Dietary effects of universal-free school breakfast: findings from the evaluation of the school breakfast program pilot project
OBJECTIVE: To determine the effects of offering universal-free school breakfast in elementary schools on students' dietary outcomes. DESIGN: Experimental study with random assignment of 153 matched elementary schools in six school districts. Treatment schools offered universal-free school breakfast, and control schools continued to operate the traditional means-tested School Breakfast Program. Twenty-four-hour dietary recalls were collected from sample students near the end of the first year. SUBJECTS: About 30 students in second through sixth grades were randomly selected from each school (n=4,358). INTERVENTION: Free school breakfasts were made available to all students in treatment schools, regardless of family income, for three consecutive school years (2000-2001 to 2002-2003). MAIN OUTCOME MEASURES: Breakfast consumption and food and nutrient intake. STATISTICAL ANALYSES: Hierarchical mixed-models and logistic regression, adjusting for age, sex, minority status, and income eligibility for the regular school meal programs, were used to estimate effects. RESULTS: Despite a significant increase in school breakfast participation among sample students in treatment schools (from 16% to 40%, P<0.01), the rate of breakfast skipping did not differ between groups (4% overall). Treatment school students were more likely to consume a nutritionally substantive breakfast (P<0.01), but dietary intakes over 24 hours were essentially the same. CONCLUSIONS: Making universal-free school breakfast available in elementary schools did not change students' dietary outcomes after nearly 1 year. To improve children's diets overall, efforts should focus on ensuring all students have access to a healthful breakfast, at home or at school.