title: 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.
abstract: BACKGROUND
  Free school breakfast programmes (SBPs) exist in a number of high-income countries, but their effects on educational outcomes have rarely been evaluated in randomised controlled trials.
  
  
  METHODS
  A 1-year stepped-wedge, cluster randomised controlled trial was undertaken in 14 New Zealand schools in low socioeconomic resource areas. Participants were 424 children, mean age 9±2 years, 53% female. The intervention was a free daily SBP. The primary outcome was children's school attendance. Secondary outcomes were academic achievement, self-reported grades, sense of belonging at school, behaviour, short-term hunger, breakfast habits and food security.
  
  
  RESULTS
  There was no statistically significant effect of the breakfast programme on children's school attendance. The odds of children achieving an attendance rate <95% was 0.76 (95% CI 0.56 to 1.02) during the intervention phase and 0.93 (95% CI 0.67 to 1.31) during the control phase, giving an OR of 0.81 (95% CI 0.59 to 1.11), p=0.19. There was a significant decrease in children's self-reported short-term hunger during the intervention phase compared with the control phase, demonstrated by an increase of 8.6 units on the Freddy satiety scale (95% CI 3.4 to 13.7, p=0.001). There were no effects of the intervention on any other outcome.
  
  
  CONCLUSIONS
  A free SBP did not have a significant effect on children's school attendance or academic achievement but had significant positive effects on children's short-term satiety ratings. More frequent programme attendance may be required to influence school attendance and academic achievement.
  
  
  BACKGROUND
  Australian New Zealand Clinical Trials Registry (ANZCTR)-ACTRN12609000854235.
authors.affiliation: Clinical Trials Research Unit, School of Population Health, University of Auckland, Auckland, New Zealand. c.nimhurchu@nihi.auckland.ac.nz
authors.forename: Cliona Ni
authors.initials: CN
authors.lastname: Mhurchu
authors.forename: Delvina
authors.initials: D
authors.lastname: Gorton
authors.forename: Maria
authors.initials: M
authors.lastname: Turley
authors.forename: Yannan
authors.initials: Y
authors.lastname: Jiang
authors.forename: Jo
authors.initials: J
authors.lastname: Michie
authors.forename: Ralph
authors.initials: R
authors.lastname: Maddison
authors.forename: John
authors.initials: J
authors.lastname: Hattie
mesh_terms: D000041:Absenteeism; D000124:Achievement; D000293:Adolescent; D017195:Adolescent Nutritional Physiological Phenomena; D002648:Child; D016000:Cluster Analysis; D005260:Female; D005522:Food Services / Q000191:economics*; D005523:Food Supply; D006078:Government Programs; D006801:Humans; D006815:Hunger / Q000208:ethnology; D007398:Interpersonal Relations; D008297:Male; D009520:New Zealand; D015397:Program Evaluation; D011632:Public Assistance; D012574:Schools / Q000706:statistics & numerical data*; D057566:Self Report; D012959:Socioeconomic Factors; D013334:Students / Q000523:psychology / Q000706:statistics & numerical data*