School Breakfast Participation Leads To Academic, Psychosocial Improvements

September 15, 1998

A new study by researchers from the Massachusetts General Hospital (MGH) and other institutions lends support to traditional beliefs about the importance of a good breakfast. The report in the September Archives of Pediatric and Adolescent Medicine finds that children who increase their participation in school breakfast programs tend to show improvement on a wide range of measures of social and academic functioning.

Conducted in public schools in Philadelphia and Baltimore, the study found that increased school breakfast participation correlated with less tardiness and absence, higher math grades, and reductions in problems like depression, anxiety and hyperactivity. The researchers also found that students were more like to participate in school breakfast programs when the meals were offered free to all students, compared with programs that provided free meals to low-income youngsters while others paid for their breakfasts.

"What your mom told you is true, eating a good breakfast really does make a difference," says J. Michael Murphy, EdD, the study's first author and a member of the MGH Child Psychiatry Service. "What we find particularly exciting is that this is a relatively simple intervention that can significantly improve children's academic performance and psychological well-being. Now the challenge is to ensure that each child actually gets a good breakfast, either at home or at school."

This study is the latest in a series conducted by Murphy and Ronald Kleinman, MD, MGH chief of pediatric gastroenterology, that examines the impact of undernutrition in low-income children. "While we don't usually see children who are really starving in this country, we know that a significant number of children experience hunger because their families cannot provide sufficient, nutritious food," Kleinman says. "In recent years our group and others have been defining just how big an issue what we call food insecurity is and how it may be linked to the problems children may experience."

The researchers gathered data on elementary and middle-school students in three inner city public schools: one in Philadelphia and two in Baltimore. Prior to the study's outset, all three schools offered breakfast according to a conventional payment system: free, reduced or full-price meals depending on family income. Before a program of universally free school breakfasts was instituted, the researchers conducted interviews with students who enrolled in the study group and their parents to assess levels of depression, anxiety and other psychosocial problems using standard questionnaires and checklists. They also determined levels of school breakfast participation for the study-group students and for the schools as a whole via information recorded by the school cafeteria staff members in the week before the universally free program was instituted.

Approximately four months after the universally free program went into effect, study-group students and their parents were reinterviewed. Cafeteria staff once more recorded whether or not students took a school breakfast during a week near the end of the term. In addition the participating schools provided information regarding the study-group students' school attendance and their grades in math and three other subject areas during the semesters before and after the universally free program was instituted.

Information on school breakfast participation and school-reported measures (attendance and grades) was completed for 133 students; of those, psychosocial data from student and parent interviews was available for 85 students. In addition, teachers in the Baltimore schools completed evaluations of student behavior before and after the free breakfast program, providing information on 76 of the study-group students.

Even before instituion of the universally free program, those students who participated in the school breakfast program more frequently had higher math grades and lower reported levels of depression, anxiety and other problem symptoms. Overall, switching to a universally free school breakfast program increased the number of students taking school breakfasts, from 15 percent of students at all three schools before the free program to 27 percent of students at all three schools four months after implementation of the free program.

Almost half of the study-group students increased their participation in the school breakfast program when it was offered without charge. Those students who increased school-breakfast participation had significantly greater increases in math grades and significantly greater decreases in absence and tardiness during the four-month study period than did students whose school-breakfast participation remained the same or decreased. They also showed greater improvement in student-reported levels of depression and anxiety and, for the Baltimore students, reduced levels of hyperactivity, as reported by teachers. Changes in reported behavioral problems from the parental interviews were not statistically significant. No significant changes were seen in non-math grades.

"This is the first time anyone has looked at the psychological and academic impact of school breakfast over an extended period of time," Kleinman says. "Other studies have looked at what happens when well-nourished children miss one breakfast. But all of us miss a meal from time to time and generally do fine. This series of studies shows that those children who are consistently hungry are most likely to do poorly in school and in other aspects of their lives."

The study was supported by grants from the Kellogg Company and the Mid-Atlantic Milk Marketing Association. Additional study co-authors were Maria Pagano, EdM, of Northwestern University; Joan Nachmani, MS, CNS, and Peter Sperling of the School District of Philadelphia; and Shirley Kane of the Baltimore Public Schools.

Massachusetts General Hospital

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