CALUSTRE, SOPHIE BENEDICT S.
12 - NEUMANN
Breakfast skipping and health-compromising behaviors in adolescents and
adults
Introduction
In the article that I had read it introduces the topic of skipping breakfast being
common among adolescents and adults in western countries. In the study conducted,
breakfast skipping is defined as not eating a morning meal at home. I, myself admitted
that I do not eat breakfast during weekdays because for me it is very time consuming
and I may come late to go to school. Breakfast may be an indicator to some health
problems such as weight gain that may lead to obesity. In industrialized countries,
breakfast skipping is has been linked to low family socioeconomic status (SES)
(Pastore et al, 1996; Brugman et al, 1998; Hoglund et al, 1998; Nordlund & Jacobson,
1999; O’Dea & Received 8 April 2002; revised 17 July 2002; accepted 13 August 2002
Caputi, 2001), although this finding is not consistent (Walker et al, 1982). I also found
that adolescent girls are more likely to skip breakfast than boys (Isralowitz & Trostler,
1996; Brugman et al, 1998; Hoglund et al, 1998; Shaw, 1998): this may be a chosen
method of weight control for girls, and is in some individuals associated with body
dissatisfaction, dieting, or disordered eating (Melve & Baerheim, 1994; Bellisle et al,
1995; Shaw, 1998). Disordered eating is generally associated with health-
compromising behaviors (Neumark-Sztainer et al, 1997). The aim of the study was to
showcase and investigate whether various factors related to health-compromising and
health-promoting behaviors and SES are associated with breakfast skipping in a large
population sample of Finnish adolescents and adults. More specifically they
hypothesized that breakfast skipping is associated with various health-compromising
factors, such as smoking, alcohol use, overweight, and also with factors more loosely
related to health-compromising behaviors, such as early puberty onset, behavioral
disinhibition, low level of education, low SES, and bad general health and also
breakfast skipping aggregates in families.
Methods
The data of the study reported are from FinnTwin16, a population-based study
of five consecutive nationwide birth cohorts of Finnish twins born between 1975 and
1979 (Rose et al, 1999). The data collection was subjected to and approved by the
local ethics committees. A questionnaire was mailed to twins born in 1975 through
1979 within 2 months of their 16th birthday and questionnaire assessed personality,
social relations, general health, and health habits, including breakfast eating, also a
follow-up questionnaires were sent to the twins at the ages of 17 and 18.5 y. Only data
on body mass index (BMI), education, and disinhibition were used for this study from
the follow-up. Questions on breakfast eating identical to those on the twin
questionnaire were sent to the twins’ mothers and fathers as part of questionnaires
that addressed parental lifestyle and health, these were mailed at the same time as
the baseline twin questionnaires and at the time of the assessment, the age of the
mothers ranged from 32.2 to 62 (mean 44.3, s.d. 4.9) y, and fathers, respectively, from
33.6 to 69.8 (mean 46.5, s.d. 5.7) y. The frequency of breakfast eating was assessed
by the following question: ‘How often do you eat breakfast (for example, sandwiches,
milk, hot cereal, other similar food) before going to school or going to work?’ The three
alternative responses were ‘every morning’, ‘a few times a week’, ‘about once a week
or less often’. The following other variables obtained from the questionnaires at the
age of 16 were used in our analyses: sex, education level at 16; height and weight,
from which BMI was calculated; smoking status, alcohol use; use of coffee, tea,
caffeinated soda, and cocoa; types of milk and bread spread used; frequency of
physical exercise, self-perceived general health, and age of puberty onset (menarche
for females, voice break for males). The researchers of the study investigated
differences between breakfast categories and explanatory variables (eg, sex, SES,
education level) using cross-tabulations and the Pearson w2 test of independence,
corrected for clustered sampling (expressed as an F ratio, as described by Rao and
Scott (1984) in Stata, version 7.0, 2000). Variables that were important correlates of
adolescent breakfast in previous studies or were otherwise considered relevant were
entered in a multivariable model. To assess whether increased breakfast-skipping was
associated with changes in the study subject’s behavior or background characteristics
in the multivariable level, we tested whether the two breakfast skipping categories
could be considered to be equal, and whether odds ratios of individual variables could
be considered equal across the two breakfast-skipping categories.
Results
The frequencies of breakfast eating in adolescents and adults are shown in a
table. Adults had breakfast significantly less often than adolescents (w2 ¼ 31.3,
Po0.00001), girls had breakfast significantly less often than boys (F ¼ 7.6, P ¼ 0.0005)
and adult men less often than adult women (F ¼ 86.2, Po0.00001). Among adults,
breakfast skipping was more prevalent in the lower SES group than in the higher SES
group (Po0.00001 for both men and women), and this was also seen in boys (F ¼
4.37, P ¼ 0.013) (Table 2). For girls, breakfast eating did not differ by SES groups (F
¼ 2.14, P ¼ 0.426). There were no significant interactions between smoking, alcohol
use, and behavioral disinhibition, or sex and age of puberty onset. These interaction
terms and the age of puberty onset could be removed from the multivariable model
without a significant decrease in model fit. However, frequent breakfast skippers
exercised less, had parents who skipped breakfast more often, and were more
behaviorally disinhibited than infrequent breakfast skippers. In age–sex-adjusted
breakfast-eating models of adultshealth-compromising or potentially less healthy
behaviors generally increased when frequency of breakfast skipping increased. We
also examined how breakfast skipping and correlated behaviors were transmitted from
the parents to the offspring by examining families where parents always have
breakfast (N ¼ 2110) vs families where parents frequently skip breakfast (N ¼ 356).
Of the children of the breakfast-eating parents, 81.7% had breakfast every morning,
whereas only 47.8% of the children of the breakfast skippers did so (the difference
was statistically significant, F ¼ 84.0, Po0.00001).
Discussion
Smoking, infrequent exercise, a low level of education, frequent alcohol use,
and high BMI were associated with breakfast skipping in both adults and adolescents.
Contrary to the hypothesis of the researcher, self-perceived general health was not
associated with breakfast-eating patterns, and age of puberty onset was of borderline
significance. Skipping breakfast reflects more than simply meal timing preferences. It
appears to be one component of frequently co-occurring health-compromising
behaviors. Individuals who skip breakfast may care less about their health than
individuals who always eat breakfast. As breakfast skippers are more likely to be
overweight than breakfast eaters, increased weight may be a result of making
unhealthy food choices to make up for a missed breakfast. Simple nutritional
interventions aimed at increasing the frequency of breakfast eating may fail to address
these more complex contextual issues. Discouraging smoking and substance use in
tandem with promoting regular exercise and meals is one way of approaching this
problem. Probably the most effective strategy to influence the offspring’s breakfast
habits is to create family and peer atmospheres that endorse generally health-
conscious lifestyles.
