Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ASCO Annual Meeting 2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

2024 ASCO Annual Meeting

Keep up to date with all the top stories and latest evidence with our hub page, including official congress videos and expert takeaways.
ADVANCED SEARCH
Log in
Top
BMC Public Health
Published in: BMC Public Health 1/2010

Open Access 01-12-2010 | Study protocol

Effects of a free school breakfast programme on school attendance, achievement, psychosocial function, and nutrition: a stepped wedge cluster randomised trial

Authors: Cliona Ni Mhurchu, Maria Turley, Delvina Gorton, Yannan Jiang, Jo Michie, Ralph Maddison, John Hattie

Published in: BMC Public Health | Issue 1/2010

Login to get access

Abstract

Background

Approximately 55,000 children in New Zealand do not eat breakfast on any given day. Regular breakfast skipping has been associated with poor diets, higher body mass index, and adverse effects on children's behaviour and academic performance. Research suggests that regular breakfast consumption can improve academic performance, nutrition and behaviour. This paper describes the protocol for a stepped wedge cluster randomised trial of a free school breakfast programme. The aim of the trial is to determine the effects of the breakfast intervention on school attendance, achievement, psychosocial function, dietary habits and food security.

Methods/Design

Sixteen primary schools in the North Island of New Zealand will be randomised in a sequential stepped wedge design to a free before-school breakfast programme consisting of non-sugar coated breakfast cereal, milk products, and/or toast and spreads. Four hundred children aged 5-13 years (approximately 25 per school) will be recruited. Data collection will be undertaken once each school term over the 2010 school year (February to December). The primary trial outcome is school attendance, defined as the proportion of students achieving an attendance rate of 95% or higher. Secondary outcomes are academic achievement (literacy, numeracy, self-reported grades), sense of belonging at school, psychosocial function, dietary habits, and food security. A concurrent process evaluation seeks information on parents', schools' and providers' perspectives of the breakfast programme.

Discussion

This randomised controlled trial will provide robust evidence of the effects of a school breakfast programme on students' attendance, achievement and nutrition. Furthermore the study provides an excellent example of the feasibility and value of the stepped wedge trial design in evaluating pragmatic public health intervention programmes.

Trial Registration Number

Australian New Zealand Clinical Trials Registry (ANZCTR) - ACTRN12609000854235
Appendix
Available only for authorised users
Literature
1.
Adolescent Health Research Group: A health profile of New Zealand youth who attend secondary school. New Zealand Medical Journal. 2003, 116 (1171): U380-
2.
Ministry of Health: A Portrait of Health: Key Results of the 2006/07 New Zealand Health Survey. 2008, Wellington: Ministry of Health
3.
Utter J, Scragg R, Mhurchu CN, Schaaf D: At-home breakfast consumption among New Zealand children: associations with body mass index and related nutrition behaviors. Journal of the American Dietetic Association. 2007, 107 (4): 570-576. 10.1016/j.jada.2007.01.010.CrossRefPubMed
4.
Rampersaud G, Pereira M, Girard B, Adams J, Metzl J: Breakfast habits, nutritional status, body weight and academic performance in children and adolescents. Journal of the American Dietetic Association. 2005, 105: 743-760. 10.1016/j.jada.2005.02.007.CrossRefPubMed
5.
Pollitt E, Matthews R: Breakfast and cognition: an integrative summary. American Journal of Clinical Nutrition. 1998, 67 (suppl): 804S-813S.PubMed
6.
Grantham-McGregor SM: Can the provision of breakfast benefit school performance?. Food and Nutrition Bulletin. 2005, 26 (2): S144-S158.CrossRefPubMed
7.
Hoyland A, Dye L, Lawton CL: A systematic review of the effect of breakfast on the cognitive performance of children and adolescents. Nutrition Research Reviews. 2009, 22: 220-243. 10.1017/S0954422409990175.CrossRefPubMed
8.
Sandercock GRH, Voss C, Dye L: Associations between habitual school-day breakfast consumption, body mass index, physical activity and cardiorespiratory fitness in English schoolchildren. European Journal of Clinical Nutrition. 2010, 64: 1086-1092. 10.1038/ejcn.2010.145.CrossRefPubMed
9.
Wilson N, Parnell W, Wohlers M, Shirley P: Eating breakfast and its impact on children's daily diet. Nutrition & Dietetics. 2006, 63: 15-20.CrossRef
10.
Read M: Malnutrition, hunger, and behavior. II. Hunger, school feeding programs, and behavior. Journal of American Dietetic Association. 1973, 63 (4): 386-391.
11.
Scrimshaw N: Malnutrition, brain development, learning and behaviour. Nutrition Research. 1998, 18 (2): 351-379. 10.1016/S0271-5317(98)00027-X.CrossRef
12.
Worobey J, Worobey H: The impact of a two-year school breakfast program for preschool-aged children on their nutrient intake and pre-academic performance. Child Study Journal. 1999, 29: 113-131.
13.
Leslie J, Jamison T: Health and nutrition considerations in education planning 1. Educational consequences of health problems among school-age children. Food and Nutrition Bulletin. 1990, 12: 191-203.
14.
Defeyter MA, Graham PL, Walton J, Apicella T: Breakfast clubs: availability for British schoolchildren and the nutritional, social and academic benefits. Nutrition Bulletin. 2010, 35: 245-253. 10.1111/j.1467-3010.2010.01843.x.CrossRef
15.
Moore L, Moore GF, Tapper K, Lynch R, Desousa C, Hale J, Roberts C, Murphy S: Free breakfasts in schools: Design and conduct of a cluster randomised controlled trial of the Primary School Free Breakfast Initiative in Wales [ISRCTN18336527]. BMC Public Health. 2007, 7:
16.
Friedman BJ, Hurd-Crixell SL: Nutrient intake of children eating school breakfast. Journal of the American Dietetic Association. 1999, 99 (2): 219-221. 10.1016/S0002-8223(99)00052-8.CrossRefPubMed
17.
New Zealand Red Cross: Red Cross Breakfast in Schools: National Evaluation Report 2008. 2008, Wellington: New Zealand Red Cross
18.
Kristjansson E, Robinson V, Petticrew M, MacDonald B, Krasevec J, Janzen L, Greenhalgh T, Wells G, MacGowan J, Farmer A, et al: School feeding for improving the physical and psychosocial health of disadvantaged students. Cochrane Database of Systematic Reviews. 2007, CD004676-1
19.
Baker I, Elwood PC, Hughes J, Jones M, Moore F, Sweetnam PM: A randomized controlled trial of the effect of the provision of free school milk on the growth of children. Journal of Epidemiology and Community Health. 1980, 34: 31-34. 10.1136/jech.34.1.31.CrossRefPubMedPubMedCentral
20.
Shemilt I, Harvey I, Shepstone L, Swift L, Reading R, Mugford M, Belderson P, Norris N, Thoburn J, Robinson J: A national evaluation of school breakfast clubs: Evidence from a cluster randomized controlled trial and an observational analysis. Child: Care, Health and Development. 2004, 30 (5): 413-427. 10.1111/j.1365-2214.2004.00453.x.
21.
Brown C, Lilford RJ: The stepped wedge trial design: a systematic review. BMC Medical Research Methodology. 2006, 6 (54):
22.
Bandura A: Perceived self-efficacy in cognitive development and functioning. Educational Psychologist. 1993, 28 (2): 117-148. 10.1207/s15326985ep2802_3.CrossRef
23.
Marsh HW, Smith ID, Barnes J: Multidimensional self-concepts: relations with sex and academic achievement. Journal of Educational Psychology. 1985, 77 (5): 581-596. 10.1037/0022-0663.77.5.581.CrossRef
24.
Mabe PA, West SG: Validity of self-evaluation of ability: a review and meta-analysis. Journal of Applied Psychology. 1982, 67 (3): 280-296. 10.1037/0021-9010.67.3.280.CrossRef
25.
Willms J: Student engagement at school: a sense of belonging and participation. 2003, Organisation for Economic Cooperation and Development
26.
Goodman A, Goodman R: Strengths and difficulties questionnaire as a dimensional measure of child mental health. Journal of the American Academy of Child and Adolescent Psychiatry. 2009, 48 (4): 400-403. 10.1097/CHI.0b013e3181985068.CrossRefPubMed
27.
Hawes DJ, Dadds MR: Australian data and psychometric properties of the Strengths and Difficulties Questionnaire. Australian and New Zealand Journal of Psychiatry. 2004, 38: 644-651.CrossRefPubMed
28.
Keller K, Assur S, Torres M, Lofink H, Thornton J, Faith M, Kissileff H: Potential of an analog scaling device for measuring fullness in children: development and preliminary testing. Appetite. 2006, 47: 233-243. 10.1016/j.appet.2006.04.004.CrossRefPubMed
29.
Ministry of Health: NZ Food NZ Children: Key results of the 2002 National Children's Nutrition Survey. 2003, Wellington: Ministry of Health
30.
Kleinman R, Hall S, Green H, Korzec-Ramirez D, Patton K, Pagano M, Murphy J: Diet, breakfast, and academic performance in children. Annals of Nutrition & Metabolism. 2002, 46 (Suppl 1): 24-30.CrossRef
31.
Frongillo EA, Rauschenbach BS, Olson CM, Kendall A, Colmenares AG: Questionnaire-based measures are valid for the identification of rural households with hunger and food insecurity. Journal of Nutrition. 1997, 127 (5): 699-705.PubMed
32.
Tapper K, Murphy S, Moore L, Lynch R, Clark R: Evaluating the free school breakfast initiative in Wales: Methodological issues. British Food Journal. 2007, 109 (3): 206-215. 10.1108/00070700710732538.CrossRef
Metadata
Title
Effects of a free school breakfast programme on school attendance, achievement, psychosocial function, and nutrition: a stepped wedge cluster randomised trial
Authors
Cliona Ni Mhurchu
Maria Turley
Delvina Gorton
Yannan Jiang
Jo Michie
Ralph Maddison
John Hattie
Publication date
01-12-2010
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2010
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/1471-2458-10-738

Other articles of this Issue 1/2010

BMC Public Health 1/2010 Go to the issue

Research article

Effect of Improved access to Antiretroviral Therapy on clinical characteristics of patients enrolled in the HIV care and treatment clinic, at Muhimbili National Hospital (MNH), Dar es Salaam, Tanzania

Research article

Patterns of smoking and its association with psychosocial work conditions among blue-collar and service employees of hospitality venues in Shenyang, PR China

Debate

The Primary Care Practitioner and the diagnosis of occupational diseases

Research article

The impact of economic recession on maternal and infant mortality: lessons from history

Research article

Prejudice and misconceptions about tuberculosis and HIV in rural and urban communities in Ethiopia: a challenge for the TB/HIV control program

Research article

Estimating alcohol-related premature mortality in san francisco: use of population-attributable fractions from the global burden of disease study