Findings of this study indicate that only 32% of children consume breakfast daily all-year round, and 62% consume breakfast daily during the weekend. Previous studies with similar samples conducted in Palestine reported 50% breakfast consumption twice or fewer per week [10], 45% breakfast consumption 4 days-per-week during school term [14], and 62% breakfast consumption [11]. The latest study with a similar sample from a neighbouring country, Jordan reported 80% of children consuming breakfast [15]. In Saudi Arabia, a survey recently reported that 79% of children skipped daily breakfast but that there was a higher breakfast consumption at weekends compared to weekdays [12]. Our findings indicate a lower proportion of children consuming breakfast in Palestine than in neighbouring countries.
Breakfast consumption was not associated with gender, age, parents’ education, parents’ work status, or pocket money, but was positively associated with living in a village. Breakfast consumption was significantly associated with regular exercise, sleeping before 10 pm, and shorter screen time. Previous studies in the same region found different associations. For example, an association between female gender and breakfast consumption has been observed [10, 11, 16]. However, this association is not seen in Saudi Arabia or Jordan [12, 15]. A relationship between education and breakfast consumption has also been seen, with a higher parental education level predicting lower breakfast skipping [10, 12], and a higher paternal level of education predicting lower breakfast skipping [14]. In 2009, no relationship was seen between rural or urban living and breakfast consumption [11]. The same study also found an association between breakfast consumption and socioeconomic status.
Almost 70% of children in the current study had more than 2 h of screen time per day, with a higher proportion among children, and 66% did not sleep the recommended amount, both of which were associated with reduced breakfast consumption [17]. Other studies have found similar associations, with waking up late associated with skipping breakfast [18], and longer sleep associated with decreased breakfast skipping [19].
Previous surveys on a regional level have not studied the relationship between breakfast consumption and exercise. Regular breakfast consumption was associated with health-promoting behaviours including exercise [20], and adolescents who skip breakfast are less likely to exercise regularly [21].
Of those consuming breakfast at home, 35% ate sandwiches (white cheese, labaneh, zaatar), 8% ate cereal and milk, and 18% cookies with milk or tea. 40% had breakfast prepared by their parents. A study conducted in Qatar, surveying a younger age group, found that 90% ate eggs or cheese for breakfast, and 42% sweets and chocolate [22]. In a study in Saudi Arabia, 48% had fried eggs sandwiches, 46% had breakfast cereal, and 41% had spread cheese sandwiches. In the same sample, 80% had breakfast prepared by parents, and only 4–7% consumed more healthy options (such as labaneh or zaatar sandwiches) [17].
Reasons for skipping breakfast
In our sample, the most common reasons given for skipping breakfast were not feeling hungry (60%), not having time (50%), and not enjoying eating early (49%). Other reasons included a desire to lose weight (15%) and the rest of the family skips (23%).There was a statistically significant association between being female and all the aforementioned factors. Both parents being out of work and lower education level were significantly associated with children reporting not having anything to eat (20%). These findings are similar to reasons identified in other studies in Arab countries and globally. In a study in Jordan, the top reasons were poor appetite (65%), not having time (60%), having nothing to eat (60%), and having no one to prepare breakfast (58%) [15]. In Saudi Arabia, 48% reported not feeling hungry and 36% reported not having time [17]. In an Australian study, the two most common reasons were a lack of hunger and a lack of time [23].
Perceptions for breakfast
There were generally positive perceptions of breakfast among our sample, with 79% believing it is beneficial for general health, 81% agreeing that it increases concentration and memorisation at school, only 13% believing that it contributes to weight gain, and 81% disagreeing that breakfast consumption made them lazy and less energetic. Such perceptions have not been found in previous research in the Arab world. There have been studies investigating perceptions of breakfast elsewhere in the world, but with very different samples and methodologies [24,25,26].
Implications
Many studies have investigated patterns of breakfast consumption and its associations with various individual and societal factors. This study has delved deeper into the reasons behind skipping breakfast, and children’s perceptions toward breakfast. This study examined factors which have not previously been investigated in Palestine, such as the relationship of children’s breakfast consumption with exercise, sleep, and screen time. These associations are particularly important because they form part of the nutritional transition.
The current research findings have led to important public health implications. For example, perception of breakfast is generally positive, with a high level of awareness of its importance and role in improving performance at school and health in general. Public health campaigns educating children on the importance of breakfast are therefore unlikely to be valuable. For a small subset of children, particularly girls, perception of weight may, on the other hand, be an important factor to address. This is particularly important in light of the increasing rates of eating disorders in Palestine.
It is essential to note that, currently in Palestine, there are no policies in place to mandate providing breakfast at schools for any age group in any class. There are only strategies and policies to control the type of food supplied into school canteens. This includes banning specific high-fat processed foods (i.e. chips and crisps). On a local level, there are some private initiatives to provide home-made food to schools.
The lack of association between breakfast consumption and parents’ work status was a surprising finding, as higher education and work-status are normally associated with increased healthy behaviour and have been found to be positively associated with breakfast consumption in previous studies in Palestine and neighbouring countries. Yet, important reasons for skipping breakfast included having no one to prepare breakfast and skipping breakfast because the rest of the family does. It is vital to understand the context defining public health issues to facilitate the design and implementation of effective public health interventions. In relation to breakfast consumption, for example, it is important to appreciate the nutrition transition, and it’s various components, such as sedentary lifestyles, increased focus on weight, higher exposure to technology, and higher female employment rates. One potential intervention to improve breakfast consumption in Palestine may be to promote breakfast provision in schools. However, this would need a more comprehensive exploration of the characteristics of breakfast for different age groups and backgrounds. This was touched upon in our survey but would need more detailed investigation. In addition, the focus should be on further examining the reasons for skipping breakfast, nutritional education to eliminate misperceptions about breakfast, and correction of unsuitable nutritional components of breakfast.
