- Email: [email protected]
Eating breakfast regularly is related to higher school connectedness and academic performance in Canadian middle- and high-school students
p u b l i c h e a l t h 1 4 5 ( 2 0 1 7 ) 1 2 0 e1 2 3
Available online at www.sciencedirect.com
Public Health journal homepage: www.elsevier.com/puhe
Short Communication
Eating breakfast regularly is related to higher school connectedness and academic performance in Canadian middle- and high-school students H. Sampasa-Kanyinga a,b,*, H.A. Hamilton c,d a
Ottawa Public Health, 100 Constellation Crescent, Ottawa, ON K2G 6J8, Canada School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, ON K1H 8M5, Canada c Centre for Addiction and Mental Health, 33 Russell St., 5th Floor, Toronto, ON M5S 2S1, Canada d Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada b
article info Article history: Received 6 September 2016 Received in revised form 30 November 2016 Accepted 18 December 2016
Introduction Research studies have documented the benefits of breakfast consumption on school performance.1 Youth who eat breakfast perform better academically1 and those who skip breakfast have been found to report poor academic performance.2 School connectedness refers to the belief among students that teachers and other adults within the school care about them as individuals and about their learning3 According to Catalano and Hawkins,4 school connectedness results from students' attachment and commitment to school and their involvement in it. The Social Development Model posits that
children learn patterns of behavior from their social environments (e.g. school) and a social bond is formed between them and others within the social environment once there is consistency in the socializing process.4 School connectedness is an important factor in both health and learning, and research studies have shown that students who feel connected to school are more likely to have a number of positive health and academic outcomes. Given that eating breakfast has been shown to have positive effects on children's cognitive performance, mental health and emotional well-being, eating breakfast can be expected to improve both school connectedness and academic performance.5 To date, research is lacking that empirically examines the association between breakfast consumption and school connectedness. Evidence of such an association would inform future prevention strategies. The objective of this study is to investigate the association between breakfast consumption and school connectedness and to extend previous research on the association between breakfast consumption and academic performance by providing a Canadian examination of this association using a large and diverse sample of middle- and high-school students. It is hypothesized that (1) students who eat breakfast regularly would have higher school connectedness and academic performance; (2) school connectedness would moderate the link between breakfast consumption and academic performance.
* Corresponding author. Ottawa Public Health, 100 Constellation Crescent, Ottawa, ON K2G 6J8, Canada. Tel.: þ1 613 580 6744; fax: þ1 613 580 9601. E-mail address: [email protected] (H. Sampasa-Kanyinga). http://dx.doi.org/10.1016/j.puhe.2016.12.027 0033-3506/© 2016 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.
p u b l i c h e a l t h 1 4 5 ( 2 0 1 7 ) 1 2 0 e1 2 3
Data were obtained from the 2013 cycle of the Ontario Student Drug Use and Health Survey, a province-wide repeated cross-sectional school-based survey of students in grades 7e12.6 The Ontario Student Drug Use and Health Survey uses a two-stage (school, class) stratified (region and school type) cluster sample design. The 2013 total sample was 10,272 students from 42 school boards, 198 schools, and 671 classrooms. The student response rate was 63%, which is above average for a survey of students that requires active parental consent. Absenteeism (11%) and lack of parental consent (26%) were the reasons for non-response. All participants provided their own assent, in addition to parental signed consent for those under 18 years of age. The study design and methods are described in detail elsewhere.6 School connectedness was measured based on students' agreement with the following three statements: ‘I feel close to people at this school’, ‘I feel like I am part of this school’, and ‘I feel safe in my school.’ Response options ranged from strongly agree 1 to strongly disagree 4. Responses were reverse coded, summed, and dichotomized, with scores less than or equal to one standard deviation below the mean classified as disconnected to school and higher scores classified as connected to school. Regular breakfast consumers were those students who ate breakfast on all five days and less regular breakfast consumers were those who ate breakfast less frequently. Academic performance was treated as a binary measure indicating whether the students achieved good marks (70%e100%) vs poor marks (below 70%). Statistical analyses accounted for the complex sample design of the survey and were restricted to the participants with complete information on all variables included in the present study, except parent education level and body mass index (BMI) (n ¼ 9912; 93%). Internal consistency of the school connectedness items was tested using Cronbach's alpha reliability test. Confirmatory factor analysis was performed to assess the overall fit of the three school connectedness items as one factor (i.e. all three items loading on a single factor). Model fit is considered to be acceptable if standardized root meanesquared residual)dwhich is the average of the differences between the observed and predicted correlationsdis near 0, with values of less than 0.08 indicating good fit,7 and if coefficient of determination is near 1. Logistic regression analyses were used to examine the associations between breakfast consumption and each of the outcome variables of school connectedness and academic performance. Covariates included age, sex, ethnicity, socioeconomic status (SES), parental education level, and BMI. Two-way interactions were used to test interactions between age and eating breakfast, and between sex and eating breakfast for each outcome, and between school connectedness and eating breakfast for the outcome of academic performance.
Results The school connectedness items demonstrated a satisfactory Cronbach alpha of 0.71. Results from confirmatory factor analysis indicated that a single factor 3-item construct had an acceptable overall fit based on the size of residuals' indices (standardized root meanesquared residual <0.001 and
121
coefficient of determination ¼ 0.79). These results point to a good measure of school connectedness among middle- and high-school students, providing further support for its use in children and adolescent surveys. Results from multivariate logistic regression analyses examining the associations between regular breakfast consumption with school connectedness and students' academic performance are provided in Table 1. After adjusting for covariates, regular breakfast consumption was significantly associated with greater odds of high levels of school connectedness (adjusted odds ratio (AOR) ¼ 1.42; 95% confidence interval (CI) ¼ 1.16e1.74) and academic performance (AOR ¼ 1.63; 95% CI ¼ 1.21e2.20). Age and sex were not significant moderators of the observed associations, and school connectedness was not a significant moderator of the association between breakfast consumption and academic performance. The link between eating breakfast and academic performance remained significant after further adjustment for school connectedness (AOR ¼ 1.58; 95% CI ¼ 1.18e2.13). Moreover, high levels of school connectedness were associated with greater odds of positive school performance (AOR ¼ 1.81; 95% CI ¼ 1.44e2.27).
Discussion This study examined empirically the associations between breakfast consumption and school connectedness and academic performance in a large and diverse sample of middleand high-school students. Results suggest that students who eat breakfast regularly are at greater odds of higher school connectedness and academic performance than those who eat breakfast on a less regular basis. Although students who feel connected to their school reported higher school performance than those who had low levels of school connectedness, the relationship between eating breakfast and academic performance did not differ by school connectedness levels. These results are congruent with those of previous studies reporting positive association between breakfast consumption and academic performance among adolescents.1 Current results extend previous findings by showing that this association is independent of levels of school connectedness. Current findings that regular breakfast consumption is related to school connectedness are somewhat consistent with those from a previous study that indicated that adolescents from food insufficient households are more likely to be suspended from school and have more difficulty getting along with other children.8 Irregular breakfast consumption is a very complex construct that is likely a result of a complicated mix of factors, such as low SES families, irregular parental breakfast consumption, dissatisfaction with body weight, mental health problems (e.g. depressive symptoms), being bullied, wide range of risk behaviors, and so forth.2,9,10 However, the fact that the present study documented a positive association between breakfast consumption and school connectedness even after adjustment for confounders, does not exclude the possibility of residual confounding which may be related to unmeasured factors, such as parental breakfast eating behavior. Although breakfast consumption is known to
122
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Table 1 e Associations between breakfast consumption and school connectedness and academic performance, 2013 OSDUHS. Sample (n ¼ 9912)
School connectedness
Academic performance unadjusted for school connectedness
Academic performance adjusted for school connectedness
% (95% CI)
OR (95% CI)
OR (95% CI)
OR (95% CI)
1 1.42 (1.16e1.74)
1 1.63 (1.21e2.20)
1 1.58 (1.18e2.13)
0.87 (0.84e0.91)
0.87 (0.54e0.69)
0.93 (0.84e1.02)
0.63 (0.54e0.72) 1
0.60 (0.52e0.69) 1
2.05 (1.64e2.56) 1
1 0.69 (0.53e0.90) 1.07 (0.86e1.33)
1 0.70 (0.54e0.90) 1.05 (0.85e1.31)
1 0.66 (0.44e0.96) 1.76 (1.21e2.58)
0.97 (0.77e1.21) 0.82 (0.67e1.01)
0.95 (0.76e1.18) 0.84 (0.68e1.03)
1.55 (1.08e2.23) 0.57 (0.44e0.74)
0.77 (0.63e0.95) 1
0.77 (0.62e0.96) 1
0.56 (0.42e0.76) 1
1.09 (1.06e1.11)
1.08 (1.05e1.11)
1.11 (1.07e1.16)
1 0.93 (0.74e1.18) 0.69 (0.57e0.84) 1.02 (0.68e1.54)
1 0.92 (0.73e1.17) 0.68 (0.56e0.83) 1.02 (0.67e1.55)
1 1.24 (0.91e1.70) 1.04 (0.71e1.51) 0.96 (0.59e1.66)
Breakfast consumption Less regular 44.8 (42.7e46.9) Regular 55.2 (53.1e57.3) Age (years) Mean (95% CI) 15.2 (15.1e15.4) Sex Female 48.6 (46.4e50.8) Male 51.4 (49.2e53.6) Ethnicity White 59.2 (55.3e63.1) Black 6.2 (5.2e7.4) East/Southeast 10.2 (8.4e12.2) Asian South Asian 10.6 (8.2e13.7) Other 13.7 (12.2e15.4) Subjective SES Low 29.8 (27.7e32.0) High 70.2 (68.0e72.3) Parental education level (years) Mean (95% CI) 13.9 (13.7e14.0) BMI Normal 70.2 (68.6e71.7) Overweight 15.8 (14.7e17.0) Obese 10.3 (9.3e11.4) Not stated 3.7 (3.0e4.6) School connectedness Low 14.8 (13.5e16.3) High 85.2 (83.7e86.5) Academic performance Below 70% 10.5 (8.8e12.5) 70%e100% 89.5 (87.5e91.2)
1 1.81 (1.44e2.27)
OR: adjusted odds ratio; CI: confidence interval; SES: socioeconomic status; BMI: body mass index; OSDUHS: Ontario Student Drug Use and Health Survey.
improve academic performance via increase of cognitive performance, the underlying mechanism supporting the relationship between breakfast consumption and school connectedness remains to be clarified. Important limitations of the study are worth noting. First, the possibility of residual confounding by unmeasured variables, such as income and single parent status in this case, is always a possibility in observational studies. For example, income variables were not available within the data set. Given that breakfast skipping is sometimes related to a lack of money to buy food for the household, future studies should consider including such covariates to account for possible effects of poverty or low income on breakfast skipping. Second, although this study used a large and diverse sample of middle- and high-school students, the student noncompletion rate due to absenteeism and lack of parental consent may have biased the sample to some degree. Third, the sample was restricted to students within regular school systems and, therefore does not represent approximately 8% of the students. Another limitation is related to the crosssectional design of this study, which limits the ability to
make causal inferences about the observed relationships. Finally, the survey is based on self-reported data with its potential for desirability bias.
Conclusion The present study addresses gaps in the literature by providing supporting evidence for the association between regular breakfast consumption and higher school connectedness and academic performance among middle- and high-school students. These findings have important implications for the development of health promotion and prevention programs. Given that school connectedness plays a key role in academic performance, decreasing risky behavior, and supporting mental health and emotional wellbeing,10 public health efforts are needed to foster greater connectedness. Future research using prospective designs is needed to better ascertain the direction of the association between breakfast consumption and school connectedness in youth.
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Author statements Ethical approval Ethics approval was obtained from the Research Ethics Boards of the Centre for Addiction and Mental Health, York University, and the school boards.
Funding The Ontario Student Drug Use and Health Survey, a Centre for Addiction and Mental Health initiative, was funded in part through ongoing support from the Ontario Ministry of Health and Long-Term Care, as well as targeted funding from several provincial agencies.
Competing interests None declared.
references
1. Adolphus K, Lawton CL, Dye L. The effects of breakfast on behavior and academic performance in children and adolescents. Front Hum Neurosci 2013;7:425.
123
2. Lien L. Is breakfast consumption related to mental distress and academic performance in adolescents? Public Health Nutr Apr 2007;10(4):422e8. 3. Wingspread Declaration on School Connections. Wingspread declaration on school connections. J Sch Health 2004;74:2. 4. Catalano RF, Haggerty KP, Oesterle S, Fleming CB, Hawkins JD. The importance of bonding to school for healthy development: findings from the Social Development Research Group. J Sch Health Sep 2004;74(7):252e61. 5. Basch CE. Breakfast and the achievement gap among urban minority youth. J Sch Health Oct 2011;81(10):635e40. 6. Boak A, Hamilton HA, Adlaf EM, Mann RE. Drug use among Ontario students: 1977e2013. Detailed OSDUHS findings (CAMH Research Document Series No. 36). Toronto, ON. 2013. 7. Bentler PM, Yuan KH. Structural equation modeling with small samples: test statistics. Multivar Behav Res Apr 1 1999;34(2):181e97. 8. Alaimo K, Olson CM, Frongillo Jr EA. Food insufficiency and American school-aged children's cognitive, academic, and psychosocial development. Pediatrics Jul 2001;108(1):44e53. 9. Sampasa-Kanyinga H, Willmore J. Relationships between bullying victimization psychological distress and breakfast skipping among boys and girls. Appetite Jun 1 2015;89:41e6. 10. Bond L, Butler H, Thomas L, Carlin J, Glover S, Bowes G, et al. Social and school connectedness in early secondary school as predictors of late teenage substance use, mental health, and academic outcomes. J Adolesc Health Apr 2007;40(4):357. e359e318.
Available online at www.sciencedirect.com
Public Health journal homepage: www.elsevier.com/puhe
Short Communication
Eating breakfast regularly is related to higher school connectedness and academic performance in Canadian middle- and high-school students H. Sampasa-Kanyinga a,b,*, H.A. Hamilton c,d a
Ottawa Public Health, 100 Constellation Crescent, Ottawa, ON K2G 6J8, Canada School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, ON K1H 8M5, Canada c Centre for Addiction and Mental Health, 33 Russell St., 5th Floor, Toronto, ON M5S 2S1, Canada d Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada b
article info Article history: Received 6 September 2016 Received in revised form 30 November 2016 Accepted 18 December 2016
Introduction Research studies have documented the benefits of breakfast consumption on school performance.1 Youth who eat breakfast perform better academically1 and those who skip breakfast have been found to report poor academic performance.2 School connectedness refers to the belief among students that teachers and other adults within the school care about them as individuals and about their learning3 According to Catalano and Hawkins,4 school connectedness results from students' attachment and commitment to school and their involvement in it. The Social Development Model posits that
children learn patterns of behavior from their social environments (e.g. school) and a social bond is formed between them and others within the social environment once there is consistency in the socializing process.4 School connectedness is an important factor in both health and learning, and research studies have shown that students who feel connected to school are more likely to have a number of positive health and academic outcomes. Given that eating breakfast has been shown to have positive effects on children's cognitive performance, mental health and emotional well-being, eating breakfast can be expected to improve both school connectedness and academic performance.5 To date, research is lacking that empirically examines the association between breakfast consumption and school connectedness. Evidence of such an association would inform future prevention strategies. The objective of this study is to investigate the association between breakfast consumption and school connectedness and to extend previous research on the association between breakfast consumption and academic performance by providing a Canadian examination of this association using a large and diverse sample of middle- and high-school students. It is hypothesized that (1) students who eat breakfast regularly would have higher school connectedness and academic performance; (2) school connectedness would moderate the link between breakfast consumption and academic performance.
* Corresponding author. Ottawa Public Health, 100 Constellation Crescent, Ottawa, ON K2G 6J8, Canada. Tel.: þ1 613 580 6744; fax: þ1 613 580 9601. E-mail address: [email protected] (H. Sampasa-Kanyinga). http://dx.doi.org/10.1016/j.puhe.2016.12.027 0033-3506/© 2016 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.
p u b l i c h e a l t h 1 4 5 ( 2 0 1 7 ) 1 2 0 e1 2 3
Data were obtained from the 2013 cycle of the Ontario Student Drug Use and Health Survey, a province-wide repeated cross-sectional school-based survey of students in grades 7e12.6 The Ontario Student Drug Use and Health Survey uses a two-stage (school, class) stratified (region and school type) cluster sample design. The 2013 total sample was 10,272 students from 42 school boards, 198 schools, and 671 classrooms. The student response rate was 63%, which is above average for a survey of students that requires active parental consent. Absenteeism (11%) and lack of parental consent (26%) were the reasons for non-response. All participants provided their own assent, in addition to parental signed consent for those under 18 years of age. The study design and methods are described in detail elsewhere.6 School connectedness was measured based on students' agreement with the following three statements: ‘I feel close to people at this school’, ‘I feel like I am part of this school’, and ‘I feel safe in my school.’ Response options ranged from strongly agree 1 to strongly disagree 4. Responses were reverse coded, summed, and dichotomized, with scores less than or equal to one standard deviation below the mean classified as disconnected to school and higher scores classified as connected to school. Regular breakfast consumers were those students who ate breakfast on all five days and less regular breakfast consumers were those who ate breakfast less frequently. Academic performance was treated as a binary measure indicating whether the students achieved good marks (70%e100%) vs poor marks (below 70%). Statistical analyses accounted for the complex sample design of the survey and were restricted to the participants with complete information on all variables included in the present study, except parent education level and body mass index (BMI) (n ¼ 9912; 93%). Internal consistency of the school connectedness items was tested using Cronbach's alpha reliability test. Confirmatory factor analysis was performed to assess the overall fit of the three school connectedness items as one factor (i.e. all three items loading on a single factor). Model fit is considered to be acceptable if standardized root meanesquared residual)dwhich is the average of the differences between the observed and predicted correlationsdis near 0, with values of less than 0.08 indicating good fit,7 and if coefficient of determination is near 1. Logistic regression analyses were used to examine the associations between breakfast consumption and each of the outcome variables of school connectedness and academic performance. Covariates included age, sex, ethnicity, socioeconomic status (SES), parental education level, and BMI. Two-way interactions were used to test interactions between age and eating breakfast, and between sex and eating breakfast for each outcome, and between school connectedness and eating breakfast for the outcome of academic performance.
Results The school connectedness items demonstrated a satisfactory Cronbach alpha of 0.71. Results from confirmatory factor analysis indicated that a single factor 3-item construct had an acceptable overall fit based on the size of residuals' indices (standardized root meanesquared residual <0.001 and
121
coefficient of determination ¼ 0.79). These results point to a good measure of school connectedness among middle- and high-school students, providing further support for its use in children and adolescent surveys. Results from multivariate logistic regression analyses examining the associations between regular breakfast consumption with school connectedness and students' academic performance are provided in Table 1. After adjusting for covariates, regular breakfast consumption was significantly associated with greater odds of high levels of school connectedness (adjusted odds ratio (AOR) ¼ 1.42; 95% confidence interval (CI) ¼ 1.16e1.74) and academic performance (AOR ¼ 1.63; 95% CI ¼ 1.21e2.20). Age and sex were not significant moderators of the observed associations, and school connectedness was not a significant moderator of the association between breakfast consumption and academic performance. The link between eating breakfast and academic performance remained significant after further adjustment for school connectedness (AOR ¼ 1.58; 95% CI ¼ 1.18e2.13). Moreover, high levels of school connectedness were associated with greater odds of positive school performance (AOR ¼ 1.81; 95% CI ¼ 1.44e2.27).
Discussion This study examined empirically the associations between breakfast consumption and school connectedness and academic performance in a large and diverse sample of middleand high-school students. Results suggest that students who eat breakfast regularly are at greater odds of higher school connectedness and academic performance than those who eat breakfast on a less regular basis. Although students who feel connected to their school reported higher school performance than those who had low levels of school connectedness, the relationship between eating breakfast and academic performance did not differ by school connectedness levels. These results are congruent with those of previous studies reporting positive association between breakfast consumption and academic performance among adolescents.1 Current results extend previous findings by showing that this association is independent of levels of school connectedness. Current findings that regular breakfast consumption is related to school connectedness are somewhat consistent with those from a previous study that indicated that adolescents from food insufficient households are more likely to be suspended from school and have more difficulty getting along with other children.8 Irregular breakfast consumption is a very complex construct that is likely a result of a complicated mix of factors, such as low SES families, irregular parental breakfast consumption, dissatisfaction with body weight, mental health problems (e.g. depressive symptoms), being bullied, wide range of risk behaviors, and so forth.2,9,10 However, the fact that the present study documented a positive association between breakfast consumption and school connectedness even after adjustment for confounders, does not exclude the possibility of residual confounding which may be related to unmeasured factors, such as parental breakfast eating behavior. Although breakfast consumption is known to
122
p u b l i c h e a l t h 1 4 5 ( 2 0 1 7 ) 1 2 0 e1 2 3
Table 1 e Associations between breakfast consumption and school connectedness and academic performance, 2013 OSDUHS. Sample (n ¼ 9912)
School connectedness
Academic performance unadjusted for school connectedness
Academic performance adjusted for school connectedness
% (95% CI)
OR (95% CI)
OR (95% CI)
OR (95% CI)
1 1.42 (1.16e1.74)
1 1.63 (1.21e2.20)
1 1.58 (1.18e2.13)
0.87 (0.84e0.91)
0.87 (0.54e0.69)
0.93 (0.84e1.02)
0.63 (0.54e0.72) 1
0.60 (0.52e0.69) 1
2.05 (1.64e2.56) 1
1 0.69 (0.53e0.90) 1.07 (0.86e1.33)
1 0.70 (0.54e0.90) 1.05 (0.85e1.31)
1 0.66 (0.44e0.96) 1.76 (1.21e2.58)
0.97 (0.77e1.21) 0.82 (0.67e1.01)
0.95 (0.76e1.18) 0.84 (0.68e1.03)
1.55 (1.08e2.23) 0.57 (0.44e0.74)
0.77 (0.63e0.95) 1
0.77 (0.62e0.96) 1
0.56 (0.42e0.76) 1
1.09 (1.06e1.11)
1.08 (1.05e1.11)
1.11 (1.07e1.16)
1 0.93 (0.74e1.18) 0.69 (0.57e0.84) 1.02 (0.68e1.54)
1 0.92 (0.73e1.17) 0.68 (0.56e0.83) 1.02 (0.67e1.55)
1 1.24 (0.91e1.70) 1.04 (0.71e1.51) 0.96 (0.59e1.66)
Breakfast consumption Less regular 44.8 (42.7e46.9) Regular 55.2 (53.1e57.3) Age (years) Mean (95% CI) 15.2 (15.1e15.4) Sex Female 48.6 (46.4e50.8) Male 51.4 (49.2e53.6) Ethnicity White 59.2 (55.3e63.1) Black 6.2 (5.2e7.4) East/Southeast 10.2 (8.4e12.2) Asian South Asian 10.6 (8.2e13.7) Other 13.7 (12.2e15.4) Subjective SES Low 29.8 (27.7e32.0) High 70.2 (68.0e72.3) Parental education level (years) Mean (95% CI) 13.9 (13.7e14.0) BMI Normal 70.2 (68.6e71.7) Overweight 15.8 (14.7e17.0) Obese 10.3 (9.3e11.4) Not stated 3.7 (3.0e4.6) School connectedness Low 14.8 (13.5e16.3) High 85.2 (83.7e86.5) Academic performance Below 70% 10.5 (8.8e12.5) 70%e100% 89.5 (87.5e91.2)
1 1.81 (1.44e2.27)
OR: adjusted odds ratio; CI: confidence interval; SES: socioeconomic status; BMI: body mass index; OSDUHS: Ontario Student Drug Use and Health Survey.
improve academic performance via increase of cognitive performance, the underlying mechanism supporting the relationship between breakfast consumption and school connectedness remains to be clarified. Important limitations of the study are worth noting. First, the possibility of residual confounding by unmeasured variables, such as income and single parent status in this case, is always a possibility in observational studies. For example, income variables were not available within the data set. Given that breakfast skipping is sometimes related to a lack of money to buy food for the household, future studies should consider including such covariates to account for possible effects of poverty or low income on breakfast skipping. Second, although this study used a large and diverse sample of middle- and high-school students, the student noncompletion rate due to absenteeism and lack of parental consent may have biased the sample to some degree. Third, the sample was restricted to students within regular school systems and, therefore does not represent approximately 8% of the students. Another limitation is related to the crosssectional design of this study, which limits the ability to
make causal inferences about the observed relationships. Finally, the survey is based on self-reported data with its potential for desirability bias.
Conclusion The present study addresses gaps in the literature by providing supporting evidence for the association between regular breakfast consumption and higher school connectedness and academic performance among middle- and high-school students. These findings have important implications for the development of health promotion and prevention programs. Given that school connectedness plays a key role in academic performance, decreasing risky behavior, and supporting mental health and emotional wellbeing,10 public health efforts are needed to foster greater connectedness. Future research using prospective designs is needed to better ascertain the direction of the association between breakfast consumption and school connectedness in youth.
p u b l i c h e a l t h 1 4 5 ( 2 0 1 7 ) 1 2 0 e1 2 3
Author statements Ethical approval Ethics approval was obtained from the Research Ethics Boards of the Centre for Addiction and Mental Health, York University, and the school boards.
Funding The Ontario Student Drug Use and Health Survey, a Centre for Addiction and Mental Health initiative, was funded in part through ongoing support from the Ontario Ministry of Health and Long-Term Care, as well as targeted funding from several provincial agencies.
Competing interests None declared.
references
1. Adolphus K, Lawton CL, Dye L. The effects of breakfast on behavior and academic performance in children and adolescents. Front Hum Neurosci 2013;7:425.
123
2. Lien L. Is breakfast consumption related to mental distress and academic performance in adolescents? Public Health Nutr Apr 2007;10(4):422e8. 3. Wingspread Declaration on School Connections. Wingspread declaration on school connections. J Sch Health 2004;74:2. 4. Catalano RF, Haggerty KP, Oesterle S, Fleming CB, Hawkins JD. The importance of bonding to school for healthy development: findings from the Social Development Research Group. J Sch Health Sep 2004;74(7):252e61. 5. Basch CE. Breakfast and the achievement gap among urban minority youth. J Sch Health Oct 2011;81(10):635e40. 6. Boak A, Hamilton HA, Adlaf EM, Mann RE. Drug use among Ontario students: 1977e2013. Detailed OSDUHS findings (CAMH Research Document Series No. 36). Toronto, ON. 2013. 7. Bentler PM, Yuan KH. Structural equation modeling with small samples: test statistics. Multivar Behav Res Apr 1 1999;34(2):181e97. 8. Alaimo K, Olson CM, Frongillo Jr EA. Food insufficiency and American school-aged children's cognitive, academic, and psychosocial development. Pediatrics Jul 2001;108(1):44e53. 9. Sampasa-Kanyinga H, Willmore J. Relationships between bullying victimization psychological distress and breakfast skipping among boys and girls. Appetite Jun 1 2015;89:41e6. 10. Bond L, Butler H, Thomas L, Carlin J, Glover S, Bowes G, et al. Social and school connectedness in early secondary school as predictors of late teenage substance use, mental health, and academic outcomes. J Adolesc Health Apr 2007;40(4):357. e359e318.