Attitudes towards Breakfast 1 Development of a Scale to Measure 9-11 Year Olds' Attitudes towards Breakfast

Objective: Development and validation of a questionnaire to measure children’s attitudes toward breakfast. Design: A pilot study was used to select questionnaire items and assess test-retest reliability. The questionnaire was then administered to a larger sample of children together with a dietary recall questionnaire. Randomly selected subsets of these children also completed a dietary recall interview or their parents were asked to complete a questionnaire relating to their child’s breakfast eating habits. Setting: Primary schools in south, west and north Wales, UK Subjects: A total of 2,495 children (199 in pilot testing, 2,382 in the main study) in years 5 and 6 (aged 9-11 years). Results: The 13 item scale showed good construct validity, high internal reliability and acceptable test-retest reliability. Boys displayed more positive attitudes towards breakfast than girls but differences between the two age groups did not reach statistical significance. Children who did not skip breakfast displayed more positive attitudes than children who skipped breakfast. In addition, more positive attitudes toward breakfast were significantly correlated with consumption of a greater number of ‘healthy’ foods for breakfast (i.e. fruit, bread, cereal, milk products), consumption of fewer ‘unhealthy’ foods for breakfast (i.e. sweet items, crisps) and parental perceptions that their child usually ate a healthy breakfast. Conclusions: The breakfast attitudes questionnaire is a robust measure that is relatively quick to administer and simple to score. These qualities make it ideal for use where validity at the individual level is important or where more time consuming dietary measures are not feasible. Attitudes towards breakfast 3 Sponsorship: The research was funded by the Health Promotion Division of the Welsh Assembly Government. Descriptors: Breakfast, attitudes, questionnaire, children, diet, nutrition Attitudes towards breakfast 4 Development of a scale to measure 9-11 year olds’ attitudes towards breakfast Breakfast consumption is associated with a range of benefits. Laboratory research shows that consumption of an adequate breakfast is linked to short-term improvements in attention (Wesnes et al., 2003), memory (Wesnes et al., 2003; Benton & Parker, 1988; Benton & Sargent, 1992; Smith & Kendrick, 1992; Smith et al., 1994, 1999), mood (Smith et al., 1994; 1999; Lloyd et al., 1996) and possibly motivation (Benton et al., 2001). (Though some studies have not found effects on specific attention, memory, and mood measures; Smith et al., 1994; Benton et al., 2001; Cromer et al., 1990.) These findings are borne out by experimental studies conducted in school settings which have shown positive effects of breakfast on memory (Vaisman et al., 1996), arithmetic (Powell et al., 1998), verbal fluency (Chandler et al., 1995), physical endurance, creativity (Wyon et al., 1997) and on-task behaviour (Bro et al., 1994). In a review of this literature, Pollitt (1995) concluded that breakfast consumption consistently improves the cognitive performance of undernourished children and, in the United States and Great Britain, also has cognitive benefits for well-nourished children. Breakfast can also represent an opportunity to consume nutrient rich foods, and thus contribute towards a healthy diet. Indeed, research indicates that skipping breakfast may be associated with dietary inadequacy (Morgan et al., 1986; Nicklas, Myers et al., 1998; Nicklas et al., 2000; Nicklas, O’Neil et al., 1998; Ruxton & Kirk, 1997) and a greater body mass index (Ruxton & Kirk, 1997; Siega-Riz et al., 1998) whilst breakfast consumption is linked to a healthier diet and lifestyle (Nicklas, Meyers et al., 1998; Smith, 1998). Attitudes towards breakfast 5 Despite these advantages, breakfast consumption among children and adults has declined (Nicklas, O’Neil et al., 1998; Haines et al., 1996), with breakfast skipping becoming increasingly prevalent as children get older (Morgan et al., 1986; Siega-Riz et al., 1998; Haines et al., 1996). For example, it is estimated that 19% of 15 year olds skip breakfast (Nicklas et al., 2000). As a consequence, there has been increasing recognition of the educational and nutritional benefits of a good breakfast and of the need to instil children with good ‘breakfast eating habits’ that will continue into adolescence. In many areas this has led to government funded school breakfast initiatives with both nutritional and educational objectives (Shemilt et al., 2003). However, with more emphasis being placed on evidenced-based policy, it is important that such schemes are rigorously evaluated. The choice of outcome measures to inform such an evidence base will in part be dictated by the objectives of the initiative. Where educational benefits are cited, measures of children’s cognitive functioning, attainment, classroom behaviour and/or school attendance will be important. Where there are nutritional goals, the obvious choice would be dietary assessment. However, dietary assessment in schools is far from simple, with many measures being either unsuitable for children or impractical for use on a large scale (Moore et al., 2005). Although measures have been developed in an attempt to address these difficulties (Moore et al., 2005; Edmunds & Ziebland, 2002), these generally assess intake during the course of just one day and therefore tend to be valid at the group level only. An alternative means of assessing the success of a scheme is to measure attitudes. Research into attitudes tends to be underpinned by either the threecomponent model or the expectancy-value model. In the present study we conceptualise attitudes using the three-component model which states that attitudes Attitudes towards breakfast 6 are a combination of the individual’s feelings, beliefs and past behaviours (Maio & Haddock, in press). Although attitudes do not always reflect behaviour (Conner & Armitage, 1998; Petty et al., 1997), several studies have found children’s attitudes towards breakfast to be predictive of their breakfast eating behaviours. Specifically, Unusan et al., (2006) found that among Turkish and German 9-10 year olds, positive attitudes toward the benefits of eating breakfast were positively associated with breakfast consumption. In a Dutch sample of 12-14 year olds, Martens et al. (2005) found that a more positive attitude toward breakfast was associated with more frequent breakfast consumption. And lastly, in a group of Swedish 11-15 year olds, Berg et al. (2000) found that over a 2 week period, consumption of milk and bread for breakfast was predicted by intentions which were in turn predicted by attitudes. Scales designed to assess attitudes offer a number of advantages: they are relatively quick and easy to administer, they can be developmentally appropriate and they are valid at the individual level. In addition, they may also be predictive of long term habits. For example, a wide range of longitudinal studies employing the Theory of Planned Behaviour have found many health behaviours to be predicted by behavioural intentions, which are in turn predicted by a combination of attitudes, subjective norms and perceived behavioural control (e.g., Sutton, 2004). Although no such longitudinal studies have specifically addressed children’s breakfast eating behaviours, it is possible that attitudes towards breakfast likewise contribute to breakfast eating intentions which may in turn predict more long-term breakfast eating behaviours. This point is especially important in the context of school breakfast schemes, where children’s food consumption will, to some degree, be determined by the foods that adults make available to them. Their actual eating behaviours in this context may therefore be less predictive of long term habits than their attitudes and Attitudes towards breakfast 7 intentions. Given that breakfast skipping increases in adolescence (Siega-Riz et al., 1998), it is important that breakfast programmes with nutritional objectives alter long term dietary habits. The aim of the present study was to develop and validate a scale to measure British 9-11 year old children’s attitudes towards breakfast. The scale was developed as part of a larger evaluation of the Welsh Assembly Governments’ Primary School Free Breakfast Initiative (see Tapper et al., in press) and was designed to be used alongside a number of other measures assessing both nutritional and educational