title: Estimating impacts of a breakfast in the classroom program on school outcomes.
abstract: OBJECTIVE
  Short-term impacts of breakfast consumption on diet quality and cognitive functioning have been reported, but more evidence is needed to draw causal inferences about long-term impacts of school breakfast on indicators of school engagement and academic achievement.
  
  
  OBJECTIVE
  To estimate the impact of a Breakfast in the Classroom (BIC) program on School Breakfast Program participation, school attendance, and academic achievement.
  
  
  METHODS
  This quasi-experimental study included a sample of 446 public elementary schools from a large, urban US school district that served predominantly low-income, racial/ethnic minority students.
  
  
  METHODS
  A total of 257 schools (57.6%) implemented a BIC program during the 2012-2013 academic year, whereas 189 (42.4%) did not.
  
  
  METHODS
  School- and grade-level data from 2012-2013 and grade-level achievement data from the prior year were collected from school district records across the elementary schools. Hypotheses that a BIC program would improve school breakfast participation at the school level, school attendance at the grade level (kindergarten through sixth grade), and academic achievement at the grade level (second through sixth grades) were tested using propensity score weights to adjust for demographic differences between the BIC and non-BIC schools.
  
  
  RESULTS
  The BIC program was linked with increased breakfast participation during the academic year (F10,414=136.90, P<.001), with mean participation rates of 73.7% in the BIC group vs 42.9% in the non-BIC group. The BIC program was also linked with greater overall school attendance rates (95.5% vs 95.3% in the non-BIC group; F1,2772=8.40, P = .004). When performing attendance analyses in the subset of grade levels for which achievement data were available, results were mostly consistent, although there was a group × time interaction (F10,1891=1.94, P=.04) such that differences between least squares means in the BIC vs non-BIC groups did not reach statistical significance at every month. There were no group differences in standardized test performance in math (57.9% in the BIC group vs 57.4% in the non-BIC group; F1,1890=0.41, P=.52) or reading (44.9% in the BIC group vs 44.7% in the non-BIC group; F1,1890=0.15, P=.70).
  
  
  CONCLUSIONS
  Findings add to the evidence that BIC can increase school breakfast participation substantially and suggest that it has the potential to improve overall school attendance rates. Additional research is needed to explore the generalizability of these findings and the potential impacts on achievement for longer periods and on additional outcomes, such as weight status.
authors.affiliation: ChildObesity180, Tufts University, Boston, Massachusetts2Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Anzman-Frasca
authors.affiliation: ChildObesity180, Tufts University, Boston, Massachusetts.
authors.forename: Holly Carmichael
authors.initials: HC
authors.lastname: Djang
authors.affiliation: ChildObesity180, Tufts University, Boston, Massachusetts.
authors.forename: Megan M
authors.initials: MM
authors.lastname: Halmo
authors.affiliation: ChildObesity180, Tufts University, Boston, Massachusetts.
authors.forename: Peter R
authors.initials: PR
authors.lastname: Dolan
authors.affiliation: ChildObesity180, Tufts University, Boston, Massachusetts2Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts.
authors.forename: Christina D
authors.initials: CD
authors.lastname: Economos
mesh_terms: D000124:Achievement; D062408:Breakfast; D004522:Educational Status; D005522:Food Services / Q000706:statistics & numerical data*; D006801:Humans; D012572:School Health Services; D012574:Schools; D013334:Students; D014481:United States / Q000453:epidemiology; D014504:Urban Health