Free School Breakfast Initiative Data Augmentation and Analysis

Lead Research Organisation: Cardiff University
Department Name: Sch of Social Sciences

Abstract

Breakfast is commonly referred to as the most important meal of the day, especially for children. It provides an opportunity to consume healthy foodstuffs such as fruit and grains and is associated with better weight management and cognitive functioning. Unfortunately, a significant number of children in the UK skip breakfast or eat poor quality food such as chocolate and crisps. Such breakfast skipping has been found to be more common amongst obese children and those from poorer backgrounds. School breakfast schemes have been implemented to try to encourage breakfast eating and the adoption of a healthy diet from an early age. It is also thought that his can result in improved performance in school. Previous evaluations of such schemes have suffered from a number of methodological shortcomings.

This study draws on data collected in a large national evaluation of the Welsh Assembly Primary School Free Breakfast Initiative, which provided the opportunity for schools and pupils to have a free healthy breakfast. The study included 111 schools that were randomly selected to either start the scheme immediately or in 12 months time. Questionnaires and interviews assessed breakfast skipping and the amount of healthy and healthy food eaten, attitudes to breakfast, school behaviour and memory, concentration and attention. This information was collected before the schemes began and 12 months later. Results indicate the scheme was effective in increasing the consumption of healthy food items at breakfast, and positive attitudes towards breakfast. But additional important analyses will not be conducted without investment in linking these results to other sources of data and subsequent analyses.

With additional funding it will be possible to identify free school meal entitlement, educational performance data, and postcodes for each pupil in the study. It will also be possible to examine additional detailed dietary nutritional information collected from pupils during the study. This will allow an examination of whether such interventions can improve the nutritional quality of school pupil?s diets and whether they can address health inequalities. It will also be possible to examine the relationship between children?s diets and future educational performance over time. This will provide important information for both the education and health sector in developing interventions to improve children?s diets and tackle rising levels of obesity. It will also provide important information on whether routine education and health data can be utilized in future public health initiatives.

Technical Summary

The recently completed cluster randomised trial of the Welsh Assembly Government s Free School Breakfast Initiative (FSBI) collected data at baseline, 4-6 month and 12 month follow-up, from approximately 4350 Year 5 and 6 children in 111 schools across Wales. A nested cohort of 1975 children completed measures at baseline and at least one other round of data collection. Outcome measures included assessments of cognitive function, attitudes towards breakfast and dietary behaviour. Further data were also collected from sub-samples of participants using comprehensive measures of dietary intake. The proposed study will augment the existing study dataset through nutrient intake coding of dietary intake data, linkage with education databases to obtain free school meal entitlement, SAT and GCSE performance data, postcode, and via linkage with census and health databases to output area socioeconomic indicators and future health outcome data. This data augmentation will then allow the following research questions to be addressed in a series of statistical analyses:
a) What is the impact of the FSBI in terms of cognitive outcomes, attitudes towards breakfast and dietary intake?
b) What is the impact of the intervention upon social gradients in diet, cognitive outcomes and attitudes?
c) Is the impact of the intervention moderated by socio-economic status and/or other contextual ecological factors, such as school policies, health promoting school status, etc.?
d) Analysis of response bias in parent questionnaires, by response time (first mailing or after reminder(s)), gender of pupil, dietary intake, socio-economic status.
e) Comparison of parental report and pupil self-report data.
f) Does the FSBI improve levels of consumption of adequate breakfasts amongst 9-11 year olds? (i.e. over 20% of daily energy intake).
g) Does the FSBI improve the balance of macronutrients within the diets of 9-11 year olds?
h) Does the FSBI improve intake of micronutrients within the diets of 9-11 year olds? (e.g., calcium, iron, vitamin C).
i) How do variations in breakfast composition (e.g. glycemic load) influence cognitive performance?
j) Are (i) breakfast and (ii) all day dietary behaviour at baseline associated with subsequent cognitive measures and school performance. Is this relationship confounded with or moderated by socio-economic status and/or other contextual ecological factors?
k) Are attitudes towards breakfast at baseline predictive of subsequent breakfast eating behaviour?
l) Are changes in breakfast and all day dietary behaviour associated with changes in cognitive outcomes?
 
Description Magenta Handbook (HM Treasury) - guidance on evaluation
Geographic Reach National 
Policy Influence Type Citation in other policy documents
Impact Research included (Box 9.D: An example of a randomised controlled trial, p.105) as a model of good practice in terms of a successful randomised controlled trial nested within the implementation of policy. HM Treasury Guidance on Evaluation, a document published by HM Treasury as guidance to those working in central government on evaluation http://www.hm-treasury.gov.uk/data_magentabook_index.htm
URL http://www.hm-treasury.gov.uk/data_magentabook_index.htm
 
Description Welsh Government Policy on Free Breakfasts
Geographic Reach National 
Policy Influence Type Citation in other policy documents
Impact The findings from this project have particulalry identified that the free school breakfast initiative was progressive in that benefits of the scheme in terms of the diets of children (healthy food items consumed at breakfast time) were positive and greater among economically disadvantaged areas. This finding has been cited as important in determining Welsh Government policy on the continuation of the free breakfast initiative. The paper in which we identified an association between breakfast consumption and subsequent educational outcomes was debated in Welsh Government and has further reinforced Governemnt commitment to investing in food provision in schools.
 
Description Collaboration with Welsh Government during SFP Trial 
Organisation Government of Wales
Country United Kingdom 
Sector Public 
PI Contribution The RCT of the Strengthening Families Programme (G0802128) will provide important evidence for policy making. We have built strong relationships with key policy makers in Welsh Government to ensure that our findings can be translated into policy and practice. Welsh Government is currently seeking to ensure that funding for the SFP in trial areas is sustained until our results are available, and we are supporting them in this work (e.g. by liaising with programme delivery teams, and organising joint presentations with local authority funding bodies).
Collaborator Contribution We have benefitted greatly from strong support from Welsh Government since the beginning of the trial. This has included: financial support for programme delivery as part of the trial (£928k); high level policy support for the need to fund SFP delivery as part of an RCT; and advice on how best to disseminate our findings to maximise their impact on policy and practice.
Impact Partnership with Welsh Government during the trial built upon existing strong relationships with policy makers and an exploratory study of the SFP in Cardiff, key aspects of which were used to inform our current trial. One publication resulted from this initial work: Segrott, J. (2013) 'Recruitment and group composition strategies for family-based substance misuse prevention interventions: an exploratory evaluation'. Journal of Children's Services..
Start Year 2007
 
Description National Government Policy Collaboration 
Organisation Welsh Assembly
Department Education Directorate and Health Improvement Division
Country United Kingdom 
Sector Academic/University 
PI Contribution We were commissioned to conduct the research component of the initial randomised trial. The NPRI grant funded augmentation of the trial data with data linkage for longer term follow up, and improved coding of dietary data. We have maintained a close relationship with Welsh Government to maximise policy makers' awareness and use of the trial findings.
Collaborator Contribution Welsh Government randomised the implementation of the Free Breakfast Initiative, funded the implementation (over £1M per year) and commissioned the research to capture initial nutritional end educational outcomes. They have also allowed educational and health data records to be linked to trial data as a key part of the data augmentation.
Impact Welsh Government policy on free breakfasts has been heavily influenced.
 
Description SAIL data linkage 
Organisation Secure Anonymised Information Linkage Databank
Country United Kingdom 
Sector Academic/University 
PI Contribution Initial trial data provided for linkage.
Collaborator Contribution SAIL used to link trial data to education and health datasets.
Impact Differential impact of free breakfasts by socio-economic status facilitated by individual level SES variable obtained through linkage (paper iunder peer review). Dataset to allow longitudinal analysis of educational outcomes created.
Start Year 2008
 
Description Community breakfast clubs 2010 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Schools
Results and Impact Approximately 150 people met to discuss community breakfast clubs and their impact on health, well-being and educational performance. Participants included academics, school / breakfast club staff, policy makers and other stakeholders. A poster providing details about our project was also displayed for delegates to read and flyers of the poster were also distributed.

We have been asked to continue to contribute to online discussions surrounding provision of breakfast clubs.
Year(s) Of Engagement Activity 2010
 
Description Debate of research in Welsh Government 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Policymakers/politicians
Results and Impact The following research publication was debated by Welsh Government via a Business Statement and Announcement on Tuesday 17th November. This may have an influence on Welsh Government's decisions regarding school breakfast provision.

Littlecott, HJ, Moore, GF, Moore, LAR, Lyons, RA. and Murphy, S. 2015. Association between breakfast consumption and educational outcomes in 9-11-year-old children. Public Health Nutrition , p. 1. 10.1017/S1368980015002669
Year(s) Of Engagement Activity 2015
 
Description Media interviews 
Form Of Engagement Activity A press release, press conference or response to a media enquiry/interview
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Public/other audiences
Results and Impact A press release was issued for the following publication in November 2015.

Littlecott, HJ, Moore, GF, Moore, LAR, Lyons, RA. and Murphy, S. 2015. Association between breakfast consumption and educational outcomes in 9-11-year-old children. Public Health Nutrition , p. 1. 10.1017/S1368980015002669

This resulted in widespread reporting of the results in newspapers, on television and other mediums worldwide. This also resulted in interviews with BBC Wales (television and radio), the BBC World Service (radio), ITV Wales (television) and Made in Cardiff (television). I also participated in an interview with RTL. RTL is Europe's largest independent broadcaster, and has an audience in excess of 12 million viewers across Germany, Austria and Switzerland.

Follow this link to view all internet and newspaper-based news items: https://www.google.co.uk/search?q=hannah+littlecott&client=ms-android-samsung?md=ivn&source=lnms&tbm=nws&sa=X&ved=0CAkQ_AUoA2oVChMI25H726iYyQIVBMcUCh0viQKY
Year(s) Of Engagement Activity 2015
URL https://www.google.co.uk/search?q=hannah+littlecott&client=ms-android-samsung&prmd=ivn&source=lnms&t...
 
Description Policy roundtable discussion 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Policymakers/politicians
Results and Impact On 4th September 2019 I travelled, by invitation, to the House of Commons to contribute to a policy roundtable discussion on the provision of free school breakfast. I was invited by an organisation called, 'Magic Breakfast', founded by Carmel McConnell MBE. During the meeting, we heard from a variety of stakeholders, such as a school principal who outlined her experience of delivering school breakfasts and her perceptions of how they have impacted upon health and wellbeing and education. I was also asked to give a 5 minute overview of our research showing a link between breakfast consumption and educational outcomes among 9-11 year old children (https://bit.ly/2m0DbRm).

In attendance were MP Nicky Morgan and MP Angela Raynor, so this provided a real chance to use our research findings to advocate for government funding for universal free school breakfast and to highlight that efforts to improve both education and health are aligned. It was brilliant to see so many school breakfast advocates in one room, all putting forward eloquent and convincing arguments. By the end of the meeting, it seemed obvious that everyone agreed that breakfast provision was a good idea that provided good 'bang for your buck' in relation to health and educational outcomes. It remains to be seen whether this will translate to Government policy but, since this meeting was prioritised during a particularly chaotic, Brexit-related week in parliament, I am hopeful that this will be the case.
Year(s) Of Engagement Activity 2019
 
Description Research put forward for debate in the Houses of Parliament 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Policymakers/politicians
Results and Impact The following research publication was put forward for debate in the Houses of Parliament via an Early Day Motion 814. This may have an influence on the UK Government's decisions regarding school breakfast provision.

Littlecott, HJ, Moore, GF, Moore, LAR, Lyons, RA. and Murphy, S. 2015. Association between breakfast consumption and educational outcomes in 9-11-year-old children. Public Health Nutrition , p. 1. 10.1017/S1368980015002669
Year(s) Of Engagement Activity 2015
 
Description School visit: Erasmus Plus School Wellbeing Network 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Schools
Results and Impact I was invited to present on my findings associating breakfast consumption with academic outcomes at a European primary school Erasmus Plus project. I presented at a primary school in Cardiff to around 30 teachers from countries in Europe, including Spain, Italy, Greece and Ireland.
Year(s) Of Engagement Activity 2016