
18. Soheiliazad AA, Nourjah N, Aalamdar E. Surveying the food intake
of primary school students in Tehran. Pejouhesh 2005;29:165‑8.
19. Rahimi T, Dehdari T, Ariaeian N, Gohari M. Survey of breakfast
consumption status and its predictors among Qom students based
on the Pender`s health promotion model constructs. Iran J Nutr Sci
Food Technol 2012;7:75‑84.
20. Lin W, Yang HC, Hang CM, Pan WH. Nutrition knowledge, attitude,
and behavior of Taiwanese elementary school children. Asia Pac J
Clin Nutr 2007;16:534‑46.
21. Sadrzadeh‑Yeganeh H, Angoorany P, Keshavarz SA, Rahimi A,
Ahmady B. Comparison of two nutrition education techniquies on
breakfast‑eating practice in primary school girls, Tehran. Journal
of School of Public Health and Institute of Public Health Research
2006;4 (1):65‑72.
22. Kellar I, Abraham C. Randomized controlled trial of a brief
research‑based intervention promoting fruit and vegetable
consumption. Br J Health Psychol 2005;10:543‑58.
23. Butler JT. Principles of health education and health promotion.
3rd ed. USA: Peter Marshall; 2001. p. 239‑41.
24. Glanz K, Rimer BK, Viswanath K. Health behavior and health
education: Theory, research and practice. 4th ed. San Francisco:
Jossey‑Bass; 2008. p. 68‑82.
25. Carson DE, Kubena KS, McIntosh WA, Goodson P, Sharkey JR.
Breakfast boosts brain power: A nutrition education intervention
based on the theory of planned behavior to improve breakfast
behavior and habits of teens. J Am Diet Assoc 2009;109:A56.
26. Kothe EJ, Mullan BA, Amaratunga R. Randomized controlled trial of
a brief theory‑based intervention promoting breakfast consumption.
Appetite 2011;56:148‑55.
27. Wong CL, Mullan BA. Predicting breakfast consumption. An
application of the theory of planned behavior and the investigation
of past behavior and executive function. Br J Health Psychol
2009;14:489‑504.
28. Berg C, Jonsson I, Conner M. Understanding choice of milk and bread
for breakfast among Swedish children aged 11‑15 years: An application
of the Theory of Planned Behavior. Appetite 2000;34 (1):5‑19.
29. Bogers RP, Brug J, Assema PV, Dagnelie PC. Explaining fruit and
vegetable consumption: The theory of planned behavior and
misconception of personal levels. Appetite 2004;42:157‑66.
30. Alexy U, Wicher M, Kersting M. Breakfast trends in children
and adolescents: Frequency and quality. Public Health Nutr
2010;13:1795‑802.
31. Keski‑Rahkonen A, Kaprio J, Rissanen A, Virkkunen M, Rose RJ.
Breakfast skipping and health‑compromising behaviors in
adolescents and adults. Eur J Clin Nutr 2003;57:842‑53.
32. Williams P. Breakfast and the diets of Australian adults. An analysis
of data from the 1995 national nutrition survey. Int J Food Sci Nutr
2005;56:65‑79.
33. Lattimore PJ, Halford JCG. Adolescence and the diet‑dieting
disparity. Healthy food choice or risky health behavior? Br J Health
Psychol 2003;8:451‑63.
34. Sandercock G, Voss C, Dye L. Associations between habitual
school‑day breakfast consumption, body mass index, physical
activity and Cardio‑respiratory fitness in English schoolchildren.
Eur J Clin Nutr 2010;64:1086‑92.
35. Nemati A, Sagha M, Nouzad Charvadeh H, Dehghan MH. Evaluation
of eating breakfast among adolescent girl students in Ardabil,
1999‑2000. Res Sci J Ardabil Univ Med Sci Health Serv 2003;2:39‑46.
36. Mullan BA, Singh M. A systematic review of the quality, content, and
context of breakfast consumption. Nutr Food Sci 2010;40:81‑114.
37. Kaheni F, Kaheni S, Sharifzadeh GR, Nasiri Foorg A, Avan M.
Consumption amount of milk and dairy products in school children
of 6‑11 year olds in Birjand during 2007. J Birjand Univ Med Sci
2009;16:61‑7.
38. DeJong CS, Lenthe FJ, Horst K, Oenema A. Environmental andcognitive correlates of adolescent breakfast consumption. Prev
Med 2009;48:372‑7.
39. Vakili M, Baghiani‑Moghadam MH, Pirzadeh A, Dehghani M.
Assessing the effect of education on knowledge, attitude and
practice of guidance school students about milk and dairy products.
Knowl Health J 2008;2:41‑7.
40. Pawlak R, Malinauskas B, Rivera D. Predicting intentions to eat a
healthful diet by college baseball players: Applying the Theory of
Planned Behavior. J Nutr Educ Behav 2009;41:334‑9.
41. Mullan B, Wong C, Kothe E. Predicting adolescent breakfast
consumption in the UK and Australia using an extended theory of
planned behavior. Appetite 2013;62:127‑32.
42. Armitage CJ, Conner M. Efficacy of the theory of planned behaviour.
A meta‑analytic review. Br J Soc Psychol 2001;40:471‑99.
43. Faghih A, Anoosheh M, Ahmadi F, Ghofranipoor F. The effect of
boy students’ participation on consumption of milk and dairy.
Hormozgan Medical Journal 2007;10:349‑56
44. Lautenschlager L, Smith C. Understanding gardening and dietary
habits among youth garden program participants using the Theory
of Planned Behavior. Appetite 2007;49:122‑30.