Lindsay Mitchell points out that there is a lot of uncertainty in a report on the KickStart Breakfast programme in Lots of ‘ifs’ and ‘maybes’
The report: KickStart Breakfasts and Indicators of Child Health in Linked Administrative Data
The existing evidence base
International evidence is that eating a healthy breakfast can lead to improvements in academic performance, appears to improve overall diet quality, and may protect against weight gain.
Existing New Zealand evidence establishes that school breakfast programmes reduce student hunger. Small New Zealand studies suggest provision of milk in schools increases the proportion of children meeting recommended guidelines for dairy intake and improves bone health.
Results from international and New Zealand studies assessing whether school feeding programmes have positive impacts on other student outcomes are mixed, but generally positive.
Evidence from research on dairy consumption and child health suggest that school food programmes that boost dairy intake could have positive effects on a range of measures of child health, with the potential to improve oral and bone health in particular.
What this study adds
This study was commissioned to provide a quantitative assessment of the impact of the KickStart programme on students’ outcomes. The Statistics New Zealand Integrated Data Infrastructure was used in this study.
Informed by the existing evidence base, and by the data available, we focussed on measures of students’ oral and bone health.
We found that after controlling for a range of other factors, students aged under 13 enrolled in schools and kura with higher uptake of KickStart – measured in terms of the average number of breakfasts served per student, per week across three school years – were significantly less likely than their peers to have hospital outpatient visits for dental
surgery.Etc.
But there is a lot of uncertainty. Mitchell points out some ifs and maybes.
“We see no evidence of a significant association between KickStart intensity and the two administrative indicators of fracture. One possible explanation is that KickStart intensity had no association with bone health. Another is that students who received more KickStart were more active as a result of increased energy intake. Falls may have increased at the same time as the likelihood of fracture upon falling was reduced as a result of improvements in bone health.”.
-KickStart may have improved the nutritional quality of the breakfasts consumed by students. This mechanism is suggested by a study by Bhattacharya et al. (2006) which examined the United States School Breakfast Program.
-The effect of the breakfasts may have been to displace consumption of unhealthy snack foods, including sugary food and drinks, as suggested by the cross-sectional study conducted by Utter and colleagues (2007).
– Reduced pressure on home budgets as a result of KickStart may have allowed families and whānau to purchase higher quality foods to eat at other times of the day and week. Such spillover effects are suggested by the Bhattacharya et al. (2006) study, which found that both adults and preschool children had healthier diets and lower percentages of calories from fat when the School Breakfast Program was available to school-aged children in the household.
If Kickstart caused improvements in diet and caused sugary food and drinks to be displaced, this would suggest that benefits might also include reduced obesity and improvements in learning, health and development (Thornley et al., 2017a), including reductions in rheumatic fever (Thornley et al., 2017b).
There are more uncertainties:
We are unable to draw conclusions about the degree to which reduced outpatient visits for dental surgery were caused by KickStart alone.
…there are plausible mechanisms that could link KickStart and reduced hospital outpatient visits for dental surgery
The limited information available through existing linked de-identified administrative data meant that we were unable to examine some of these wider potential benefits.
No clear association was found between increased exposure to KickStart and administratively sourced measures indicative of bone fractures in students aged under 13.
And that’s before getting to the Introduction. Jumping to…
Conclusion
Schools and kura are overwhelmingly positive about the KickStart programme and report positive effects on students’ health and wellbeing and engagement with school. Our analysis of linked administrative data shows that after controlling for a range of confounders, students enrolled in schools and kura with higher uptake of KickStart – measured in terms of the average number of breakfasts served per student per week across three school years – are significantly less likely than their peers to have hospital outpatient visits for dental surgery.
While plausible causal mechanisms exist, we are unable to draw conclusions about the degree to which this association reflects the causal impact of KickStart.
A report that is unable to draw conclusions seems of limited use.