Impacts of the Primary School Free Breakfast Initiative on socio-economic inequalities in breakfast consumption among 9-11-year-old schoolchildren in Wales.
OBJECTIVE
Universal interventions may widen or narrow inequalities if disproportionately effective among higher or lower socio-economic groups. The present paper examines impacts of the Primary School Free Breakfast Initiative in Wales on inequalities in children's dietary behaviours and cognitive functioning.


METHODS
Cluster-randomised controlled trial. Responses were linked to free school meal (FSM) entitlement via the Secure Anonymised Information Linkage databank. Impacts on inequalities were evaluated using weighted school-level regression models with interaction terms for intervention × whole-school percentage FSM entitlement and intervention × aggregated individual FSM entitlement. Individual-level regression models included interaction terms for intervention × individual FSM entitlement.


METHODS
Fifty-five intervention and fifty-six wait-list control primary schools.


METHODS
Approximately 4500 children completed measures of dietary behaviours and cognitive tests at baseline and 12-month follow-up.


RESULTS
School-level models indicated that children in intervention schools ate a greater number of healthy items for breakfast than children in control schools (b = 0·25; 95 % CI 0·07, 0·44), with larger increases observed in more deprived schools (interaction term b = 1·76; 95 % CI 0·36, 3·16). An interaction between intervention and household-level deprivation was not significant. Despite no main effects on breakfast skipping, a significant interaction was observed, indicating declines in breakfast skipping in more deprived schools (interaction term b = -0·07; 95 % CI -0·15, -0·00) and households (OR = 0·67; 95 % CI 0·46, 0·98). No significant influence on inequality was observed for the remaining outcomes.


CONCLUSIONS
Universal breakfast provision may reduce socio-economic inequalities in consumption of healthy breakfast items and breakfast skipping. There was no evidence of intervention-generated inequalities in any outcomes.
1 DECIPHer, School of Social Sciences, Cardiff University, 1-3 Museum Place, Cardiff CF10 3BD, UK.
Graham F
GF
Moore
1 DECIPHer, School of Social Sciences, Cardiff University, 1-3 Museum Place, Cardiff CF10 3BD, UK.
Simon
S
Murphy
2 School of Social and Community Medicine, University of Bristol, Bristol, UK.
Katherine
K
Chaplin
3 Health Information Research Unit, College of Medicine, Swansea University, Swansea, UK.
Ronan A
RA
Lyons
3 Health Information Research Unit, College of Medicine, Swansea University, Swansea, UK.
Mark
M
Atkinson
1 DECIPHer, School of Social Sciences, Cardiff University, 1-3 Museum Place, Cardiff CF10 3BD, UK.
Laurence
L
Moore
D062408:Breakfast; D002648:Child; D003071:Cognition; D004032:Diet; D005191:Family Characteristics; D063105:Food Assistance; D005522:Food Services; D006801:Humans; D011203:Poverty; D012044:Regression Analysis; D012574:Schools; D012959:Socioeconomic Factors; D014852:Wales