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

A cross-sectional survey of 3rd, 4th, and 5th 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.

Methods Additional Results• 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).

OverallBackgroundSince 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.

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 PercentItems/Child Number Percent

Items/Child

Home 625 59.9% 2.4 868 69.7% 2.5

Bodega 205 19.6% 2.4 253 20.3% 2.1

Cafeteria 147 14.1% 2.2 335 26.9% 2.2

Classroom 695 66.6% 2.3 75 6.0% 1.9School (overall) 740 70.9% 2.6 385 30.9% 2.8

Didn't Eat 91 8.7% 0 187 15.0% 0

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)

Eating from multiple locationsThe 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

 Locations

Intervention Control(n=1044) (n=1245)

Number PercentItems/Child Number Percent

Items/Child

0 91 8.7% 0.0 187 15.0% 0.01 420 40.2% 2.5 685 55.0% 2.42 380 36.4% 4.3 287 23.1% 4.43 120 11.5% 7.5 72 5.8% 7.04 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.

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.

Table 3: Consumption of food items by intervention and control groups

 Intervention (N=1044) Control (N=1245)

Number Percent Number PercentCereal 627 60.1% 426 34.2%Bread 288 27.6% 282 22.7%Waffle 122 11.7% 237 19.0%Donut 81 7.8% 120 9.6%Chips 71 6.8% 81 6.5%

Milk 567 54.3% 399 32.0%Eggs 163 15.6% 252 20.2%Meat 164 15.7% 276 22.2%Fruit 173 16.6% 178 14.3%

Vegetable 23 2.2% 34 2.7%Juice 508 48.7% 264 21.2%SSB 149 14.3% 204 16.4%

Candy 83 8.0% 81 6.5%Coffee 107 10.2% 121 9.7%Water 244 23.4% 291 23.4%