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
Ni Mhurchu C, Gorton D, Turley M, Jiang Y, Michie J, Maddison R, Hattie J · 2013
grade Brctindependentunreplicated
Sample
14 schools, 424 children, mean age 9 (SD 2), 53% female
Population
New Zealand primary schoolchildren in low socioeconomic-resource areas. A high-income country with real food insecurity at the margin but not clinical undernutrition.
Design
One-year stepped-wedge cluster randomised controlled trial of a free daily school breakfast programme versus no programme - i.e. the true breakfast-vs-no-breakfast contrast, unlike the in-class-vs-cafeteria trials. Primary outcome prespecified as school attendance. Secondary outcomes included academic achievement, self-reported grades, sense of belonging, behaviour, short-term hunger, breakfast habits, food security. Authors note actual programme attendance was low, which limits the effective dose delivered.
Key findings
No statistically significant effect on school attendance (OR 0.81, 95% CI 0.59 to 1.11, p = 0.19) and no effect on academic achievement or any other outcome except short-term satiety, which improved by 8.6 units on the Freddy satiety scale (95% CI 3.4 to 13.7, p = 0.001). The programme successfully made children less hungry and did not move any educational outcome.
Genetic confound
None for internal validity - schools were randomised. Parental traits cannot select into the programme arm.
Effects
| Outcome | Metric | Value | Measure | Timing | Vs | Horizon | Class |
|---|---|---|---|---|---|---|---|
| School attendance (behavioral) | OR of attendance rate <95% | 0.81 (95% CI 0.59 to 1.11), p = 0.19 - null | standardized | 12 months | business-as-usual | end-of-treatment | behaviour |
| Academic achievement (domain skills) | standardised achievement | no significant effect | standardized | 12 months | business-as-usual | end-of-treatment | domain-skill |
| Short-term hunger (proximal target) | Freddy satiety scale units | +8.6 (95% CI 3.4 to 13.7), p = 0.001 | researcher-designed | same morning, during intervention phase | business-as-usual | end-of-treatment | health |
Cited by
- Breakfast, school meals, and micronutrients — what feeding children actually buysmixedconf: mediumgc: low