Longitudinal Changes of Breakfast and Physical Activity Behaviors of Children in 5th Grade

1. Longitudinal Changes of Breakfast
and Physical Activity Behaviors of
Children in 5th Grade
Brianna D. Higgins, Emily N. Werner, Abigail
Gilman, Patricia A. Shewokis,
Stella Lucia Volpe, FACSM
Department of Nutrition Sciences
Drexel University, Philadelphia, PA

2. Importance of Breakfast and Physical
Activity in Children
• Key behaviors associated with excess weight gain among
youth and adolescents
• Infrequent breakfast consumption
• Infrequent physical activity
(Barlow, Pediatrics. 2007;120 Suppl 4:S164-192)

3. (Freedman et al., J Pediatr. 2007;150(1):12-17.e12; Sinha et al. NEJM. 2002;346(11):802-810; Wiegand et al., Eur
J Endocrinol. 2004;151(2):199-206; Fernandez et al., J Pediatr. 2004;145(4), 439-444; Skoczen et al., Exp Clin
Endocrinol Diabetes. 2015;123(4):252-259; Bekkers et al., PloS one. 2012;7(12):e51801)
Measure How Defined for Children Associations with Health
Status
Body Mass
Index (BMI)
Weight-to-height ratio (kg/m2)
≥ 95th percentile for
sex and age
Increased risk for
cardiovascular disease
Impaired glucose tolerance
Type 2 diabetes mellitus
Abdominal
Obesity
Waist circumference
≥ 90th percentile for
sex and age
Increased risk for metabolic and
cardiovascular diseases
Insulin resistance
Hypertension
Hypercholesterolemia

4. Current Childhood Obesity Rates
• United States
• 16% overweight
• 17% obese
• Philadelphia, PA
• 15% overweight
• 25% obese
• 57% of children, 6 to 11 years of age, categorized as
overweight or obese
(http://www.cdc.gov/obesity/data/childhood.html; http://www.cdc.gov/HealthyYouth/obesity/facts.htm;
http://www.cdc.gov/nccdphp/dch/programs/CommunitiesPuttingPreventiontoWork/communities/profiles/both-
pa_philadelphia.htm; http://www.phila.gov/health/pdfs/Obesity_in_Philadelphia_3.10.10.pdf)

5. Effective Strategies to Prevent
Childhood Obesity
• Multi-component, community-based approaches show
promise to be effective
• School-based
• Institute of Medicine recommends that schools be the
focal point for childhood obesity prevention
• No other institution has as much contact with children
• Play a pivotal role in promoting healthy behaviors to
prevent obesity
(Summerbell et al., Cochrane Database Syst Rev. 2005;CD001871; Gortmaker et al., Arch Pediatr Adolesc Med
1999;153:409-418; Koplan et al., J Am Diet Assoc. 2005; 105(1), 131-138; Baranowski, et al., Am J Health Behav.
2002; 26(6), 486-493)

6. Purpose
• To assess the changes in the number of days of breakfast
consumption and days spent participating in 60 minutes of
physical activity per week, over the 2014 to 2015 school
year, in children in the fifth grade provided a school-based
health intervention

7. Methods
• 13 schools recruited to participate in a three-year school-
based intervention
• From five counties in Greater Philadelphia Area
• Chester, Delaware, Montgomery, Bucks, Philadelphia
• Mixture of public, charter and parochial schools
• Children followed from 4th through 6th grades

8. Methods
• Randomized into three levels of intervention
• 4 Core Schools
• 5 Level 1 Schools
• 4 Control Schools

9. Partner Programs for Core Schools
Vetri Foundation
For Children
 Eatiquette 1 to 2 days per week
 Up to 4 Culinary Classrooms per school year
Greener Partners  Monthly in-classroom Seed-2-Snack lessons
 2 Farm Explorer visits per year
Fit Essentials  One 45-minute fitness period per week, with one take-away fitness
assignment to complete outside of school
 Biannual cardiovascular health, muscular strength, balance and
flexibility measurements
Philadelphia Union  2 coach/player visits per year (90 minutes each)
Villanova
University
 VioScreen accounts for all students in grade for parental completion
 Focus group with 10 students per school per focus group

10. Partner Programs for Level 1 Schools
Vetri Foundation For
Children
 No programming
Greener Partners  4 in-classroom Seed-2-Snack lessons
 1 Farm Explorer visit per year
Fit Essentials  One 45-minute fitness period per month, with one take-away fitness
assignment to complete outside of school
 Biannual cardiovascular health, muscular strength, balance and
flexibility measurements
Philadelphia Union  1 coach/player visits per year (90 minutes each)
Villanova Unviersity  No programming

11. Partner Programs for Control Schools
Vetri Foundation For
Children
 No programming
Greener Partners  No programming
Fit Essentials  No programming
Philadelphia Union  No programming
Villanova University  No programming

12. Measurements
• Population analyzed
• Children in 5th grade
• During 2014 to 2015 school year
• Health behaviors
• Youth Behavior Survey Questionnaire
• 26-question multiple choice survey
• Beginning and end of school year

13. Example Questions from
Youth Behavior Survey Questionnaire
• During the past 7 days, on
how many days did you eat
breakfast?
• During the past 7 days, on
how many days were you
physically active for a total of
at least 60 minutes per day?
(Add up all the time you spent
in any kind of physical activity
that increased your heart rate
and made you breathe hard
some of the time)
o 0 days
o 1 days
o 2 days
o 3 days
o 4 days
o 5 days
o 6 days
o 7 days

14. Statistical Analyses
• IBM SPSS standard edition 23 software
• Microsoft Excel 2015
• Descriptive Statistics
• Age
• Anthropometric Measures
• Matched paired t-tests
• From beginning to end of school year
• Change in number of days
• Breakfast consumed
• Participated in 60 minutes of physical activity

15. Variable Core
(n = 216)
Level 1
(n = 234)
Control
(n = 153)
Age (years) 10.3 ± 0.5 10.2 ± 0.5 10.2 ± 0.4
Body weight (kilograms [kg]) 41.5 ± 12.5 43.2 ± 11.6 41.5 ± 16.2
Height (centimeters [cm]) 144.1 ± 12.4 144.1 ± 7.0 144.7 ± 8.3
Body mass index (kg/m2) 19.6 ± 4.6 20.7 ± 4.7 20.7 ± 5.1
Waist circumference (cm) 66.7 ± 11.4 72.5 ± 13.4 68.2 ± 12.3
Values represent mean + standard deviation
Participant Characteristics ~ Baseline

16. Variable Core
(n = 213)
Level 1
(n = 244)
Control
(n = 141)
Age (years) 10.8 ± 0.5 10.8 ± 0.5 10.8 ± 0.6
Body weight (kilograms [kg]) 46.3 ± 13.9 47.2 ± 13.7 47.7 ± 15.6
Height (centimeters [cm]) 149.5 ± 7.7 152.2 ± 89.8 148.9 ± 8.1
Body mass index (kg/m2) 20.4 ± 4.8 23.3 ± 13.9 21.2 ± 5.2
Waist circumference (cm) 69.5 ± 11.8 70.5 ± 11.6 69.9 ± 12.6
Values represent mean + standard deviation
Participant Characteristics ~ Post-intervention

17. P>0.05; Values represent mean ± standard deviation
0
1
2
3
4
5
6
7
8
9
Core Level 1 Control
NumberofDaysofConsumption
Change in Breakfast Consumption
Baseline Follow-Up
N=232N=211 N=204 N=245 N=141 N=154

18. 0
1
2
3
4
5
6
7
8
Core Level 1 Control
NumberofDaysofMeeting60minsPA
Change in Physical Activity Participation
Baseline Follow-Up
P>0.05; Values represent mean ± standard deviation
N=211 N=201 N=236 N=244 N=141 N=143

19. Conclusions
• No significant changes were observed in children in the 5th
grade, from the beginning to the end of the school year in
• Daily breakfast consumption
• Number of days engaged in 60 minutes of physical
activity
• Although this school-based intervention may not have
resulted in significant changes in healthy behaviors over
one school year, the larger three-year intervention may
result in positive changes

20. Independence Blue Cross Foundation