Nutrition and Cognitive Achievement: An Evaluation of the School Breakfast Program

Assessing the Dietary Practices and Anthropometric Outcomes of Students Consuming Mid-day Meals Versus Home-Cooked Meals

INTRODUCTION

 Early childhood and adolescence are prime years that people spend in school. These formative years give the school ample opportunities to impart certain aspects of lifestyle and healthcare to the student, in addition to academics. School health programs are vital in providing comprehensive education and healthcare services. The objectives of the study are to enlist the socio-demographic factors affecting the nutritional level between students who enrolled for the mid-day meal scheme and those who did not.

METHODOLOGY

 This is a cross-sectional questionnaire-based study, which was carried out between children who enrolled in the mid-day meal program and home-cooked meals for students from 3rd to 12th grade in Faridabad. The study was conducted by the Department of Public Health Dentistry, Faridabad, from January to June 2024.

RESULT

 It was determined that 162 (53.6%) males and 222 (74.9%) females were obese. 332 (55.3%) believed that social media had an impact on their dietary decisions, while 268 (44.7%) disagreed. When asked to rate how many healthy food alternatives were available at their school, 53 (8.8%) of them said it was great, 194 (32.3%) said it was good, 196 (32.7%) said it was fair, and 157 (26.2%) said it was poor. 236 (78.7%) parents of the mid-day meal group never had dietary supplemental education, which is why children have indigent nutritional status. The mean waist-to-hip ratio (WHR) was calculated as 0.92 ± 0.43 and 0.88 ± 0.69 with significant values of 0.00 (p≤0.05) in the home-cooked and mid-day meal-consuming groups respectively.

CONCLUSION

 Students consuming home-cooked meals showed a better WHR for age than those consuming mid-day meals. Children of parents with high education levels have good nutritional status and are healthier as compared to children with parents who have low education levels. Thus, there is a dire need to include school health programs to provide healthy and nutritious food to children, in need.

School Meal Nutrition Standards Reduce Disparities Across Income and Race/Ethnicity

INTRODUCTION

Children's diets in the U.S. typically fail to meet dietary recommendations, contributing to associated adverse health outcomes. The Healthy, Hunger-Free Kids Act (HHFKA) of 2010 required the U.S. government to update nutrition standards for school meals to align with the Dietary Guidelines for Americans (DGAs). This study estimates the evolving impact of substituting school-prepared food for home-prepared food on overall daily diet quality and by subcomponents of diet quality. Subgroup analyses are performed by race/ethnicity and income.

METHODS

Two, nonconsecutive days of dietary recall data from the National Health and Nutrition Examination Survey (2005-March 2020) are used to calculate schoolchildren's Healthy Eating Index (HEI)-2020 scores. The study includes children with complete two-day dietary intakes who attend kindergarten through twelfth grade in a school offering lunch. An individual-level fixed effects regression is employed to examine the relationship of school food consumption on HEI-2020 scores before and after HHFKA-mandated changes in nutrition standards. Analyses were conducted on September 23, 2023.

RESULTS

Prior to changes in standards (2005-2008), school food did not impact diet quality within the overall group of children. In 2009-2012, positive associations between school food and diet quality emerged for low-income students and for non-Hispanic Black students. By 2013-2020, improvements were seen across all groups. The association between school food and diet quality was most attributable to more favorable consumption of dairy, fruit, whole grains, refined grains, added sugars and saturated fats.

CONCLUSIONS

HHFKA-based nutrition standards were associated with beneficial dietary changes and reduced dietary disparities for children across diverse backgrounds.

Free school meals and cognitive ability: Evidence from China's student nutrition improvement plan

The China Student Nutrition Improvement Plan (SNIP) covers 40.6 million students in the compulsory education stage, accounting for 42% of all students enrolled in rural compulsory education in 2021. This paper utilizes the county-by-county rollout of the SNIP and estimates the effect of this nutritional intervention on students' cognitive outcomes. We find that SNIP increases math test scores but has a statistically insignificant effect on verbal achievement. The effect is greater for middle school students and children from disadvantaged families. The SNIP affects the cognitive performance of students by improving their health status, increasing school attendance, fostering good study habits, raising educational expectations, and improving the human capital of peers.

Co-benefits from health and health systems to education

This review draws on over 70 studies spanning 2000 to 2023 to analyze the causal effect of health on educational outcomes. Health and health system interventions during the prenatal, infant, and childhood period impact longer-run educational attainment and performance. The magnitude of these effects is both statistically and economically significant, comparable in size to impacts on educational outcomes of interventions found in the literature. These impacts of health and health system interventions differ across gender and socioeconomic status, illustrating how health and health systems can exacerbate or mitigate educational inequalities. By showing the intertwined nature of health and education, this review highlights the importance of a comprehensive approach in policy-making that aligns with the Sustainable Development Goals.

[Déterminants de la qualité de vie liée à la santé chez les adolescents : le rôle de la diète méditerranéenne]

BACKGROUND

A number of physical, emotional, cognitive and psychological changes shape the adolescence phase, which may influence health and well-being. Therefore, it is important to develop healthy eating habits that will persist into adulthood.

OBJECTIVE

This study was conducted in order to investigate in depth the association between components of the Mediterranean diet (MD) and health-related quality of life (HRQoL), along with its different subscales, among Lebanese adolescent students attending schools in Tripoli, North Lebanon.

METHODS

A cross-sectional survey was undertaken among 798 teenagers aged 11 to 18. All responded to a questionnaire that evaluated their HRQoL, sociodemographic characteristics and adherence to the Mediterranean diet.

RESULTS

The results of the study revealed that only 15.9% of the students had a high adherence to the MD. With regard to the components of the MD associated with the HRQoL, it was revealed that fruit intake by the students (once daily) was associated with a better general well-being (P = 0.047). In addition, fish consumption (two to three times per week) and daily intake of a dairy product for breakfast were positively associated with the total KIDSCREEN score (P < 0.001 and P = 0.003, respectively). Finally, skipping breakfast was correlated with a poorer general well-being (P = 0.013).

CONCLUSION

Our results suggest a strong correlation between MD adherence and HRQoL in Lebanese adolescents. However, future studies are warranted in order to strengthen the evidence of this association.

Parent Willingness to Pay for School Feeding Programs in Junior High Schools in Malang Regency, Indonesia

In Indonesia, school feeding programs have not been established nationally due to the government's limited budget. To examine the possibility of copayment for school feeding programs, parents' intentions to use the school feeding programs and their willingness to pay (WTP) for these programs should be considered. We conducted an online questionnaire survey among the parents of junior high school students in all five public junior high schools in the Kepanjen District of Malang Regency, East Java Province, Indonesia. We used the contingent valuation method to elicit parents' WTP for school feeding and calculated the price elasticity of school feeding. Factors associated with the WTP were examined using logistic regression analysis. Of the 940 participants, 90% intended to use school feeding programs, and 30% were willing to pay Rp 15,000 (USD 1.05) or higher per meal. Of the 944 students (participants' children), all but two students consumed meals or snacks at school, with 74% consuming foods three or more times daily. Higher WTP for school feeding was associated with frequent food consumption at school, higher income, and a better perception of meals at school. In contrast, lower WTP was associated with more household members. Most parents intended to use school feeding programs with certain WTP irrespective of the price of school feeding. Therefore, school feeding in Indonesia might be expanded through copayment.

Global pattern in hunger and educational opportunity: a multilevel analysis of child hunger and TIMSS mathematics achievement

In low-income countries, there exists a common concern about the effect of hunger and food insecurity on educational outcomes. However, income inequalities, economic slowdown, conflict, and climate change have raised those concerns globally. Yet, little is known about how widespread the problem of hunger in schools is worldwide. This study examines child hunger and student achievement internationally, using data from the Trends in Mathematics and Science Study (TIMSS) 2019. To examine the relationship between hunger and student achievement, we fitted multilevel models to the data and controlled for student SES, class SES, teacher experience, and teacher educational attainment.  The results suggest that hunger among students is not exclusive to low-income countries. Instead, child hunger is a common issue around the world, affecting about one-third of children and exacerbating unequal education opportunities globally. Controlling for other variables, the achievement gap between students who never come to school hungry and those who come to school always or almost always hungry is significant and deserves our attention. A clear policy recommendation from our results suggests that all countries that participated in TIMSS need to examine their school meal programs and explore ways to feed the students who show up to school hungry.

The Effect of Free School Meals on Household Food Purchases: Evidence from the Community Eligibility Provision

We find access to universal free school meals through the Community Eligibility Provision (CEP) had a meaningful impact on grocery spending for households with children, with monthly food purchases declining by about $11, or 5 percent. For households in zip codes with higher exposure, the decline is as high as $39 per month, or 19 percent. The composition of food purchases also changes after CEP, with low income households experiencing a 3 percent improvement in dietary quality. Finally, CEP exposure is associated with an almost 5 percent decline in households classified as food insecure. Our results on the heterogeneous effects of CEP exposure by prior free/reduced price lunch eligibility reveal benefits in terms of both spending, dietary composition, and food insecurity for previously eligible low-income families, suggesting that the stigma of free school meals may be declining after universal access.

Associations between a Universal Free Breakfast Policy and School Breakfast Program Participation, School Attendance, and Weight Status: A District-Wide Analysis

Breakfast consumption among youth is associated with improved diet quality, weight, cognition, and behavior. However, not all youth in the United States consume breakfast. Participation in the School Breakfast Program (SBP) is also low relative to the lunch program. Universal free breakfast (UFB) policies have been implemented to increase breakfast participation by reducing cost and stigma associated with the SBP. This study examined whether a UFB policy implemented in a school district in the Southeast US was associated with changes in breakfast participation, school attendance, and student weight. A longitudinal study of secondary data was conducted, and a mixed modeling approach was used to assess patterns of change in SBP participation. General linear models were used to assess attendance and student weight change. On average, across schools in the district, there was an increase in breakfast participation of 4.1 percentage points following the implementation of the policy. The change in breakfast participation in schools differed by the percent of students in the school who received school meals for free or at a reduced price, the percent of students of color, and the grade level of the school. Increases in SBP participation were not associated with significant changes in attendance or weight. UFB policies may be effective in increasing participation in the SBP.

Sugar rush or sugar crash? Experimental evidence on the impact of sugary drinks in the classroom

Sugary drinks in schools have been demonized for their potential long-term contribution to rising obesity rates. Surprisingly, there is only little evidence on the immediate effects of sugary drinks in schools. This paper provides experimental evidence on the in-class effects of sugary drinks on behavior and student achievement. We randomly assigned 462 preschool children to receive sugary drinks or artificially sweetened drinks and collected data before and after consumption. Our findings suggest that the consumption of one sugary drink induces an initial "relaxing" effect for boys, before making them more restless. Girls' behavior is not significantly affected. We find a negative effect on student achievement for boys and a positive effect for girls. We show the robustness of the results across two field experiments.

Breakfast and School-Related Outcomes in Children and Adolescents in the US: A Literature Review and its Implications for School Nutrition Policy

PURPOSE OF REVIEW

To identify and review the latest research on the connections between breakfast and school-related outcomes in children and adolescents in the US, and to explore the implications of this research on US school nutrition policy, particularly as it applies to students experiencing or at risk for food insecurity.

RECENT FINDINGS

Although school personnel, parents, and students have positive attitudes about breakfast and its benefits for learning, recent research finds mixed evidence for the role of breakfast in improving objectively measured grades and test scores. Few recent studies examined behavioral outcomes, limiting the ability to draw clear conclusions about breakfast and school behavior. Several studies observed improved attendance with increased school breakfast access and participation, especially when schools offered breakfast at no cost to all students. There are many challenges to studying the connections between breakfast and learning. The recent research on breakfast and academic outcomes is mixed, but there is a growing body of evidence that eliminating fees for both school breakfast and lunch has promise for improving school-related outcomes.

Breakfast in the Classroom Initiative Does Not Improve Attendance or Standardized Test Scores among Urban Students: A Cluster Randomized Trial

BACKGROUND

Breakfast in the Classroom (BIC), a common approach to implementing the federal School Breakfast Program, is advocated as a method to improve students' academic performance. However, the impacts of BIC on academic outcomes are unclear.

OBJECTIVE

To examine the effect of a BIC initiative which provided free, universal BIC on attendance and standardized test performance over 2.5 years, versus free universal breakfast served in the cafeteria before school, among students in an urban school district serving a low-income population.

DESIGN

Secondary analysis of data from a cluster randomized controlled trial conducted between 2013 and 2016; sixteen kindergarten through 8^th grade public schools in Philadelphia, Pennsylvania were enrolled and randomized to condition. Baseline data for 1,362 4^th through 6^th grade students were provided by the school district. Midpoint data were collected after 1.5 years and endpoint data after 2.5 years.

PARTICIPANTS/SETTING

Schools were eligible if ≥50% of students qualified for free/reduced-priced meals, did not offer BIC, and received programming as part of the USDA's Supplemental Nutrition Assistance Program. Parents consented for their children to participate.

INTERVENTION

Intervention schools provided BIC and breakfast-related nutrition promotion activities. Control schools provided breakfast in the cafeteria before the school day.

MAIN OUTCOME MEASURES

Student attendance and standardized exam scores.

STATISTICAL ANALYSES PERFORMED

Weighted generalized estimating equations were used to evaluate differences in outcomes between conditions at midpoint and endpoint.

RESULTS

The BIC initiative did not impact attendance (Beta (SE) = 0.004 (0.06), P = 0.94) or standardized reading exam scores (Beta (SE) = 0.02 (0.06), P = 0.79) after 2.5 years. Students in BIC initiative schools had lower standardized math exam scores than those in control schools although this difference was small (Beta (SE) = -0.20 (0.07), P = 0.005).

CONCLUSIONS

BIC did not improve academic outcomes among students attending low-income, urban schools.

Prep School for Poor Kids: The Long-Run Impacts of Head Start on Human Capital and Economic Self-Sufficiency

This paper evaluates the long-run effects of Head Start using large-scale, restricted administrative data. Using the county rollout of Head Start between 1965 and 1980 and age-eligibility cutoffs for school entry, we find that Head Start generated large increases in adult human capital and economic self-sufficiency, including a 0.65-year increase in schooling, a 2.7 percent increase in high school completion, an 8.5 percent increase in college enrollment, and a 39 percent increase in college completion. These estimates imply sizable, long-term returns to investments in means-tested, public preschool programs.

Small Effects: The Indispensable Foundation for a Cumulative Psychological Science

We draw on genetics research to argue that complex psychological phenomena are most likely determined by a multitude of causes and that any individual cause is likely to have only a small effect. Building on this, we highlight the dangers of a publication culture that continues to demand large effects. First, it rewards inflated effects that are unlikely to be real and encourages practices likely to yield such effects. Second, it overlooks the small effects that are most likely to be real, hindering attempts to identify and understand the actual determinants of complex psychological phenomena. We then explain the theoretical and practical relevance of small effects, which can have substantial consequences, especially when considered at scale and over time. Finally, we suggest ways in which scholars can harness these insights to advance research and practices in psychology (i.e., leveraging the power of big data, machine learning, and crowdsourcing science; promoting rigorous preregistration, including prespecifying the smallest effect size of interest; contextualizing effects; changing cultural norms to reward accurate and meaningful effects rather than exaggerated and unreliable effects). Only once small effects are accepted as the norm, rather than the exception, can a reliable and reproducible cumulative psychological science be built.

Nutrition, Cognition, and Social Emotion among Preschoolers in Poor, Rural Areas of South Central China: Status and Correlates

Existing empirical evidence suggests that the prevalence of undernutrition in remote and poor, rural areas is still high among Chinese children. While evidence reveals that undernutrition may detrimentally affect child development, studies focusing on rural Chinese preschoolers are sparse. Using the baseline survey of a preschool's free nutritious lunch pilot program, this study examined the relationship between child undernutrition and developmental outcomes among a preschool-aged sample in poor, rural areas of China. We conducted the baseline survey in Hunan province in south central China in September 2018. A total of 1293 preschoolers living in two (then) nationally designated poverty counties in rural Hunan served as our study sample. Children's nutritional statuses were measured using height-for-age z-score, weight-for-age z-score, and anemia, while their cognitive and socio-emotional skills were assessed using the Wechsler Preschool and Primary Scale of Intelligence (WPPSI) and Strengths and Difficulties Questionnaire (SDQ), respectively. We find that 33% of sample preschoolers were anemic, whereas the incidences of stunting and wasting were 11% and 2%, respectively. About 54% of the sample children had delay in at least one of the developmental domains measured in this study. Our findings provide suggestive evidence supporting that children from certain backgrounds tend to experience worse nutritional and developmental outcomes than their counterparts. After controlling for socioeconomic status, we observed that both anemia and stunting were negatively associated with children's cognitive performance; however, they were not associated with socio-emotional performance. As such, this study suggests that free lunch programs have the potential to change children's developmental trajectory in preschool. We believe that our results will contribute to the debate surrounding whether the nutritious lunch program in China should be expanded to the preschool education level.

Cost-effective Analyses of an Urban Public School District's Classroom Breakfast Program

BACKGROUND

We assessed the cost-effectiveness and student outcomes related to providing breakfast in the classroom (BIC) setting versus breakfast in the traditional school cafeteria (Cafe).

METHODS

The sample included 2906 African American and Hispanic students attending urban elementary and middle schools in a city in the Northeastern United States. Teachers and other school personnel completed interviews. Teachers completed an online survey.

RESULTS

School absences were lower for students in the BIC program than in the Cafe program. The school suspension rate was lower for the BIC students than the Cafe students. A larger percentage of BIC students (80%) ate breakfast than Cafe students (30%). The BIC program was more cost-effective than the Cafe program.

CONCLUSIONS

Our findings demonstrate that low-income students in the BIC program showed improved attendance and increased breakfast consumption. Students who consume a healthy in-class breakfast may develop better eating habits and academic performance.

The New school food standards and nutrition of school children: Direct and Indirect Effect Analysis

The Healthy, Hunger-Free Kids Act (HHFKA) of 2010 made sweeping changes to school nutritional standards. We estimate the impacts of shifts in school nutritional standards on dietary quality as well as dietary quantity of children's food intakes from school and away-from-school food sources. We find the average effect of consuming school food, rather than away-from-school food, on children's overall dietary quality significantly increased from the pre- to post-HHFKA implementation period. This effect was solely driven by substantial improvements in the dietary quality of foods acquired at school, mainly among older and higher-income children. Our indirect effect analysis indicated that children shifted towards consuming lower-quality diets at home in the post-HHFKA period, thereby partially offsetting the positive effects of the HHFKA on their overall dietary quality. Indirect impacts were primarily driven by a subset of children consuming more than a third of their daily calories from school food. Additionally, we find suggestive evidence of a modest decrease in daily calorie intake, particularly among older and higher-income children. Together, our findings imply that the HHFKA, despite its unintended negative indirect effects, led children to consume more-nutritious, less-energy-dense diets.

The Role of District Wellness Policies in Encouraging Student Participation in the School Breakfast Program, United States

Eating breakfast is associated with better academic performance and nutrition and lower risk of obesity, but skipping breakfast is common among children and adolescents, and participation in the U.S. Department of Agriculture's School Breakfast Program (SBP) is low. This study assessed the association between school district wellness policy provisions coded as part of the National Wellness Policy Study and student SBP participation and acceptance of the breakfasts provided using cross-sectional survey data from the School Nutrition and Meal Cost Study. Separate survey-adjusted multivariable logistic regressions were computed, linking students eating (N = 1575) and liking (N = 726) the school breakfast to corresponding district policy measures, controlling for school and student characteristics. Strong district policy, as opposed to no policy, was associated with significantly higher odds of students eating the school breakfast (odds ratio (OR): 1.86; 95% CI: 1.09, 3.16; p = 0.022), corresponding to an adjusted prevalence of 28.4% versus 19.2%, and liking the school breakfast (OR: 2.14; 95% CI: 1.26, 3.63; p = 0.005), corresponding to an adjusted prevalence of 69.0% versus 53.9%. District policy has the potential to play an important role in encouraging higher levels of SBP participation.

Do High School Students Participate in Second Chance Breakfast Programs?

BACKGROUND

Breakfast consumption often decreases as youth get older. The School Breakfast Program (SBP) provides an opportunity to intervene and increase breakfast consumption, especially among high school students.

METHODS

Project breakFAST implemented an expanded breakfast service at 12 high schools. In this longitudinal evaluation, school administrators provided SBP participation and demographic data on all ninth and 10th graders for two full consecutive school years. Students screened for eating breakfast <3 times/week were randomly selected to participate in the cohort study. The cohort completed a survey on perceived barriers, benefits, and breakfast habits.

RESULTS

At baseline, all 12 schools had only traditional before school cafeteria SBP service. Mean participation was 16.3% and ranged from 7.9 to 38.1%. After the intervention, there was an increase in participation to 25.7% (p = .004) ranging from 14.1 to 47.5%. There was no change in breakfast participation before school (13.3%, p = .06). Students who traveled to school by car, bike, or walking at baseline were 4.5% less likely to participate in second chance breakfast at follow-up than those who took the bus to school (p = .006).

CONCLUSION

Second chance breakfast is an option for increasing high school breakfast participation, especially for those riding the bus.

Effect of Eating Breakfast on Cognitive Development of Elementary and Middle School Students: An Empirical Study Using Large-Scale Provincial Survey Data

Background

In existing research on the importance of student breakfast, few studies have focused on the impact of breakfast on student cognitive development. Further, empirical research in this field is mostly based correlation analysis, in which it is difficult to control the influence of selection bias on the analysis results.

Material/Methods

Here, we used student academic performance, based on the academic quality monitoring data of Jiangsu basic education students, as a proxy variable for cognitive development, and used both ordinary least-squares regression and propensity score matching methods to analyze the impact of eating breakfast on the cognitive development of primary and middle school students.

Results

We found that it is still common for students in primary and secondary schools to go without breakfast, and that this is even true in middle schools. Whether students eat breakfast is affected by many factors, and the frequency of eating breakfast has a significant positive impact on student achievement.

Conclusions

In primary school, students who eat breakfast every day in a week scored 31.322 points higher in academic performance than those who did not. In middle school, students who ate breakfast on time every day had significantly better academic performance (31.335 points higher) than those who did not eat breakfast every day. This indicates that eating breakfast every day has a significant effect on the cognitive development of students.

Universal Access to Free School Meals through the Community Eligibility Provision Is Associated with Better Attendance for Low-Income Elementary School Students in Wisconsin

BACKGROUND

Beginning in 2014-2015, schools nationwide have had the option of offering free meals to all students in qualifying schools through the Community Eligibility Provision (CEP). The CEP has been linked to greater likelihood of eating school meals, but little is known about its impact on broader outcomes.

OBJECTIVE

The purpose of this study was to estimate the association between the CEP and school attendance among elementary school students (grades 1 to 5).

DESIGN

This was a quasi-experimental study in which students' attendance records were observed over 1 baseline and 2 follow-up years in a sample of CEP and eligible non-CEP schools.

PARTICIPANTS/SETTING

The participants were elementary school students in Wisconsin during three consecutive school years beginning 2013-2014. The main sample included 92,126 observation-years for students in 37 CEP and 108 eligible non-CEP elementary schools.

INTERVENTION

CEP-participating schools offered breakfast and lunch free to all students through the School Breakfast Program and the National School Lunch Program beginning in 2014-2015.

MAIN OUTCOME MEASURES

The outcome measures were the attendance rate (defined as the percentage of school days attended) and low attendance (defined as attending fewer than 95% of available days) during the first and second implementation years.

STATISTICAL ANALYSES PERFORMED

Difference-in-difference regression models with student fixed effects were estimated, with separate impacts for the first and second CEP years. Models adjusted for time-varying school and student characteristics.

RESULTS

Implementing the CEP had no association with attendance in the initial year. The second year of CEP was associated with a 3.5 percentage point reduction in the percentage of students with low attendance (P=0.045). An association between CEP and attendance was only found for economically disadvantaged students.

CONCLUSIONS

Offering meals free to all students through the CEP may modestly reduce the risk of low attendance among economically disadvantaged students in participating schools.

Practice Paper of the Academy of Nutrition and Dietetics: Comprehensive Nutrition Programs and Services in Schools

It is the position of the Academy of Nutrition and Dietetics, School Nutrition Association (SNA), and Society for Nutrition Education and Behavior (SNEB) that comprehensive, integrated nutrition programs in preschool through high school are essential to improve the health, nutritional status, and academic performance of our nation's children. To maximize impact, the Academy, SNA, and SNEB recommend specific strategies in the following key areas: food and nutrition services available throughout the school campus, nutrition initiatives such as Farm to School and school gardens, wellness policies, nutrition education and promotion, and consideration of roles and responsibilities. This paper supports the joint position paper of the Academy of Nutrition and Dietetics, SNA, and SNEB published in the May 2018 Journal of Academy of Nutrition and Dietetics. In alignment with the joint position paper, this practice paper provides registered dietitian nutritionists and nutrition and dietetics technicians, registered with an overview of current school nutrition services and opportunities for professional careers in school settings. The Academy of Nutrition and Dietetics has several position papers related to youth preschool through adolescence that cover specific nutrition needs in more detail at www.eatright.org.

Breakfast Is Brain Food? The Effect on Grade Point Average of a Rural Group Randomized Program to Promote School Breakfast

BACKGROUND

Adolescents frequently miss breakfast which may impact cognitive, academic, and health outcomes. This analysis describes the effect of a trial to assess school level changes to increase breakfast consumption on grade point average (GPA).

METHODS

Sixteen rural Minnesota high schools were randomized to a policy and environmental change intervention or delayed intervention (control) group. Baseline screening identified, randomly selected and enrolled 9th and 10th grade students who eat breakfast ≤3 times per school week for assessment. Mean unweighted GPA was provided by 13 schools for 636 students. Student-level and administrative data were used for sociodemographic and free or reduced-price meals (FRPM). Linear mixed models and latent class analysis (LCA) were used to assess change in GPA.

RESULTS

Students were 54% female, 76% white, and 34% received FRPM. Unweighted cumulative GPA mean = 2.82 (0.78) at baseline. There was no significant intervention effect on GPA postintervention or 1-year follow-up. LCA revealed two classes: "higher" (N = 495) and "lower" (N = 141) resource. There was an intervention effect among low-resource students from baseline to 1-year post only among the control condition (delayed intervention).

CONCLUSIONS

In combination with the full study results, increasing breakfast consumption may have an impact particularly for low resource students.

The changing role of Australian primary schools in providing breakfast to students: A qualitative study

ISSUE ADDRESSED

In recent years, state governments throughout Australia have provided significant funding to support the expansion of school breakfast programs (SBPs), in response to concerns about children arriving at school hungry. This study investigated how schools have responded to the growing expectation that they provide breakfast for students.

METHODS

This qualitative study draws on case studies of five Australian primary schools that operate SBPs. Interviews or focus groups were conducted with 78 children, parents, staff, volunteers and funders and data underwent thematic analysis.

RESULTS

Three key themes were identified: Adjusting to the changing role of schools, SBPs reflecting the school's culture, Schools as an alternative or additional site for breakfast. Some staff and parents expressed unease about SBPs shifting responsibility for breakfast provision from parents to schools but were committed to supporting vulnerable students as part of the broader school culture. SBPs were found to provide an alternative or additional site for breakfast consumption for many children not experiencing food insecurity.

CONCLUSION

The expectation that schools provide breakfast has created some challenges and tensions that have not been fully resolved. The adoption of an inclusive approach, undertaken to ensure students were not stigmatised for attendance, had resulted in concerns about the resources used by the programs as well as over-consumption of breakfast by some students. SO WHAT?: Increasingly, Australian schools are providing breakfast for students. Concerns about shifting responsibility and over-consumption could be addressed if schools were given more advice on program management by government and non-government funding bodies.

Serving Breakfast Free to All Students and Type of Breakfast Serving Model Are Associated with Participation in the School Breakfast Program

BACKGROUND

Many students experience challenges participating in the School Breakfast Program (SBP) when breakfast is served before school in the cafeteria. Serving breakfast free to all students or offering innovative breakfast serving models, such as breakfast in the classroom (BIC), grab n' go, or second chance breakfast, may encourage higher SBP participation rates.

OBJECTIVE

To examine the association between offering breakfast free to all students as well as breakfast serving model with student participation in the SBP in October 2017 among public schools in North Carolina.

DESIGN

Cross-sectional study using data from the North Carolina Department of Public Instruction.

PARTICIPANTS/SETTING

This study included data from 2,285 North Carolina public schools who served breakfast in October 2017 with 1,445,287 students.

MAIN OUTCOME MEASURES

The main outcome measures are the odds of a student participating in the SBP among students overall, students eligible for free or reduced-price (FRP) meals, and students not eligible for FRP meals.

STATISTICAL ANALYSES PERFORMED

Multiple logistic regression assessed the association between offering breakfast free to all students and breakfast serving model with the probability of participating in the SBP (number of students participating out of number of students enrolled) for students overall, eligible for FRP meals, and not eligible for FRP meals. Statistical models were stratified by school type (elementary, middle, and high schools).

RESULTS

Breakfast serving models positively associated with SBP participation were BIC and BIC plus grab n' go for elementary and high school students and grab n' go and second chance for middle and high school students (P<0.05). Serving breakfast free to all students was positively associated with SBP participation alone and in combination with BIC, second chance, and BIC plus grab n' go (P<0.05).

CONCLUSIONS

Serving breakfast free to all students and breakfast serving model were associated with SBP participation, and different relationships existed for different school levels.

Effect of a Breakfast in the Classroom Initiative on Obesity in Urban School-aged Children: A Cluster Randomized Clinical Trial

IMPORTANCE

Serving breakfast in the classroom is promoted to increase participation in the federal School Breakfast Program. However, little is known about the effect of breakfast in the classroom on children's weight status.

OBJECTIVE

To evaluate the effect of a breakfast in the classroom initiative, which combined breakfast in the classroom with breakfast-specific nutrition education, on overweight and obesity among urban children in low-income communities.

DESIGN, SETTING, AND PARTICIPANTS

A cluster-randomized clinical trial among 1362 fourth- through sixth-grade students from low-income urban communities across 2.5 years. Sixteen kindergarten through eighth grade Philadelphia public schools with universal breakfast participated. Participants were recruited in September 2013, and the intervention began in January 2014. Data analysis took place from April 1, 2018, to August 30, 2018.

INTERVENTIONS

Intervention schools received a program that included breakfast in the classroom and breakfast-specific nutrition education. Control schools continued breakfast before school in the cafeteria and standard nutrition education.

MAIN OUTCOMES AND MEASURES

The primary outcome was the combined incidence of overweight and obesity. Secondary outcomes included the combined prevalence of overweight and obesity, incidence and prevalence of obesity, changes in body mass index (BMI) z score, and School Breakfast Program participation.

RESULTS

Among the 1362 students, mean (SD) age was 10.8 (0.96) years and 700 (51.4%) were female; 907 (66.6%) were black, 233 (17.1%) were Hispanic, 100 (7.3%) were white, 83 (6.1%) were Asian, and 39 were of multiple or other race/ethnicity. After 2.5 years, students in intervention schools had participated in the School Breakfast Program 53.8% of days, compared with 24.9% of days among students in control schools (β = 0.33; 95% CI, 0.22-0.42). There was no difference between intervention and control schools in the combined incidence of overweight and obesity after 2.5 years (11.7% vs 9.3%; odds ratio [OR] 1.31; 95% CI, 0.85-2.02; P = .22). However, the incidence (11.6% vs 4.4%; OR, 2.43; 95% CI, 1.47-4.00) and prevalence (28.0% vs 21.2%; OR, 1.46; 95% CI, 1.11-1.92) of obesity were higher in intervention schools than in control schools after 2.5 years.

CONCLUSIONS AND RELEVANCE

A breakfast in the classroom initiative increased participation in the School Breakfast Program and did not affect the combined incidence of overweight and obesity. However, the initiative had an unintended consequence of increasing incident and prevalent obesity. Further research is needed to identify approaches to increase participation in the School Breakfast Program that do not increase obesity among students.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT01924130.

Eating Breakfast and Family Meals in Adolescence: The Role of Body Image

Regularly eating breakfast and meals with family has important health implications for youth. However, the association between eating breakfast and family meals regularly with body image has not been explored. Utilizing the 2009-2010 World Health Organization's Health Behavior in School-Aged Children U.S. survey (N = 12,642), we sought to begin this conversation. Our findings suggest that eating breakfast and meals with parents more regularly may be related to more positive body image. This cross-sectional glance suggests that policies and programs that encourage youth and families to regularly eat breakfast and family meals may also encourage better body image among youth.

Access to the School Breakfast Program Is Associated with Higher Attendance and Test Scores among Elementary School Students

BACKGROUND

The School Breakfast Program (SBP) has grown and evolved substantially since its inception, yet relatively little is known about its impact on school engagement and academic outcomes.

OBJECTIVES

The purpose of this study is to estimate the impact of the SBP on school attendance and standardized test scores, as well as how impacts differ among student subpopulations and between traditional and nontraditional program models.

METHODS

The study uses administrative data from ∼1000 Wisconsin elementary schools during 2009-2014, including almost all public elementary schools in the state except those in Milwaukee Public School District. Over the 5-y period, 168 schools in our sample introduced a new SBP and/or changed the location of breakfast (classroom or cafeteria) or the payment structure. The impact of breakfast availability and type was evaluated using multivariable regression models with school fixed effects and extensive demographic controls, leveraging within-school changes in SBP availability and type.

RESULTS

Implementing the SBP was associated with a 3.5-percentage-point reduction in the percentage of students with low attendance and an increase of 0.08 SD in normalized reading scores among likely-participant boys (P = 0.015), with no impact among girls. When breakfast was offered free to all students, the probability of low attendance was 3.5 percentage points lower than with traditional SBP for a broad cross-section of students (P < 0.001), and math and reading scores were 0.07 and 0.04 SD higher among the higher-income sample, respectively (P = 0.001 and P = 0.035, respectively). When breakfast was offered in the classroom, neither attendance nor reading scores differed relative to cafeteria-based SBP, whereas math scores among likely-participant boys were 0.05 SD lower (P = 0.045).

CONCLUSIONS

Offering breakfast at school can modestly improve educational engagement and performance, but benefits differ across children and by program structure. Universally free breakfast appears particularly beneficial to both attendance and test scores.

School Health as a Strategy to Improve Both Public Health and Education

Because schools materially influence both health and education, they substantially determine the future well-being and economic productivity of populations. Recent research suggests that healthier children learn better and that more educated adults are healthier. School health is a cross-disciplinary field of study and a fundamental strategy that can be used to improve both health and education outcomes. Modern school health programs include 10 interactive components: health education; physical education and physical activity; nutrition environment and services; health services; counseling, psychological, and social services; physical environment; social and emotional climate; family engagement; community involvement; and employee wellness. This review is written for both health and education audiences. It integrates recent research and developments in relationships among health, education, and economic outcomes; health and education systems; the school health program, its components, and their effectiveness; cross-disciplinary collaboration; local, state, national, and international infrastructures and strategies; implementation science; and relevant academic research, training, and service.

Hunger in Higher Education: Experiences and Correlates of Food Insecurity among Wisconsin Undergraduates from Low-Income Families

There is growing awareness that a substantial share of undergraduates are food insecure, potentially undermining investments in higher education and hindering upward social mobility. This mixed-methods paper uses survey and interview data from low-income students at 42 public colleges and universities in Wisconsin to illuminate the day-to-day experiences of food insecurity and examine how food security status varies across background characteristics. Results indicate that students who grew up in food insecure homes, self-identify as a racial/ethnic minority, live off-campus, and attend college in an urban area are significantly more likely to report the lowest level of food security, often associated with hunger. Students explain that challenges stemming from the interrelationship of lack of time and inadequate money are their biggest barriers to food security. Most rely on friends or family for support, but few students draw on the social safety net, in part due to eligibility restrictions. In recognition of the diversity of students’ experiences, we discuss the need for a multi-faceted response to promote food security and student success.

Position of the Academy of Nutrition and Dietetics: Child and Adolescent Federally Funded Nutrition Assistance Programs

It is the position of the Academy of Nutrition and Dietetics that children and adolescents should have access to safe and healthy foods that promote physical, cognitive, and social growth and development. Federally funded nutrition assistance programs, such as food assistance, meal service, and nutrition education, play a vital role in ensuring that children and adolescents have access to the foods they need and in improving the overall nutrition and health environments of communities. Federally funded nutrition assistance programs help to ensure that children and adolescents receive safe, healthy foods that provide adequate energy and nutrients to meet their growth and development needs. These programs provide access to adequate food supplies to combat hunger and food insecurity; provide healthy foods to children and adolescents who have nutritional or medical risk factors, such as iron deficiency anemia; and provide nutrition education. In addition, federally funded nutrition assistance programs serve as a means to prevent or reduce obesity and other chronic diseases. It is important that permanent and full federal funding be provided for these programs, which have been consistently shown to have a positive impact on child and adolescent nutrition and health outcomes. Registered dietitian nutritionists and nutrition and dietetic technicians, registered-trained in food science, nutrition, and food systems to implement programs to monitor, evaluate, and improve the nutritional status of children and adolescents-are preeminently qualified to implement and evaluate nutrition assistance programs for children and adolescents.

Fit "N" Cool Kids: The Effects of Character Modeling and Goal Setting on Children's Physical Activity and Fruit and Vegetable Consumption

Efforts to decrease the risk of overweight and obesity should focus on children's physical activity (PA) and fruit and vegetable (FV) consumption. Within school-based interventions, there is insufficient evidence on the effectiveness of the use of character modeling and goal setting to determine changes in step counts, MVPA, and FV consumption. Study participants were 187 students in grades 4 and 5 from 2 Title 1 elementary schools in the Southwest United States. The intervention was a quasi-experimental character modeling and goal setting program. New Lifestyles NL-1000 activity monitors were used to assess number of steps taken and MVPA by the participants. Fruit and vegetable consumption was measured by direct observation. School day steps, MVPA, and FV consumption were recorded at baseline, intervention, and during a 10-week follow-up. There were not differences between groups at baseline. Steps and MVPA were statistically significantly (P < .05; Δ = ~2500 steps and ~5 minutes of MVPA) greater in the intervention compared with the control group over time. Fruit and vegetable consumption was not significantly (P = .308) greater in the intervention compared with the control group over time. Students in the intervention school were significantly more active than students in the control school during the intervention phase and at follow-up. The findings reported here would suggest that character modeling and goal setting can increase PA among elementary aged children but did not increase FV consumption.

Maternal Sociodemographic Characteristics and Behaviors as Correlates of Preadolescent's Breakfast Habits

PURPOSE

To explore factors affecting skipping breakfast rate, and to identify its perceived reasons among preadolescent students and their mothers in Jordan.

DESIGN AND METHODS

Using cluster stratified sampling, preadolescent (10-11years) students (N=1915) and their mothers (N=1299) from 26 public and private schools completed a self-reported questionnaire. Breakfast skipping and its related habits were described. Children's and mothers' perceptions of regular breakfast eating and sociodemographic factors were analyzed in relation to breakfast skipping in children.

RESULTS

Although the majority of both children and mothers perceived breakfast as very important, 23% of the children and mothers reported skipping breakfast. Male students skipped breakfast more than female students. Students whose mothers had a low level of education and students with a low value of breakfast consumption had a higher likelihood of skipping breakfast. Mothers' high value of breakfast and encouragement of children to eat breakfast were directly related to an increase in children's perceived importance of breakfast consumption. Preadolescents' and mothers' perceptions of the importance of breakfast and mothers' encouragement to eat breakfast were significant predictors of breakfast consumption among students.

CONCLUSION

The high prevalence of breakfast skipping among students, and knowledge about association between mothers' perceived importance of breakfast consumption and encouragement highlighted the pivotal role of mothers in preadolescent's breakfast consumption.

PRACTICAL IMPLICATIONS

The findings suggest that health care providers, including school health practitioners, are recommended to assess children's and mothers' perceived value of breakfast and to include mothers in health promotion interventions on breakfast consumption.

The Relationship between the School Breakfast Program and Food Insecurity

Food insecurity rates have risen significantly in the United States beginning with the recent recession and remained high. The implications of these high rates are severe in that food insecurity has been associated with a wide range of health, behavioral, social and cognitive difficulties. This paper examines the relationship between the School Breakfast Program (SBP) and food insecurity outcomes. The SBP has the potential to reduce food insecurity because of the direct provision of breakfast to students and the implied income transfer to households. We use state-level cutoffs tied to school-level poverty rates that mandate the provision of the SBP to compare the food security outcomes of students in similar schools, but with different requirements to provide breakfast. Our estimates suggest that state policies requiring schools to offer the SBP have reduced food insecurity for young children.

Understanding Perceptions of School Administrators Related to School Breakfast in a Low School Breakfast Participation State

BACKGROUND

The National School Breakfast Program (SBP) is a federally funded program that allows states to offer nutritious breakfast to K-12 students. However, rates of SBP participation are low in some rural states, and the reasons are not well understood. The purpose of the study was to explore administrators' perceptions, attitudes, and beliefs related to the SBP, and factors they identify as barriers or facilitators to increased participation.

METHODS

Data were collected from a cross-sectional, online survey of K-12 school administrators (N = 152) in a rural, midsized Midwestern state fielded over an academic year. Descriptive statistics were calculated and open-ended questions were coded and analyzed for relevant themes.

RESULTS

Administrators identified busing schedules, time constraints, and a lack of flexibility within the school schedule to accommodate breakfast as primary structural barriers to SBP participation. Administrators described family-centered norms as reasons for low participation in rural areas. Administrators are at varying stages of readiness to work on improving participation.

CONCLUSIONS

Low SBP participation can be explained in part by a convergence of factors related to access, community norms, and structural barriers. Results may be used to inform ways in which administrators at the state, district, and school level can work to increase participation.

The Effect of Breakfast in the Classroom on Obesity and Academic Performance: Evidence from New York City

Participation in the federally subsidized school breakfast program often falls well below its lunchtime counterpart. To increase take-up, many districts have implemented Breakfast in the Classroom (BIC), offering breakfast directly to students at the start of the school day. Beyond increasing participation, advocates claim BIC improves academic performance, attendance, and engagement. Others caution BIC has deleterious effects on child weight. We use the implementation of BIC in New York City (NYC) to estimate its impact on meals program participation, body mass index (BMI), achievement, and attendance. While we find large effects on participation, our findings provide no evidence of hoped-for gains in academic performance, or of feared increases in obesity. The policy case for BIC will depend upon reductions in hunger and food insecurity for disadvantaged children, or its longer-term effects.

School Breakfast Receipt and Obesity among American Fifth- and Eighth-Graders

BACKGROUND

School breakfast consumption can improve children's nutrition, but the implications of breakfast at school for children's weight remains unclear.

OBJECTIVE

The aim of this study was to determine whether receiving breakfast at school is related to changes in children's weight between the fifth and eighth grades, and whether the relationship between school breakfasts and obesity varies for children of different socioeconomic backgrounds.

DESIGN

This was a longitudinal study of children observed in the fifth and eighth grades.

PARTICIPANTS

Data are from the Early Childhood Longitudinal Study, Kindergarten Class of 1998-99, a nationally representative prospective cohort of children in the United States. The analytic sample consisted of 6,495 children interviewed in the fifth and eighth grades.

MAIN OUTCOME MEASURE

Standard thresholds from the Centers for Disease Control and Prevention were used to classify children as not obese or obese based on direct-measured height and weight.

STATISTICAL ANALYSES PERFORMED

Difference-in-difference propensity score matching and fixed-effect logistic regression models were used to estimate the relationship between receipt of school breakfast and change in obesity between the fifth and eighth grades, adjusting for child, household, and school characteristics.

RESULTS

School breakfast receipt was not associated with a change in obesity status between the fifth and eighth grades for children overall (odds ratio=1.31; P=0.129). In the propensity score model, receiving school breakfasts more than doubled the odds of becoming obese (odds ratio=2.31; P=0.0108) for children from families below the federal poverty line compared with children of similar socioeconomic backgrounds who did not regularly receive school breakfasts.

CONCLUSIONS

School breakfast receipt was not independently related to obesity for most children. Receiving school breakfasts in the fifth grade may be associated with weight gain between the fifth and eighth grades for children from families below the federal poverty line compared with children of similar socioeconomic status who did not receive breakfasts.