The socioeconomic and ethnic characteristics of the children were similar in all three schools (>70% of the children were eligible for free or reduced-price meals, and >70% of the children were of African-American or Hispanic descent). In the combined sample, approximately half of the children were male (41%; 40/97). Eighty-two percent (80/97) were from elementary grades (3 through 5), and 18% (17/97) were from middle school (grade 6). Fifty-five percent (53/97) of the children were from single-parent families.
Twenty-nine percent (28/97) of the children had two or more nutrient intakes that were ≤50% of the RDA. Thirteen percent (13/97) of the children consumed ≤50% of the RDA for energy. Combining the two groups, 30% (29/97) of these children consumed two or more of the micronutrients and/or a total energy intake of ≤50% of the RDA. Children in the low nutrient intake group did not differ significantly from their peers with respect to gender, grade, or parental marital status.
Data on low nutrient intake and child functioning prior to the start of the USBP are shown in . Prior to the introduction of the USBP, 61% (59/97) of the children were classified as eating school breakfast rarely, 16% (15/97) as eating school breakfast sometimes, and 24% (23/97) ate school breakfast often. Children who ate school breakfast rarely were significantly more likely (41%) to be nutritionally at risk than were children who ate school breakfast sometimes (7%) or often (17%; χ2 = 5.8, d.f. = 2, p < 0.05).
Child nutritional indicators and psychosocial functioning measures pre-USBP1
According to the 8-item CCHIP scale, 72% (70/97) of children were classified as not hungry, 19% (18/97) were classified as at risk for hunger, and 9% (9/97) were classified as hungry. Parent-reported child hunger on CCHIP was significantly associated with nutritional risk, with rates that were about five times higher in hungry and at risk for hunger children as in not-hungry children (56 and 72% vs. 16%; χ2 = 24.9, d.f. = 2, p < 0.0001). Average CCHIP scores also differed significantly according to nutritional status: children in the nutritional risk group had average hunger scores of 2.5 compared to children with adequate nutrient intakes who had an average hunger score of 0.6 (F = 18.6, d.f. = 1, p < 0.0001).
Child report of hunger as measured by the CHI-C followed the same patterns as parent report of hunger. Forty-seven percent of CHI-C hungry children were at nutritional risk, as were 67% of the CHI-C at-risk children but only 19% of the not-hungry children, a difference that was also statistically significant (χ2 = 13.9, d.f. = 2, p < 0.001). Average CHI-C scores also differed significantly according to nutritional status: children in the nutritional risk group had average hunger scores of 1.2 compared to children with adequate nutrient intakes who had an average hunger score of 0.5 (F = 5.0, d.f. = 1, p < 0.05).
Children who were nutritionally at risk had significantly higher PSC mean scores than those who were not at nutritional risk (19.2 vs. 12.0; F = 11.6, d.f. = 1, p < 0.001). Similarly, children who were nutritionally at risk had a mean PSC-Y score of 22.7 and those who were not at nutritional risk had a mean PSC-Y score of 18.5, a difference that was marginally statistically significant (F = 3.7, d.f. = 2, p < 0.10).
The mean grade point average (GPA) of the children for the full year prior to the introduction of the USBP was 2.6 (SD = 0.8). Children with low nutritional intakes had a significantly lower GPA (M = 2.1) than children with adequate intakes of both nutrients and energy (M = 2.8; F = 8.5, d.f. = 2, p < 0.001). The same pattern was observed in each of the four subject areas (Reading, Math, Social Studies, and Science): with statistically significant differences of between one half and one full letter grade between nutritionally at-risk children and those who were not at risk.
Prior to the implementation of USBP, children who were not at nutritional risk had an absence rate of 6.5 days, and those who were nutritionally at risk had an absence rate of 11.5 days, a difference that was statistically significant (F = 3.7, d.f. = 1, p < 0.05). Children who were not at nutritional risk prior to the start of the USBP had been tardy an average of 1.9 days during the previous school year, whereas children who were at nutritional risk were tardy 5.7 days the year before, a difference that was also statistically significant (F = 3.6, d.f. = 1, p < 0.05).
Approximately 6 months following the implementation of the USBP the same measures were used when students were re-interviewed and their records for the year that USBP started were compared with the same academic indicators for the year before the program. For each of these variables the change from pre-USBP to post-USBP were calculated. These changes were examined in the light of changes in nutritional risk.
Data collected 6 months following implementation of the USBP are shown in . Changes in nutritional risk were calculated by subtracting the pre-USBP nutritional risk score (low intake of both, either, or neither energy nor micronutrients; coded 2, 1, or 0) from the post-USBP nutritional risk score (coded the same way), so that children could be rated as improved, the same, or worse. Six months after implementing the USBP, 19% of the sample were coded as having improved their nutrient intake, 64% of the sample were unchanged, and 18% were at increased nutritional risk.
Changes in nutritional risk and child outcome measures post-USBP1
Children whose nutritional status improved showed significantly larger increases in school breakfast participation than children whose nutritional status stayed the same or worsened (average school breakfast participation rates of +55.8 vs. +20.2 vs. −11.0, respectively; F = 8.4, d.f. = 2, p < 0.001). Conversely, 44 children showed an increase in school breakfast participation and 14 of these children (32%) showed an improvement in nutritional status. Children who showed improved nutrient intake reported a significantly greater decrease in symptoms of hunger on the CHI-C (mean change = −1.4) than children whose nutritional status remained the same (−0.2), or those who reported a worsening of their nutritional status (M = +0.3 [an increase in hunger]; F = 13.4, d.f. = 2, p < 0.0001). Children who improved their nutritional intake showed significantly larger decreases (improvements in functioning) in their PSC-Y scores (M = −3.2), compared to children whose nutritional status remained the same (M = −2.0), or children whose nutritional intake category worsened (M = +1.9; χ2 = 5.2, d.f. = 2, p < 0.01).
Of the four individual subjects examined, only changes in math grades were found to be significantly related to changes in nutrient intake (F = 3.3, d.f. = 2, p < 0.05). Children who improved their nutrient intake significantly decreased in the number of days in which they were absent (M = −4.4 days) in comparison to a smaller decrease in absences among children whose nutrient intake did not change (M = −1.7 days) or children whose nutrient intake worsened (M = +3.0 days absent; F = 5.9, d.f. = 2, p < 0.01). The overall decrease in tardiness among those with increased breakfast participation failed to reach statistical significance, but was in the predicted direction.