School breakfast program and school performance meyers

Further study of this question is indicated, using prospective control designs as well as data regarding protein, fat and carbohydrate content of the meals. Conners has reported beneficial effects on behavior and learning of a sugar load following a protein breakfast whereas adverse effects were noted with sugar alone. Personal communication. School Breakfast Program and school performance.

Millichap, J. School Breakfast Program and School Performance. Pediatric Neurology Briefs , 3 10 , pp. Millichap JG. Pre-post test. High rate of off-task behavior at baseline. Increase in on-task behavior post SBP compared to baseline.

Low SES. Behavior coded: on-task. Two conditions: Teacher led in-class SBP. Fruit juice, milk, English muffins, blueberry muffins, bagels, cream cheese, eggs, toast, hot cakes No SBP In-class observation conducted by teacher in academic and vocational setting.

Increase in on-task behavior at follow up compared with baseline in both vocational and academic setting. Acceptable Inter-rater reliability in both settings.

Decrease in subjective ratings of ability to stay on-task at follow up. Subjective ratings of ability to stay on task. Primary school children UK. Three conditions, 4-week SBP. No significant effect of BF on other behavior. Low SES school. Cueto and Chinen SBP evaluation. Multiple and full grade schools.

Reduction in time spent in classroom indicative of on-task behavior in intervention schools. Increased time spent in recess following SBP. Male: Wender and Solanto RM randomized acute experimental study. Lab based USA. Two conditions. Behavior coded: Aggression, hitting, kicking throwing. Good periodic inter-rater reliability. No effects of BF on aggression. Benton and Jarvis RM, randomized acute experimental study. Mean age: 9 years 4 months. Behavior coded: on-task, distracted, disruptive, interacting with teacher, out of chair.

Categories collapsed into on-task or off-task behavior. Proportion of children eligible for FSM or reduced priced meals: Teachers perceived positive impact of SBP on social behavior and readiness to learn compared with pre intervention. Teacher reported increase attention and concentration following SBP. Decrease in discipline referrals following SBP. Behavior assessed: Readiness to learn and social behavior. Number of discipline referrals.

Overby and Hoigaard Cross-sectional survey study. Four secondary schools Norway. Questionnaire, 1 item to measure BF. Score range: 4— Higher scores indicating poorer behavior. Total scores dichotomized into two categories: No behavioral problems: 4—11 Behavioral problems: 12—20 Frequent breakfast consumption significantly associated with decreased odds of behavior problems AOR: 0. Free SBP. Considered nutritionally balanced including milk, RTEC, bread, muffin, fruit, juice.

Significantly greater decreases in hyperactivity scores in children who increased participation in SBP post intervention compared with children who had not changed SBP participation. Ni Mhurchu et al. SBP evaluation. No significant effect of SBP on behavior vs. Proportion of children eating BF everyday did not change. Decrease in proportion of children eating BF at home, increase in proportion of children eating BF at school.

Low SES schools. Primary schools UK. Teacher completed behavior assessment on sub-sample of 5 pupils in 2 year groups. Classroom behavior rated. No difference in classroom behavior in intervention vs. Teachers completed questionnaire for primary school children. Self-report version for secondary school children. Adjusted for school type, gender, FSM status. For analysis of behavior, children classified as: Non-attendees: Never attended Attendees: Attended at least once O'Sullivan et al.

The Western Australian Pregnancy cohort study. Three-day food diary. BF intake classified based on 5 core food groups defined by AGHE: Bread and cereals, vegetables, fruit, dairy, and dairy alternatives, meat, and meat alternatives.

Increase in BF quality associated with decrease in internalizing behavior score and a decrease in externalizing behavior scores. Increase in BF quality associated with decrease in total child behavior score. Stepwise decrease in total score with increasing breakfast quality. Adjusted for: PA, sedentary behavior, weight status, family income, maternal education, maternal age of conception, family structure, family functioning.

Data collection in five waves: preschool , grade 1 , grade 3 , grade 5 , grade 8. Parental questionnaire, 1 item to assess family BF frequency. No significant association between frequency of family BF and behavior. Fixed effects model results used as provides most unbiased estimates: account for all controls and eliminates between-subject variation. Extensive controls: Gender, ethnicity, family SES, parental education, family income, parental job prestige, family structure, area of residence, language, maternal employment during preschool, birth weight, teaching quality, school quality, region of residence, parental working hours, single parent family.

Externalizing subscale behavior coded: arguing, fighting, angry, impulsivity, disturbed activities, talked during quiet study. Internalizing subscale behavior coded: anxious, lonely, sad, low self-esteem. Teachers rated behavior until grade 5. Children completed scales at grade 8. Acceptable to good reliability on both scales. Open in a separate window. Observations of behavior in the classroom Direct measures of classroom behavior were utilized in 11 studies.

Rating scales and questionnaires Twelve studies utilized teacher completed rating scales to assess children's behavior at school following breakfast. Table 2 Tabulation of studies investigating the effects of breakfast on academic performance in children and adolescents. Questionnaire, 1-item to assess BF frequency.

Adjusted for: parental education, family structure, immigrant status, smoking, dieting, soft drink consumption. Grade scale: 1 lowest to 6 highest. So Cross-sectional survey study. Korea Youth Risk Behavior Web-based survey. Internet questionnaire, 1-item to assess BF frequency. AOR males: 1. Children who increased their SBP participation were significantly more likely to increase mathematics grades compared to those who had decreased or unchanged participation.

No effects of SBP on other grades. Kleinman et al. Two conditions, SBP. Rahmani et al. Girls had significantly higher average grade point following intervention compared with control. Girls were significantly higher in weight following intervention compared with control.

Medium SES. Questionnaire to assess BF eating frequency and type. BF defined as first eating occasion during the morning before school. Regular BF significantly predicted total average grade. Composition of breakfast not reported Total average grade and individual subject grades used in analysis.

Regular BF and education of mother predicted English grades. Regular breakfast, type of family and height for age significantly predicted science grades. No association between BF and mathematics grades. Physical education, biology, and languages grades were highest in no BF group compared with full and food quality BF groups.

Total average grade calculated. Boschloo et al. Questionnaire, 1-item to assess BF frequency on school days. Attention problems partially mediated the relationship between BF skipping and school performance. Adjusted for: age, sex, educational track, parental education.

Grade range: 1 very bad to 10 outstanding All children in advanced educational tracks in secondary schools. Kim et al. FFQ and dietary behavior questionnaire.

Scores range from 1—5 obtained from school records Korean Mathematics Social Studies Science Physical education Music Art Practical course Ethics English grade 8 and 11 Regular BF associated with higher average grade in 10—11 years old boys, higher average grade in 13—14 years old boys and girls and higher average grade 16—17 years old boys and girls.

Adjusted for: parental education, physical fitness, physical status. Herrero Lozano and Fillat Ballesteros Cross-sectional survey study. Recall BF of previous day 1 day only. BF intake classified as: Good quality: 3 food groups of dairy, cereals and fruit Improvable quality: Missing one of the food groups Insufficient quality: Missing two food groups Poor quality: No BF Average end of year grade.

Significantly higher average grades obtained in good quality BF groups compared with poor quality. Average grade increased when good quality snack was eaten in poor and insufficient BF quality groups. No significant effect of SBP in full grade schools. No association between BF alone and test scores. Adjusted for household size, mothers education, land quantity owned, school attendance, gender head of household, feeding habits, age, household wealth.

Powell et al. No effects of BF on spelling and reading. No differential effects by nutritional group. Simeon Study 1 SBP evaluation. BF at h. Children receiving school BF performed better on arithmetic test relative to control group post intervention. Wahlstrom and Begalle SBP evaluation. Mathematics Reading Within school effects pre-post intervention show general increase in scores for reading and mathematics.

Jacoby et al. Meyers et al. Language Reading Mathematics Lower total scores at baseline in non-attendees. Greater increase in total and language scores in attendees compared with non-attendees.

SBP attendance positively associated with total scores at follow up. School selected food: Low sugar RTEC, low-fat milk, bread, spreads honey, jam, margarine , chocolate flavored milk powder, and sugar Control: No SBP Standardized school achievement tests: Literacy Numeracy No significant effects on achievement tests, self-report reading ability and attendance.

Self-report assessment of reading ability using questionnaire. Scores from 1 not very well to 5 very well. Regression analysis indicated BF intake was significantly associated with mean MAP mathematics scores. Lopez-Sobaler et al. Weighed 7-day food diary. Better quality breakfast significantly predicated better reasoning and total scores. Direct scores, centile scores, and IQ score obtained.

O'Dea and Mugridge Cross-sectional survey study. Questionnaire and interview with dietitian. BF defined as solid or liquid eaten before h on day of testing.

BF intake classified as: 0. Non-significant association between BF and numeracy scores. Few children skipped BF. Adjusted for: age, gender, SES, maternal education. Fixed effects model results used as provides most unbiased estimates: accounts for all controls and eliminates between subject variations.

Extensive controls. Adjusted for: Gender, ethnicity, family SES, parental education, family income, parental job prestige, family structure, area of residence, language, maternal employment during preschool, birth weight, teaching quality, school quality, region of residence, parental working hours, single parent family. Average school grades Ten studies examined the effects of breakfast on average school grades.

Standardized achievement tests Age specific standardized achievement tests are routinely administered by schools in developed countries for monitoring and provide an overall indication of intellectual level. Discussion The effects of breakfast on behavior Overview of findings This review identified 19 studies that examined the effects of breakfast on behavior in children and adolescents of which 11 studies demonstrated a positive effect of breakfast on behavior.

Methodological issues Behavioral measures. The effect of breakfast on academic performance Overview of findings This review identified 21 studies that demonstrated suggestive evidence that habitual breakfast frequency and quality and SBPs are associated with children and adolescents' academic performance. Methodological issues Influence of confounders. Conflict of interest statement Katie Adolphus declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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Validity of reported energy intake in preadolescent girls. The role of breakfast and a mid-morning snack on the ability of children to concentrate at school. The influence of the glycaemic load of breakfast on the behaviour of children in school. The relation between breakfast skipping and school performance in adolescents. Mind Brain Educ. Ingesting breakfast meals of different glycaemic load does not alter cognition and satiety in children.

The effects on an in class breakfast program on attendance and on task behaviour of high school students. Child Fam. Effects of a breakfast program on on-task behaviors of vocational high school students. The effects of poverty on children. Future Child. Effects of breakfast on classroom behaviour in rural Jamaican schoolchildren.

Changes in regional cerebral blood flow during brain maturation in children and adolescents. A critical period of brain development: studies of cerebral glucose utilization with PET. Breakfast consumption and cognitive function in adolescent schoolchildren. Breakfast glycaemic index and cognitive function in adolescent school children.

Breakfast consumption and physical activity in British adolescents. Educational impact of a school breakfast programme in rural Peru. Breakfast prevents delays of attention and memory functions among nutritionally at-risk boys. Does regular breakfast cereal consumption help children and adolescents stay slimmer? A systematic review and meta-analysis. Facts 6 , 70—85 Health 39 , — The relationship of breakfast skipping and type of breakfast consumption with nutrient intake and weight status in children and adolescents: the National Health and Nutrition Examination Survey Socio-economic differences in adolescents' breakfast eating, fruit and vegetable consumption and physical activity in Ghana.

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Breakfast eating habit and its influence on attention-concentration, immediate memory and school achievement. Indian Pediatr. A review of studies on the effect of iron deficiency on cognitive development in children. Micronutrient intakes, micronutrient status and lipid profiles among young people consuming different amounts of breakfast cereals: further analysis of data from the National Diet and Nutrition Survey of Young People aged 4 to 18 years.

School lunch and learning behaviour in primary schools: an intervention study. Immigrant families' perceptions on walking to school and school breakfast: a focus group study. Methods to improve reliability of video-recorded behavioral aata. Health 32 , — Breakfast habits and factors influencing food choices at breakfast in relation to socio-demographic and family factors among European adolescents. Appetite 56 , — A study on breakfast and school performance in a group of adolescents.

A systematic review of the effect of breakfast on the cognitive performance of children and adolescents. Breakfast consumption in UK schoolchildren and provision of school breakfast clubs. A low glycaemic index breakfast cereal preferentially prevents children's cognitive performance from declining throughout the morning. Appetite 49 , — Benefits of a school breakfast programme among Andean children in Huaraz, Peru.

Behavioural effects of dietary sucrose in disturbed children. An adaptation of the nitrous oxide method to the study of the cerebral circulation in children - normal values for cerebral blood flow and cerebral metabolic rate in childhood. Academic performance of Korean children is associated with dietary behaviours and physical status.

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School breakfast program and school performance. Glycaemic index and glycaemic load of breakfast predict cognitive function and mood in school children: a randomised controlled trial.

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School breakfast and cognition among nutritionally at-risk children in the Peruvian Andes. Nutrition and education: a randomized trial of the effects of breakfast in rural primary school children. Effects of daily milk supplementation on improving the physical and mental function as well as school performance among children: results from a school feeding program.

It has been argued that increasing school breakfast participation among underserved children is especially important given their increased risks of skipping breakfast and negative outcomes across developmental domains 10 , 16 and evidence suggesting that breakfast's benefits may be greatest among these children.

Findings differed in a large experimental evaluation of the School Breakfast Pilot Program, in which universal-free school breakfast was provided to treatment group schools via varying delivery models. Observed effects of school breakfast may have been greater if group differences in participation in the SBP had been larger in these studies.

The drastic increases in participation in the SBP that accompany the BIC program also mean that this delivery model expands the reach of the SBP to students who are otherwise unlikely to participate. Systematic studies of the effects of the BIC program are needed to understand the implications of these possibilities, especially given that the implementation of the BIC program is ongoing in many large US school districts. Although one study 20 found academic impacts of the BIC program, most larger studies 13 , 14 of the impact of the SBP have included a mixture of delivery models.

The aim of this study was to examine school breakfast participation, school attendance, and academic achievement in elementary schools with vs without a BIC program in a large urban school district. These research questions can add to the evidence base on school breakfast and inform future efforts to study and expand the SBP. Study procedures were approved by the Tufts University Institutional Review Board and by the large urban school district under study.

No individual consent was required for this analysis of aggregate-level, deidentified data. The sample consisted of public elementary schools within one large urban US school district. Of these schools, School- and grade-level data in , as well as grade-level achievement data from the prior year, were collected from school district records across the elementary schools. Analyses included all elementary schools except for those examining participation in the SBP participation data were available for elementary schools.

Most study schools included kindergarten through fifth grade; one-quarter also included sixth grade. Participation in the SBP was calculated for each month of the academic year at the school level by dividing average daily breakfast meal counts by total student enrollment. Grade level nested within schools served as the identification variable in models that examined attendance, with kindergarten through sixth grade included.

Achievement was measured yearly via state standardized tests. Data were available at the grade level in spring and spring Percentages of students in each grade who achieved state benchmarks in reading and math were used to indicate academic achievement. Grade level nested within schools served as the identification variable in models that examined achievement, with second through sixth grade included because these were the grades in which standardized tests were administered.

In addition, indicators of whether schools were pilot schools that implemented the BIC program before and whether they were participating in a technology initiative were collected 3. Analyses were conducted with SAS statistical software, version 9.

Propensity score weighting was used to facilitate causal inferences about the impacts of the BIC program on school breakfast participation, school attendance, and academic achievement. All available school-level variables were tested for association with the grouping variable the BIC vs non-BIC schools and outcomes of interest. Variables that were associated with both ie, potential confounders were included in the propensity score model.

The propensity score model, with the BIC group as the outcome and these 13 variables as predictors, was estimated using logistic regression. Generalized linear mixed models were used to estimate the impact of the BIC program on outcomes of interest given the multilevel data.

Models contained a random statement with the residual option and subject variable specified school identification for the participation outcome; grade level nested within school for other outcomes and with month specified when there were repeated measures participation and attendance outcomes. For repeated-measures models, multiple covariance structures were tested eg, compound symmetry and unstructured , and the best-fitting model was selected. Final models included generalized linear mixed models that estimated the impacts of the BIC program on school breakfast participation and school attendance over 10 months August to June , adjusting for school-level propensity score weights, with the BIC group, month, and interaction as predictors.

Final attendance analyses were repeated in the subset of grade levels for which achievement data were available second through sixth grades. Models that estimated the impact of the BIC program on math and reading achievement in spring were also conducted, adjusting for the propensity score weights, and significant BIC group differences in least squares means were examined.

Alternate analyses specifying a random intercept for schools in grade-level models were explored to examine robustness of the results. Initially, the BIC and non-BIC schools differed on measured covariates, as indicated by the unadjusted mean differences.

Adjusting for propensity score weights balanced the groups on these covariates Table. There was a significant main effect of BIC on attendance, such that grade-level attendance rates were higher for the BIC schools compared with grade-level attendance rates in the non-BIC schools across the academic year As shown in Figure 3 , there were no significant main effects of the BIC program on grade-level math The goal of the current study was to draw causal inferences about the impacts of the BIC program on participation in the SBP, school attendance, and academic achievement in a large urban school district, in which approximately half of elementary schools offered the BIC program during Although findings that the BIC program increased participation in the SBP were not surprising, they provide confirmation that school breakfast exposure differed between the study groups.

These findings also add to the evidence that the BIC program has the potential to increase participation in the SBP more than other delivery models, supporting the idea that the impact of this manipulation may be greater than those seen in previous studies of the SBP. Therefore, we estimated the impacts of the BIC program on school attendance and achievement, finding that attendance was higher in the BIC group across the academic year compared with the non-BIC group.

These findings parallel research reporting that the SBP is associated with increased attendance, 5 , 10 although some previous research examining this outcome has produced null results. Results were also similar in the subset of grade levels for which achievement data were available, although the BIC vs non-BIC group comparisons did not reach significance at every month in this follow-up analysis.

These results may be attributable to smaller sample sizes in subset analyses. Associations between the SBP and increased attendance have been discussed as a potential mechanism through which breakfast may benefit academic achievement. One interpretation of this result is that, despite concerns about potential decreased instructional time, 20 there were no negative impacts of the BIC program on achievement. However, the achievement results should be interpreted with caution for multiple reasons.

Although the participation and attendance results were robust to various model specifications tested, including alternate attendance models specifying random intercepts for schools, the achievement results were not. Furthermore, only one time point of achievement outcome data was available, and at the time of standardized testing, the BIC program had been recently implemented in some schools. It is possible that increased attendance may translate into increased academic performance during a longer period or using different measures of achievement.

Standardized test scores may not reflect the BIC impacts if there are district-wide efforts to promote school meal consumption on testing days, which is a common practice nationwide.

Strengths of the current study include its specific focus on the timely BIC delivery model, as well as the use of propensity score methods to facilitate causal inferences. In addition, data were obtained directly from the school district and were available over multiple time points and, in most cases, by grade level.

Limitations of the study include the inability to examine actual consumption of school breakfast or broader dietary patterns and the possibility that there are additional unmeasured covariates that should be considered, such as mobility rates. In addition, these data do not allow examination of outcomes at the individual level, and results cannot be generalized beyond the current delivery model, sample characteristics, and outcomes.

Our study did not include measures of physical health, dietary intake, physical activity, or weight status. These outcomes will be important to measure to determine the impacts of the BIC program on the whole child. In one study, 29 it was suggested that the BIC program may have an undesirable impact on weight outcomes through the increased likelihood of consuming 2 breakfasts, but total daily energy intake was not measured.

At this time, the impact of the BIC program on energy balance is an open and important question. The current study contributes evidence about school outcomes after implementation of the BIC program in a large urban school district with a substantial proportion of underserved children.

Results confirm that the BIC program can increase school breakfast participation rates drastically and highlight potential positive impacts on school attendance, as well as the absence of negative impacts on academic achievement.

Additional research is needed to examine impacts on academic achievement across different demographics and for longer periods and on outcomes in other domains, such as energy balance. Continuing the expansion of this evidence base can inform policy decisions and promote the health and well-being of the whole child.