Effects of a free school breakfast programme on children's attendance, academic achievement and short-term hunger: results from a stepped-wedge, cluster randomised controlled trial
- Cliona Ni Mhurchu1,
- Delvina Gorton1,
- Maria Turley1,
- Yannan Jiang1,
- Jo Michie1,
- Ralph Maddison1,
- John Hattie2
- 1Clinical Trials Research Unit, School of Population Health, University of Auckland, Auckland, New Zealand
- 2Teaching Learning and Development, Faculty of Education, University of Auckland, Auckland, New Zealand
- Correspondence to Associate Professor Cliona Ni Mhurchu, Clinical Trials Research Unit, School of Population Health, University of Auckland, Private Bag 92019, Auckland Mail Centre, Auckland 1142, New Zealand;
Contributors Principal responsibility for study design was assumed by DG, YJ, RM and CNM. DG, JM and MT developed the study protocol and materials. DG was the principal investigator from July to October 2009. MT was the principal investigator from November 2009 to August 2010. JH had substantial input into study design and oversight. JM was responsible for day-to-day study management. YJ was responsible for all aspects of statistical design and analysis. CNM was the principal investigator from August 2009 onwards and drafted the study manuscript integrating contributions from all coauthors. All authors approved the final manuscript. CNM had full access to all data in the study and takes responsibility for integrity of the data and the accuracy of the data analysis.
- Accepted 11 August 2012
- Published Online First 6 October 2012
Background Free school breakfast programmes (SBPs) exist in a number of high-income countries, but their effects on educational outcomes have rarely been evaluated in randomised controlled trials.
Methods A 1-year stepped-wedge, cluster randomised controlled trial was undertaken in 14 New Zealand schools in low socioeconomic resource areas. Participants were 424 children, mean age 9±2 years, 53% female. The intervention was a free daily SBP. The primary outcome was children's school attendance. Secondary outcomes were academic achievement, self-reported grades, sense of belonging at school, behaviour, short-term hunger, breakfast habits and food security.
Results There was no statistically significant effect of the breakfast programme on children's school attendance. The odds of children achieving an attendance rate <95% was 0.76 (95% CI 0.56 to 1.02) during the intervention phase and 0.93 (95% CI 0.67 to 1.31) during the control phase, giving an OR of 0.81 (95% CI 0.59 to 1.11), p=0.19. There was a significant decrease in children's self-reported short-term hunger during the intervention phase compared with the control phase, demonstrated by an increase of 8.6 units on the Freddy satiety scale (95% CI 3.4 to 13.7, p=0.001). There were no effects of the intervention on any other outcome.
Conclusions A free SBP did not have a significant effect on children's school attendance or academic achievement but had significant positive effects on children's short-term satiety ratings. More frequent programme attendance may be required to influence school attendance and academic achievement.
Trial registration Australian New Zealand Clinical Trials Registry (ANZCTR)—ACTRN12609000854235.
- randomised controlled trial
- child health
- public health
- randomised trials
Funding The study was funded by the Health Research Council of New Zealand (09/337). CNM holds the National Heart Foundation Senior Fellowship (grant 1380). The Health Research Council and the Heart Foundation played no role in design and conduct of the study; collection, management, analysis and interpretation of the data; or preparation, review or approval of the manuscript. Food for the Red Cross Breakfast in Schools programme was provided free of charge by Countdown supermarkets (Progressive Enterprises Ltd). Fonterra Co-operative Group Limited and Sanitarium Health Food Company supplemented provision of foods for the private sector programme. The Red Cross, Countdown, Fonterra and Sanitarium played no role in design and conduct of the study; collection, management, analysis and interpretation of the data; and preparation or approval of the manuscript.
Competing interests None.
Patient consent Both child assent and parental consent were obtained for each participant.
Ethics approval The ethics approval was provided by the Northern Y Regional Ethics Committee (Reference: NTY/09/09/084).
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement Any additional unpublished data can be made available to academic researchers on request.
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