Plain English Summary
Background and study aims
Healthy eating habits are important to reduce the risk of certain lifestyle diseases. It is also well established that people with shorter education live unhealthier lifestyles than their counterparts with longer educations. One population group that belongs to people with short education is vocational students. Besides the risks they take in relation to their lifestyle, vocational students are more likely to drop out of school compared to their peers in gymnasiums. One eating habit that could change for the better is breakfast. Suited places for serving breakfast to these young people are vocational schools where students are naturally gathered. This study has three aims. The first is to assess whether wholegrain breakfast could change certain eating habits of vocational students. The second aim is to assess whether wholegrain breakfast has an effect on students’ concentration ability as a prerequisite for learning. The third aim is to find out to what extent the breakfast experiment is feasible, assessed through students’, teachers’ and managements’ perspectives on facilitators and barriers.
Who can participate?
Students aged 16 years or over at four Danish vocational schools.
What does the study involve?
Participating schools are randomly allocated to one of two groups. Two of the schools serve breakfast and the other two schools do not serve breakfast. The schools serve wholegrain breakfast as an integrated part of the first lesson of each school day for four months from March 2012. The breakfast consists of wholegrain cereals with milk and sugar. Besides this, one of the schools also serves wholegrain bread with toppings each Friday. The breakfast is free for students and is served as a buffet. Measurements are conducted three times in total. The first measurement is before the schools begin serving breakfast. The second measurement is in the middle of the experiment and the last measurement is at the end of the experiment. In each measurement students fill out a questionnaire about their breakfast and morning eating habits. It also covers other issues, like their attitude towards breakfast served at the school. Besides the questionnaire, students also take a test that assesses their ability to concentrate. It is voluntary for students to participate in measurements, as it is to eat the breakfast served. However, presence in the breakfast club is mandatory because it was a part of their school day. In order to assess facilitators and barriers of the breakfast club in schools, interviews with students, teachers and management are also conducted.
What are the possible benefits and risks of participating?
By participating in the breakfast club experiment, schools have an opportunity to encourage their students to eat wholegrain breakfast. Besides, the meal likely created a positive atmosphere where students and teachers could interact and talk about everyday issues but also course related questions in an informal manner. This might help towards a constructive atmosphere in class. Possible disadvantages for the schools include expenses for example relating to breakfast and cleaning. Besides that participation took time from lessons each day and during measurements. The Danish Whole grain Partnership granted all wholegrain breakfast products, whereas schools provided all other breakfast products.
Where is the study run from?
Four Danish vocational schools
When is the study starting and how long is it expected to run for?
March 2011 to June 2012
Who is funding the study?
1. Aalborg University
2. Danish Cancer Society
3. Danish Veterinary and Food Administration
Who is the main contact?
1. Mrs Camilla Berg Christensen
2. Prof. Bent Egberg Mikkelsen
Trial website
Contact information
Type
Public
Primary contact
Mrs Camilla Berg Christensen
ORCID ID
Contact details
Hastrupvej 1582
Qaqortoq
3920
Greenland
Type
Scientific
Additional contact
Prof Bent Egberg Mikkelsen
ORCID ID
http://orcid.org/0000-0002-8700-6899
Contact details
A.C. Meyers Vænge 15. Bygning: A
København SV
2450
Denmark
+45 (0)99402556
bemi@learning.aau.dk
Additional identifiers
EudraCT number
ClinicalTrials.gov number
Protocol/serial number
id: 2018-899/10-0068
Study information
Scientific title
The breakfast club: a quasi-experimental study in vocational schools
Acronym
Study hypothesis
The study had three main research questions. The first was whether the provision of wholegrain breakfast could affect selected eating habits among students. The second assessed the effect of wholegrain breakfast on concentration and sustained attention among students. The final research question regarded the feasibility and asked if the breakfast club intervention was feasible assessed through facilitators and barriers in the experience of students, teachers and management.
Ethics approval
Aalborg University Contract Unit, 27/02/2018, id: 2018-899/10-0068
Study design
Multicentre cluster randomised trial
Primary study design
Interventional
Secondary study design
Cluster randomised trial
Trial setting
Schools
Trial type
Other
Patient information sheet
Vocational schools were invited to participate through written material about the study, which included information about the study. If school management responded positive, a meeting between management, researchers and possible teachers was arranged to further explain and discuss the conditions of the study. Three measurements were conducted during the intervention period; each time students were informed both orally and in writing (participation information sheet) about the purpose of the study, that participation was voluntary and that their information would be treated confidentially. Not available in web format, please use contact details to request a participant information sheet.
Condition
Healthy young people in vocational schools
Intervention
Participants were randomised into either control or intervention at the school level. The intervention lasted for approximately four months (2012).
The intervention consisted of free breakfast: wholegrain cereals with milk and sugar. One school served wholegrain bread with toppings on Fridays. The breakfast session occurred during first lesson every school day for approximately four months. The breakfast was served as a buffet and eating was voluntary.
Control schools proceeded as normal but constraining from serving free breakfast to their students or having other ongoing similar health promotion projects.
Intervention type
Other
Phase
Drug names
Primary outcome measure
1. Eating habits measured by consumption of selected breakfast items. The items included wholegrain products and other items that were considered normal breakfast in the particular population group. Both frequency and quality of breakfast intake were assessed. Measurement instrument was a food frequency questionnaire. Measured at week 0, 7 and 8 weeks after baseline, and 14 to 16 weeks after baseline.
2. Students attention and concentration measured by a concentration test called "the d2 test of attention" at week 0, 7 and 8 weeks after baseline, and 14 to 16 weeks after baseline.
3. Barriers and facilitators were established by interviews with stakeholders i.e. students, teachers and management. Interviews with participants at the two intervention schools were conducted at the end and after the intervention period.
Secondary outcome measures
The amount of students eating during the breakfast club was counted through observations performed at both intervention schools at approximately 7 and 8 weeks after baseline and the end of the intervention period approximately 14 to 16 weeks after baseline
Overall trial start date
01/03/2011
Overall trial end date
22/06/2012
Reason abandoned (if study stopped)
Eligibility
Participant inclusion criteria
Schools:
1. Within a restricted geographical range due to time constraints
2. Ability and willing to pay certain expenses connected to the breakfast club intervention e.g. sugar, milk, toppings and extra cleaning
3. Willingness to participate as control school depending on the randomisation
4. Prepared to serve wholegrain breakfast as an integrated part of the school day
Students:
1. Both genders
2. Age ≥ 15 (participants were all aged 16 years or older)
3. Vocational student attending their first basic part of their education, which is situated in the school setting (Danish vocational training and education is divided into two main parts, the first period takes place at the school and the second part consist of a apprenticeship often in companies)
4. Attending courses considered primarily masculine with a high drop-out rate: auto mechanics and electricians*
*This criterion was not eligible and was changed to also include other courses
Participant type
Healthy volunteer
Age group
Other
Gender
Both
Target number of participants
The study encompassed 318 students in total. They belonged in two clusters with two schools in each.
Participant exclusion criteria
Schools were excluded if:
1. They had ongoing health promotion activities including eating projects
2. They lacked kitchen facilities to store the breakfast products
3. They only had students attending food related courses
Recruitment start date
01/05/2011
Recruitment end date
01/02/2012
Locations
Countries of recruitment
Denmark
Trial participating centre
EUC Lillebælt
Fredericia
7000
Denmark
Trial participating centre
TEC Ballerup
Ballerup
2750
Denmark
Trial participating centre
TEC Frederiksberg
Frederiksberg
2000
Denmark
Trial participating centre
Mercantec
Viborg
8800
Denmark
Sponsor information
Organisation
Aalborg University Copenhagen
Sponsor details
A. C. Meyers Vænge 15
Copenhagen SV
2450
Denmark
+45 (0)9940 3770
aau@aau.dk
Sponsor type
University/education
Website
Funders
Funder type
University/education
Funder name
Aalborg Universitet
Alternative name(s)
Aalborg University, AAU
Funding Body Type
private sector organisation
Funding Body Subtype
Universities (academic only)
Location
Denmark
Funder name
Kræftens Bekæmpelse
Alternative name(s)
Danish Cancer Society, The Danish Cancer Society, DCS
Funding Body Type
private sector organisation
Funding Body Subtype
Other non-profit organizations
Location
Denmark
Funder name
Danish Whole Grain Partnership
Alternative name(s)
Funding Body Type
Funding Body Subtype
Location
Funder name
Danish Veterinary and Food Administration
Alternative name(s)
Funding Body Type
Funding Body Subtype
Location
Results and Publications
Publication and dissemination plan
1. An article about the breakfast club intervention’s possible effects on students eating habits (first research question) is under revision in the BMC Public Health Journal. Publication date probably late 2018 or early 2019
2. An extended abstract about whether breakfast, provided in a breakfast club intervention, can affect students’ ability to concentrate and pay attention was published in proceedings of ICCAS (International Conference on Culinary Arts & Sciences) 2017.
3. Publication of an article about the feasibility of the breakfast club intervention is planned to be submitted to a journal in 2018 or early 2019.
4. PhD dissertation will be submitted late 2018.The thesis will be available from 2019 from Aalborg University Press.
5. Publication of other documents is not planned.
IPD sharing statement
Please contact camillabergchrstensen@gmail.com and/or bemi@learning.aau.dk for access to the datasets. The datasets consist of questionnaires including food frequency questions and selected answers from the d2 test of sustained attention. Besides interviews will be available upon request. The data will be available when the manuscript is published. Access criteria: a description of purpose and intended analysis. Content from participants was received through answering the questionnaire and the intervention conformed with the regulations on nonclinical trials by the National Committee on Health Research Ethics in Denmark. Participants' names were initially recorded and masked into anonymisation during data processing.
Intention to publish date
31/12/2018
Participant level data
Available on request
Basic results (scientific)
Publication list
2019 results in: https://www.ncbi.nlm.nih.gov/pubmed/30943941 [added 05/04/2019]