School Breakfast Policy Is Associated with Dietary Intake of Fourth- and Fifth-Grade Students.

BACKGROUND: Breakfast skipping has been associated with obesity. Schools have adopted breakfast policies to increase breakfast participation. Recently, there have been concerns that students in schools where breakfast is served in the classroom may be eating two breakfasts--one at home and one at school--thereby increasing their risk of excessive energy intake and weight gain. OBJECTIVE: The study objective was to compare the prevalence of not eating breakfast, eating breakfast at home or school only, and eating double breakfasts (home and school) by students in schools with distinct breakfast policies and evaluate the relationship of breakfast policy to energy intake and diet quality. DESIGN: Baseline data were collected in 2011-2012 as part of a cluster randomized controlled trial to evaluate the effectiveness of a school-based intervention to promote fruit and vegetable intake and physical activity in low-resource elementary schools in California. PARTICIPANTS/SETTING: Participants were 3,944 fourth and fifth graders from 43 schools, 20 served breakfast in the cafeteria before school, 17 served breakfast in the classroom at the start of school, and 6 served "second chance" breakfast (in the cafeteria before school and again at first recess). STATISTICAL ANALYSIS: As part of a secondary data analysis, differences in school and individual characteristics by school breakfast policy were assessed by χ(2) test of independence or analysis of variance. Associations between school breakfast policy and breakfast eating patterns were assessed. Outcomes included calorie intake at breakfast, total daily calorie intake, and diet quality as measured by the Healthy Eating Index 2010. Control variables included student race/ethnicity, grade, and language spoken at home, and clustering of students by school. RESULTS: Breakfast in the classroom was associated with fewer students not eating breakfast (P<0.001), but more eating breakfast at both home and school (P<0.001). Students in the breakfast in the classroom group did not have higher mean energy intakes from breakfast or higher daily energy intakes that were higher than other breakfast policy groups. The breakfast in the classroom group had higher overall diet quality (P=0.01). CONCLUSIONS: No evidence was found to support discontinuation of breakfast in the classroom policy on the basis of concerns that children will eat excess calories.

Eat lunch first or play first? Inconsistent associations with fruit and vegetable consumption in elementary school.

Scheduling play before eating lunch has been suggested as a relatively simple environmental strategy to increase fruit and vegetable (FV) intake among elementary school students. However, the few small studies to date have had mixed findings. The primary aim of this observational study was to evaluate the possible relationship between the relative order of play and eating and students' lunch intake of FV. A secondary aim was to examine whether any differences existed in this relationship by student sex, ethnicity, language spoken at home, and school lunch source. A diary-assisted 24-hour recall was collected during the 2011-2012 school year from 2,167 fourth- and fifth-graders attending 31 elementary schools in California. The association of play before eating with FV intake was estimated using Generalized Estimation Equations. Overall, lunch FV intake was not significantly higher for students who had a play-before-eating vs a play-after-eating lunch schedule at school. However, variables included in the model showed significant interaction with play before eating, resulting in the need for separate effect estimates for distinct strata based on sex, ethnicity, language spoken at home, and school lunch source. For 10 of the 16 strata, no significant effect of play before eating was observed on lunch FV intake, while increases in intake were observed in four strata and decreases in two strata. Before rescheduling play before eating for the purpose of improving student FV intake, additional research is recommended.

The Disruptive Behavior Rating Scale-Parent Version (DBRS-PV): Factor analytic structure and validity among young preschool children.

OBJECTIVE: Despite recognition that disruptive behavior disorders often begin early in development, existing assessment tools are largely based on research with school-aged children. Further empirical work is needed to evaluate the utility of these tools in younger children. METHODS: The present study investigated the factor structure, internal consistency, and validity of the Disruptive Behavior Rating Scale -Parent Version (DBRS-PV) in a sample of preschoolers. Participants included mothers and fathers of 261 three- to four-year-old children with and without behavior problems. RESULTS: Findings provide support for the use of the DBRS-PV as a measure of disruptive behavior disorder symptoms in this age group, with strong internal consistency and evidence of convergent/divergent and discriminative validity. CONCLUSIONS: Results provide evidence in favor of a two-factor (a. inattention/hyperactivity -impulsivity and b. oppositional defiant behaviors) and moderate support for a three-factor (a. inattention, b. hyperactivity -impulsivity, and c. oppositional defiant behaviors) conceptualization of attention and disruptive behavior disorder symptoms among preschool children.

Examining subtypes of behavior problems among 3-year-old children, Part II: investigating differences in parent psychopathology, couple conflict, and other family stressors.

This study examined family stressors among 3-year-old children who were classified as hyperactive (HYP), hyperactive and oppositional defiant (HYP/OD), and non-problem based on mothers' reports of behavior. Children with HYP/OD were found to experience higher levels of family stressors than non-problem children on almost every family stressor variable. Compared to children with HYP, families of children with HYP/OD also tended to report more Axis II maternal psychopathology, Axis I paternal psychopathology, and high intensity couple conflict tactics. However, the HYP and HYP/OD group did not significantly differ on maternal Axis I psychopathology, paternal Axis II psychopathology, parental marital status, negative life events, frequency of couple conflict, or use of lower intensity couple conflict tactics. Parents of children with HYP and HYP/OD reported more negative life events, more maternal adult ADHD symptoms, and more maternal avoidance and verbal aggression during marital conflict than parents of non-problem children. Implications for treatment and etiology are discussed.

Examining subtypes of behavior problems among 3-year-old children, Part I: investigating validity of subtypes and biological risk-factors.

This study examined 3-year-old children who were classified as hyperactive (HYP), oppositional-defiant (OD), hyperactive and oppositional defiant (HYP/OD), and non-problem based on mothers' reports of behavior. Using fathers,' teachers,' and observers' ratings of children's behavior, concurrent validity was excellent for the HYP/OD group, moderate for the HYP group, and poor for the OD group. As predicted, both the HYP/OD and HYP groups reported more prenatal/perinatal birth complications and a greater family history of hyperactivity than did non-problem children. Furthermore, the HYP/OD group showed a greater family history of conduct disorder and oppositional defiant disorder (ODD) symptoms than did non-problem children; however, the HYP group also showed a greater family history of ODD than did non-problem children. Results suggest that as early as age 3, these behavior subtypes appear to be linked to biologically-based risk-factors in ways that are consistent with theories of the development of ADHD.

Examining subtypes of behavior problems among 3-year-old children, Part III: investigating differences in parenting practices and parenting stress.

This study examined parenting of mothers and fathers of 3-year-old children who were classified as hyperactive (HYP), hyperactive and oppositional defiant (HYP/OD), and non-problem based on mothers' reports of behavior. Parents of children with HYP/OD were less warm, showed more negative affect, and more laxness than parents of non-problem children; however, contrary to prediction, they did not differ significantly from parents of children in the HYP group. Compared to mothers of non-problem children, mothers of children in the HYP/OD group reported significantly more parenting stress across all domains, whereas mothers of children in the HYP group only reported elevated levels of stress associated with having a difficult child. Theoretical and treatment implications are discussed.

Developmental and contextual influences on autonomic reactivity in young children.

Studies of cardiovascular reactivity in young children have generally employed integrated, physiologically complex measures, such as heart rate and blood pressure, which are subject to the multiple influences of factors such as blood volume, hematologic status, thermoregulation, and autonomic nervous system (ANS) tone. Reactivity studies in children have rarely employed more differentiated, proximal measures of autonomic function capable of discerning the independent effects of sympathetic and parasympathetic responses. We describe 1) the development, validity, and reliability of a psychobiology protocol assessing autonomic reactivity to challenge in 3- to 8-year-old children; 2) the influences of age, gender, and study context on autonomic measures; and 3) the distributions of reactivity measures in a normative sample of children and the prevalences of discrete autonomic profiles. Preejection period (PEP) and respiratory sinus arrythmia (RSA) were measured as indices of sympathetic and parasympathetic nervous system reactivity, respectively, and autonomic profiles were created to offer summative indices of PEP and RSA response. Results confirmed the protocol's validity and reliability, and showed differences in autonomic reactivity by age and study context, but not by gender. The studies' findings offer guidelines for future research on autonomic reactivity in middle childhood and support the feasibility of examining sympathetic and parasympathetic responses to challenge in 3- to 8-year-old children.