Impacts of the Primary School Free Breakfast Initiative on socio-economic inequalities in breakfast consumption among 9-11-year-old schoolchildren in Wales

Objectives: Universal interventions may widen or narrow inequalities if disproportionately effective among higher or lower socio-economic groups. The present paper examines impacts of the Primary School Free Breakfast Initiative in Wales on inequalities in children's dietary behaviours and cognitive functioning. Design: Cluster-randomised controlled trial. Responses were linked to free school meal (FSM) entitlement via the Secure Anonymised Information Linkage databank. Impacts on inequalities were evaluated using weighted school-level regression models with interaction terms for intervention 3 whole-school percentage FSM entitlement and intervention 3 aggregated individual FSM entitlement. Individual-level regression models included interaction terms for intervention 3 individual FSM entitlement. Setting: Fifty-five intervention and fifty-six wait-list control primary schools. Subjects: Approximately 4500 children completed measures of dietary behaviours and cognitive tests at baseline and 12-month follow-up. Results: School-level models indicated that children in intervention schools ate a greater number of healthy items for breakfast than children in control schools (b = 0.25; 95% CI 0.07, 0.44), with larger increases observed in more deprived schools ( interaction term b=1.76; 95% CI 0.36, 3.16). An interaction between intervention and household-level deprivation was not significant. Despite no main effects on breakfast skipping, a significant interaction was observed, indicating declines in breakfast skipping in more deprived schools ( interaction term b=-0.07; 95% CI -0.15, -0.00) and households (OR = 0.67; 95% CI 0.46, 0.98). No significant influence on inequality was observed for the remaining outcomes. Conclusions: Universal breakfast provision may reduce socio-economic inequalities in consumption of healthy breakfast items and breakfast skipping. There was no evidence of intervention-generated inequalities in any outcomes.