Transcript In-Class Breakfast: Impact on Breakfast Skipping and Eating in Multiple Locations G.

In-Class Breakfast: Impact on Breakfast Skipping and Eating in Multiple Locations
G. Van Wye, PhD, MA; H. Seoh, MPH, MS; T. Marx, MD, MPH; S. Timmins DeGregory, MPH; C. Gordon, PhD, MA; L. Silver, MD, MPH
New York City Department of Health and Mental Hygiene
Background
Since 1960, breakfast for children in
schools has been subsidized by the United
States School Breakfast Program. In NYC,
over 70% of public school students qualify
for free or reduced meals, and breakfast is
universally offered at no cost to students,
but participation is about 20%. Recently, a
voluntary classroom breakfast program has
been introduced, and, in January 2010,
approximately 10% of NYC schools were
serving breakfast in the classroom. In-class
breakfast is implemented at the classroom
level, as decided by the school principal:
some schools opt to have all classrooms
participate in classroom breakfast, while
others conduct the program for only certain
grades or floors. In the 2009-2010 school
year, several schools in the NYC
Department of Health and Mental Hygiene’s
District Public Health Office neighborhoods
(East and Central Harlem, North and
Central Brooklyn, and the South Bronx)
initiated in-class breakfast initiatives to
varying degrees in their classrooms. An
evaluation of the impact of these initiatives
on the morning eating habits of children in
these high-need neighborhoods was
recently conducted, and a summary of key
findings follows. The implementation and
evaluation of the in-classroom breakfast
program were collaboratively supported by
DOHMH and DOE.
Methods
3rd,
4th,
Additional Results
5th
A cross-sectional survey of
and
grade students attending elementary
schools in high-need neighborhoods in New
York City was conducted between January
and March 2010. Nine schools conducting
breakfast in the classroom (BIC) in either
some or all of their classrooms
(“intervention” schools) and seven
geographically, and where possible,
demographically matched “control” schools
with classrooms exposed to school cafeteria
breakfast only were selected and agreed to
participate in the evaluation. A survey
based on instruments developed for the
Child and Adolescent Trial for
Cardiovascular Health and child food
frequency questionnaires were adapted for
brief administration by elementary school
students. The survey asked students to
report whether they ate food that came from
any of the following 4 locations: home,
bodega/restaurant, school cafeteria, or
classroom. From each location, students
indicated the specific foods they ate at
these locations from a list of possible food
items, e.g. eggs, cereal, candy, etc.
Surveys were conducted in 125 classrooms
(55 intervention classrooms & 70 control
classrooms) and a total of 2,289 students
(n=1044 intervention and n=1245 control)
were surveyed (748 3rd graders; 800 4th
graders; and 741 5th graders). A summary
of key findings follows.
Where do students eat in the morning?
The following table illustrates where students reported eating in the
morning (categories are not mutually exclusive as students can eat in
multiple locations)
Table 1: Percent who ate at each location, among intervention and
control and average number of food items eaten
Intervention (n=1044)
Control (n=1245)
Number Percent
Home
625
59.9%
Bodega
205
19.6%
Cafeteria
147
14.1%
Classroom
695
66.6%
School
(overall)
740
70.9%
Didn't Eat
91
8.7%
Items/
Items/
Child Number Percent Child
2.4
868
69.7%
2.5
2.4
253
20.3%
2.1
2.2
335
26.9%
2.2
2.3
75
6.0%
1.9
2.6
0
385
187
30.9%
15.0%
2.8
0
Eating from multiple locations
The following table illustrates the total number of locations from which
students reported eating in the morning
Table 2: Number of Locations and Average Number of Items Eaten
Intervention
Control
(n=1044)
(n=1245)
Items/
Items/
Locations Number Percent Child Number
Percent
Child
0
91
8.7%
0.0
187
15.0%
0.0
1
420
40.2%
2.5
685
55.0%
2.4
2
380
36.4%
4.3
287
23.1%
4.4
3
120
11.5%
7.5
72
5.8%
7.0
4
33
3.2%
11.2
14
1.1%
9.7
2 or more
533
51.1%
5.5
373
30.0%
5.1
A table of food items that students reported eating in the morning at any
of four locations (home, bodega, cafeteria, classroom) follows.
Interpretation Example: Among intervention students, 60.1% reported
eating cereal in the morning.
Table 3: Consumption of food items by intervention and control groups
Cereal
Bread
Waffle
Donut
Chips
Milk
Eggs
Meat
Fruit
Vegetable
Juice
SSB
Candy
Coffee
Water
Intervention (N=1044)
Number
Percent
627
60.1%
288
27.6%
122
11.7%
81
7.8%
71
6.8%
567
54.3%
163
15.6%
164
15.7%
173
16.6%
23
2.2%
508
48.7%
149
14.3%
83
8.0%
107
10.2%
244
23.4%
Control (N=1245)
Number
Percent
426
34.2%
282
22.7%
237
19.0%
120
9.6%
81
6.5%
399
32.0%
252
20.2%
276
22.2%
178
14.3%
34
2.7%
264
21.2%
204
16.4%
81
6.5%
121
9.7%
291
23.4%
Overall
• We found that 91.3% of BIC students and 85.0% of
control students reported eating something in the
morning; conversely, 8.7% of BIC students and 15.0%
of control school students reported eating nothing in the
morning (p<0.0001).
• BIC was also associated with an increased likelihood of
children eating from multiple locations: 51.1% of BIC
students reported eating in two or more locations while
30.0% of control students reported eating in two or
more locations (p<0.0001).
• For both BIC and control students, the average number
of items eaten per child increased with increasing
locations: children who reported eating at one location
reported eating about 2.4 items while those who ate at
two or more locations reported eating slightly more than
5 items.
• BIC students were more likely than control students to
consume cereal (60.1% vs. 34.2%), milk (54.3% vs.
32%) and juice (48.7% vs. 21.2%).
• Consumption of fruits or vegetables in the morning was
similar among BIC and control students (18.8% vs.
17.0%).
• There was no difference in BIC and control students in
eating candy, donuts, or chips (Overall, 22.6% vs.
22.6% reported eating these items and the patterns
were similar for home and bodega consumption of
these items).
Conclusions
• While the in-class breakfast program was associated
with an additional 6.3% of students getting breakfast, it
was also associated with an additional 21.1% of
students possibly eating two breakfasts.
• Future evaluations should assess the total caloric
consumption among students schools with in-class
breakfast program vs. other breakfast programs vs.
schools without breakfast programs.
• Continued efforts should be made to increase
consumption of a healthy breakfast among children
who now start school without anything to eat; however,
special care should be taken to ensure that children
are not inadvertently taking in excess calories by eating
in multiple locations.