Presented by Hannah Campbell, MPH student Walden University PH 6165-1

1. Start Early for SuccessThe Role of School Breakfast Programs in Improving the School Nutrition Environment Presented by Hannah Campbell, MPH student Walden University PH 6165-1 Instructor: Dr. Rebecca Heick Winter Quarter, 2009

2. Prospective Audience • School Administrators • Principals • Teachers

3. Purpose • Describe the need for a universal school breakfast program • Evaluate barriers to the implementation of a breakfast program • Discuss implementation solutions for a universal school breakfast program

4. Learning Outcomes • Elucidation of the food insecurities of many United States students. • Understanding of the consequences of malnutrition on the learning capabilities of students. • Finding new methods for schools to provide universal breakfast programs.

5. The Growing Trend of Obesity • 12.6% adult obesity in 1990 • ―> 34% adult obesity in 2006 (Johnson, 2010) • 1/3 of all U.S. children are overweight/obese (Ehrlich, 2008) Ehrlich, G. (2008, October). Health = Performance: Efforts to increase student achievement also should address physical activity and a good diet. American School Board Journal, 40-44. Johnson, M. (2010). Human Biology. San Francisco, CA: Benjamin Cummings, 344.

6. Malnourishment Among U.S. Children • Most overweight/obese children are from low socioeconomic status families and are malnourished. (Johnson, 2010) • Readily available energy sources are high in: • Saturated fats • Simple sugars • Readily available energy sources are low in: • Proteins • Fibers • Vitamins (Murphy, 2007) Johnson, M. (2010). Human Biology. San Francisco, CA: Benjamin Cummings, 344. Murphy, J. (2007). Breakfast and learning: An updated review. Current Nutrition and Food Science, 13, 3-36.

7. Breakfast Trends • 38% of U.S. children report skipping breakfast (5% breakfast skipping in 1965) • 56% of low-income currently skip breakfast • Missing breakfast is associated with chronic disease, obesity, and diabetes • Skipping breakfast leads to hunger • Hunger leads to overeating • Overeating leads to obesity Murphy, J. (2007). Breakfast and learning: An updated review. Current Nutrition and Food Science, 13, 3-36.

8. Psychological Impact of Malnutrition • Poorer cognitive function • Decreased school attendance • Diminished academic achievement (Taras, 2005) • Lower grades in mathematics • More likely to repeat a grade • Increased school problems • Tardiness • Absence (Murphy, 2007). • Attention problems • Display for aggression • Depression • Anxiety (Kleinman, Murphy, &Little 1998). Kleinman, R., Murphy, J. & Little, M. (1998). Hunger in children in the United States: Potential behavioral and emotional correlates. Pediatrics, 101(1), e3. Murphy, J. (2007). Breakfast and learning: An updated review. Current Nutrition and Food Science, 13, 3-36. Taras, H. (2005, August). Nutrition and student performance at school. Journal of School Health, 75(6), 199-213.

9. Benefits of School Breakfast Programs • Physical benefits • Improved height to weight ratio • Decreased obesity • Better school attendance (Powel, Walker, Change, & Granthan-McGregor, 1998) • Mental benefits • Improved verbal skills • Improved math skills • Improved memory, creativity, and attention (Taras, 2005) • Behavioral benefits • Decreased hyperactivity • Decreased aggression (Dillon, 2010) Dillon, N. (2010, January). It’s the most important meal of the day, are your students getting what they need? American School Board Journal, 17-21. Powel, C., Walker, S., Chang, S., & Granthan-McGregor, S. (1998). Nutrition and education: A randomized trial of the effects of breakfast in rural primary school children. American Journal of Clinical Nutrition, 68, 873-879. Taras, H. (2005, August). Nutrition and student performance at school. Journal of School Health, 75(6), 199-213.

10. Types of Breakfast Foods are Important • Meals for home and bought from vendors • May be high in saturated fats and sugars • May be low in essential nutrients • Vending machines selling sugary drinks and snacks should be reduced or eliminated on campus • School breakfast programs based around hot meals • Pancakes and bacon are high in sugar and saturated fat • Ready to eat cereal (RTEC) with milk and fruit • Regular consumption linked to decreased BMI Rosado, J., Arellano, M., Montemayor, K., Garcia, O., & Caamano, M. (2008, September). An increase of cereal intake as an approach to weight reduction in a randomized controlled trial. Nutrition Journal, 7(28), 1-9.

11. RTEC ConsumptionAmong At-Risk Children • Four groups of children compared • Group 1 ate one meal of RTEC with milk per day • Group 2 ate two meals of RTEC with milk per day • Group 3 ate one meal of RTEC with milk per day with nutritional education • Group 4, the control group, had no intervention • After 12 weeks of evaluation • Only group 3 had statistically significant lower body mass average Rosado, J., Arellano, M., Montemayor, K., Garcia, O., & Caamano, M. (2008, September). An increase of cereal intake as an approach to weight reduction in a randomized controlled trial. Nutrition Journal, 7(28), 1-9.

12. Understanding Nutritionand Nutrition Education • 2 classes of 10th graders compared • Class 1 was provided with free breakfast every morning and nutrition education • Class 2 received only nutrition education • After 16 weeks of evaluation • Class 1 showed weight reduction toward a healthier BMI • Class 2 showed significant weight gain Ask, A., Hernes, S., Aarek, I., Johannessen, G., & Haugen, M. (2006, December). Changes in dietary pattern in 15 year old adolescents following a 4 month dietary intervention with school breakfast: A pilot study. Nutrition Journal, 5(33), 1-6.

13. Other Benefits of RTEC with Milk • Low in saturated fats and sugars • Provides ¼ RDA of energy • Proteins, carbohydrates • Vitamin A, vitamin C • Iron • Calcium Murphy, J. (2007). Breakfast and learning: An updated review. Current Nutrition and Food Science, 13, 3-36.

14. Barriers to Breakfast Eating at Home • Working parents lack time in the morning • Economic insecurity leads to food insecurity at home • Food insecurity effects 21% of U.S. children • 8% of U.S. children are chronically hungry Murphy, J. (2007). Breakfast and learning: An updated review. Current Nutrition and Food Science, 13, 3-36.

15. Barriers to Universal SchoolBreakfast Programs • Scheduling problems (Hentzler, 2010) • Lack of participation from: • Children • Parents • School staff (Greves, Lozano, Liu, Busby, Cole, & Johnston, 2007; Murphy, 2007) • Economic constraints Greves, H., Lozano, P., Liu, L., Busby, K., Cole, J., & Johnston, B. (2007, December). Immigrant families’ perception on walking to school and school breakfast: A focus group study. International Journal of Behavioral Nutrition and Physical Activity, 4(64), 1-9. Hentzler, J. (2010, January). Fuel for success: A strong nutrition program can help both your students and your district. American School Board Journal, 18-19. Murphy, J. (2007). Breakfast and learning: An updated review. Current Nutrition and Food Science, 13, 3-36.

16. Universal School Breakfast Program Solutions • Scheduling breakfast within the school day • Bus-riding children will not miss the meal • Breakfast participation could increase by 400% (Hentzler, 2010) • Involve children with meal program taste tests (Dillon, 2010; Greves et al., 2007) Dillon, N. (2010, January). It’s the most important meal of the day, are your students getting what they need? American School Board Journal, 17-21. Greves, H., Lozano, P., Liu, L., Busby, K., Cole, J., & Johnston, B. (2007, December). Immigrant families’ perception on walking to school and school breakfast: A focus group study. International Journal of Behavioral Nutrition and Physical Activity, 4(64), 1-9. Hentzler, J. (2010, January). Fuel for success: A strong nutrition program can help both your students and your district. American School Board Journal, 18-19.

17. Universal School Breakfast Program Solutions, continued • Economic concerns • Provision 2 (Dillon, 2010) • Universal School Breakfast Program (Hentzler, 2010) • Could increase participation by reducing stigma of subsidized meals • RTEC with milk and fruit • Provides needed nutrition • Easy to provide within the classroom • Minimal kitchen staff required to provide Dillon, N. (2010, January). It’s the most important meal of the day, are your students getting what they need? American School Board Journal, 17-21. Hentzler, J. (2010, January). Fuel for success: A strong nutrition program can help both your students and your district. American School Board Journal, 18-19.

18. Conclusion • Low socioeconomic status children are at risk for: • Obesity • Impaired cognitive function • Food insecurity • Also at risk for chronic health problems • behavioral problems • poor school performance • RTEC with milk and fruit • allows for a meal within the school day with minimum extra staff and cost

19. Sources for Additional Reading Alaimo, K., Olson, C., & Frongillo, E. (2001). Food insufficiency and American school-aged children’s cognitive, academic, and psychosocial development. Pediatrics, 108(1), 44-53. Child nutrition and WIC programs renewed (2009, December). State Legislatures, 35(10), 10. David, J. (2009, December). School meals and learning. Educational Leadership, 88-89. Murphy, J., Pagano, M., Nachman, J, Sperling, P., Kane, S., & Kleinman, R. (1998). The relationship of school breakfast to psychosocial and academic function: Cross-sectional and longitudinal observations in an inner-city school sample. Archives of Pediatric and Adolescent Medicine, 152, 899-907. Murphy, J., Wehler, C., Pagano, M., Kleinman, R., Little, M., & Jellinek, M. (1998). Relationship between hunger and psychosocial functioning in low-income American children. Journal of the American Academy on Child Adolescent Psychiatry, 37, 163-170.