Relationships among School Breakfast, Hunger & Grades

Transcription

1 Relationships among School Breakfast, Hunger & Grades Marilyn S. Susie Nanney, PhD, MPH, RD Associate Professor Department of Family Medicine and Community Health March 24, 2015 Sponsored by: Human Capital Research Collaborative (HCRC)

2 UNIVERSITY OF MINNESOTA RESEARCH TEAM: UNIVERSITY OF MINNESOTA EXTENSION TEAM: PRINCIPAL INVESTIGATOR SUSIE NANNEY PHD, MPH, RD ASSOCIATE PROFESSOR FAMILY MEDICINE AND COMMUNITY HEALTH UNIVERSITY OF MINNESOTA PROJECT MANAGER AMY SHANAFELT, MA INTERVENTION COORDINATOR KATE YOUNG, MPH, RD MEASUREMENT COORDINATOR ELLEN DODDS, MS, RD DATA MANAGER SUSAN LOWRY BIO-STATISTICIAN QI WANG, MS CO-INVESTIGATORS: MARY HEARST, PHD ASSOCIATE PROFESSOR DIRECTOR OF PUBLIC HEALTH ST. CATHERINE S UNIVERSITY LISA HARNACK, PHD PROFESSOR & DIRECTOR, NUTRITION COORDINATING CENTER UNIVERSITY OF MINNESOTA MARTHA KUBIK, PHD, MSN, RNC ASSOCIATE PROFESSOR DIRECTOR OF INTERNATIONAL PROGRAMMING UNIVERSITY OF MINNESOTA ROBERT LEDUC, PHD RESEARCH ASSOCIATE SCHOOL OF PUBLIC HEALTH DIVISION OF BIOSTATISTICS MARY SCHROEDER EXTENSION EDUCATOR DIANNE DAVIS-KENNING SNAP-ED EDUCATOR BONNIE CHRISTIANSEN REGIONAL COORDINATOR DEEANN LEINES EXTENSION EDUCATOR DARLYCE RANGAARD SNAP-ED EDUCATOR KAM SCHROEDER PROGRAM COORDINATOR ANDREA KRONBACH PROGRAM COORDINATOR The study was funded in February 2013 by the National Institutes of Health

3 Our Partners Kathleen Milbrath School Meals Specialist

4 About the School Breakfast Program (SBP) Evidence that SBP participation: Improves dietary intakes Decreases risk of food insecurity Improves academic performance May protect against childhood obesity Access to school breakfast decreases the risk of marginal food insecurity and breakfast skipping, especially among low income children. Generally low participation Much less participation than the School Lunch Program Decreases with grade level

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6 Primary Aim Improve participation in the SBP among high school students

7 Improving access through school-wide policies and practices Expand SBP serving locations outside of the traditional cafeteria Expand SBP eating locations SBP marketing campaign

8 Study Design Longitudinal cohort study Clinical Trial

9 Rural High School Focus

10 Conceptual Model Marketing Campaign Exposure Student Perceptions (Secondary Aim 3) Student Actions Student Health Impacts Student Academic Impacts Beliefs Attitude Norms Selfefficacy Social Support Interaction w/peers, administrators Intention to eat school breakfast Interactions w/school food environment (Availability) Moderators SBP Participation (Primary Aim) Interactions w/school policies & practices (Access) Maintain or Calories Diet quality (Secondary Aim 2) Maintain or BMI Maintain or Body fat (Secondary Aim 1) Absences Nurses visits Discipline visits Grade point averages (Exploratory)

11 Key Intervention Strategies School Breakfast Expansion Team (SBET) Grab n Go service and menu 2 nd chance breakfast (after the bell) Hallway, classroom eating Kick-off Taste testing Student-driven marketing UMN Extension (training and school liaison/support)

12 Data Driven Approach

13 Second Chance Breakfast Traditional Breakfast times: 7:10 7:45am start 7:30 8:10am finish Second Chance time ranged from: 9:15 9:25am start time 9:22 9:32am finish (all were served between 1 st and 2 nd periods/blocks)

14 Interventions Up and Running!

15 Marketing and School Spirit

16 Marketing: Creative Strategies

17 Marketing: Videos New London Spicer Thief River Falls Willmar Bemidji Available at:

18 Communications/other promotions Daily morning announcements Assembly skits T-shirts, water bottles Homecoming parade float w/gift cards Student and staff meeting taste testing Free breakfast Newspaper and TV PR

19 What schools are saying Steady increase, instant doubling and tripling of participation Both full paid and have free/reduced students Upper classmen Most schools have from 2-5 additional hallway carts Teachers report more attentive students Custodial service reports little to no added mess Food service staff like the program and report student thank you s Principal report of decrease in disciplinary events near breakfast cart Food Service Director reports of turn around among nay sayers

20 Measurements: 2 Sources Pre, post, one year follow up School and Student provided data All 9 th and 10 th graders SBP participation, free/reduced priced lunch status, grades, absences, disciplinary events 3%-17% SBP participation 37% free/reduced price lunch 13% students of color Screened all 9 th and 10 th graders A cohort of breakfast skippers Weight and height, body fat Dietary intakes Survey

21 Student Enrollment - Measurements Enrolled 904 Students Baseline BMI measurements 890 (98%) Baseline surveys 833 (92%) Baseline diet interviews 738 (82%) Cohort 54% Female 30% students of color (versus 13%) 37% free/reduced price lunch

22 Trivia FACT: San Francisco to New York, NY is ~3,000 How many trips have our study measurement team taken? 1. 4 trips or 12,000 miles 2. 5 trips or 15,000 miles 3. 6 trips or 18,000 miles 4. 7 trips or 21,000 miles

23 18,209 miles

24 Baseline Data BMI Percentile Status N=890 Boys = 405 Girls = 485 Weight Status Underweight 4% 2% Normal Weight 57% 64% Overweight 15% 19% Obese 24% 16%

25 Working Analysis Conceptual Model HUNGER LOW SES School Breakfast Healthy Diet Attendance Cognition Grades

26 Beliefs about breakfast (N=833) % of Students who agree with the following statements 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 41% Eating breakfast helps me pay attention in class 45% 21% 24% I have more energy when I eat breakfast 37% 18% If I miss breakfast, I feel more tired in the morning Full Paid Free/Reduced 23% 12% Eating breakfast helps me control my weight

27 Benefits of Breakfast (N=833) 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 54% 48% 47% 47% 45% 29% 27% 25% 24% 25% 38% 24% 19% 16% Full Paid Free/Reduced

28 Food Insecurity Hunger (14%) Mostly female (64% vs 53%) Students of color (42% vs 29%) Participated in government supported meal programs (54% vs 32%) Compared to food secure adolescents, food insecure students were less likely to report excellent or very good health half hour of weekly exercise eat dinner as a family at home participate in sports teams during past year

29 Food Insecure Students Higher participation in the school breakfast program Reported fewer barriers to eating school breakfast No differences between groups for weight status perceived benefits of eating breakfast hours of sleep attendance rates

30 Food Security and Grades: Cross Sectional Analysis Food insecure 9 th and 10 th grade students had lower GPA s than food secure students Cum GPA 1,2 GPA Percentile 2, 3 LS Means (SE) LS Means (SE) Food Secure 2.77 (0.04) 44 th (1.03) Insecure, no hunger 2.46 (0.10) 37 st (2.83) Insecure with hunger 2.26 (0.15) 27 rd (4.45) 1 Cumulative, unweighted GPA, 13 schools (N=629 students) 2 Adjusted for gender, grade level, and free/reduced priced meal status 3 16 schools (N=789 students)

31 Healthy Eating Index (HEI) Overall (n=739) Male (n=315) Female (n=424) Full Paid Meals (n=424) F/R Meals (n=267) Avg HEI Low HEI Hi HEI

32 Healthy Eating Index and Grades: Cross Sectional Analysis 9 th and 10 th grade students with unhealthy diets had lower GPA s than those with healthier diets Cum GPA 1,2 GPA Percentile 2, 3 Student total diet needs Improvement (HEI >= 50/100) Substantial improvement (HEI < 50/100) LS Means (SE) LS Means (SE) 2.77 (0.05) 45 th (1.30) 2.67 (0.05) 41 th (1.43) 1 Cumulative, unweighted GPA, 13 schools (N=580 students) 2 Adjusted for gender, grade level, and free/reduced priced meal status 3 16 schools (N=736 students)

33 Preliminary change analysis (Wave 1 only): SBP and HEI in Breakfast Skippers Total HEI Score improved on average 0.5 points per ten percentage point increase in SBP (p=0.3629) in Breakfast Skippers

34 Preliminary change analysis (Wave 1 only): SBP and HEI in Breakfast Skippers: Differences by FRPL Status However, Students enrolled in Free/Reduced Price Lunch programs may achieve a greater benefit on average 0.8 points per 10 point increase in SBP (p=0.1482):

35 Preliminary change analysis (Wave 1 only): SBP and Hunger: change in SBP is negatively associated with Hunger in Breakfast Skippers Breakfast Skippers that ate more SBP from time 1 to time 2 reported lower odds of hunger. Students enrolled in FRPL programs did not see this benefit. Group Odds Ratio Hunger/Not Hunger Per Percentage Point Increase in SBP Results adjusted for race, sex, age (grade)k 95% CI P-value FRPL 0.80 (0.73, 0.88) < Not FRPL 1.02 (0.96,1.07)

36 Next Steps Complete study implementation and evaluation Did it work? Who did it work for? Conduct qualitative interviews and economic analysis Identify best practices (rural high schools) Work with partners to share findings and materials

37 Questions?