Ni Mhurchu et al. BMC Public Health 2010, 10:738 http://www.biomedcentral.com/1471-2458/10/738 S T U D Y P R O T O C O L Open Access Effects of a free school breakfast programme on school attendance, achievement, psychosocial function, and nutrition: a stepped wedge cluster randomised trial Cliona Ni Mhurchu1*, Maria Turley1, Delvina Gorton1, Yannan Jiang1, Jo Michie1, Ralph Maddison1, John Hattie2 Abstract Background: Approximately 55,000 children in New Zealand do not eat breakfast on any given day. Regular breakfast skipping has been associated with poor diets, higher body mass index, and adverse effects on children’s behaviour and academic performance. Research suggests that regular breakfast consumption can improve academic performance, nutrition and behaviour. This paper describes the protocol for a stepped wedge cluster randomised trial of a free school breakfast programme. The aim of the trial is to determine the effects of the breakfast intervention on school attendance, achievement, psychosocial function, dietary habits and food security. Methods/Design: Sixteen primary schools in the North Island of New Zealand will be randomised in a sequential stepped wedge design to a free before-school breakfast programme consisting of non-sugar coated breakfast cereal, milk products, and/or toast and spreads. Four hundred children aged 5-13 years (approximately 25 per school) will be recruited. Data collection will be undertaken once each school term over the 2010 school year (February to December). The primary trial outcome is school attendance, defined as the proportion of students achieving an attendance rate of 95% or higher. Secondary outcomes are academic achievement (literacy, numeracy, self-reported grades), sense of belonging at school, psychosocial function, dietary habits, and food security. A concurrent process evaluation seeks information on parents’, schools’ and providers’ perspectives of the breakfast programme. Discussion: This randomised controlled trial will provide robust evidence of the effects of a school breakfast programme on students’ attendance, achievement and nutrition. Furthermore the study provides an excellent example of the feasibility and value of the stepped wedge trial design in evaluating pragmatic public health intervention programmes. Trial Registration Number: Australian New Zealand Clinical Trials Registry (ANZCTR) - ACTRN12609000854235 Background Up to one-fifth of New Zealand children leave for school without eating breakfast [1-3]. Missing breakfast is more common amongst older children, girls, Māori and Pacific children, and those living in lower socioeco- nomically resourced areas [2,3]. Missing breakfast has been associated with adverse effects on cognitive * Correspondence: c.nimhurchu@ctru.auckland.ac.nz 1Clinical Trials Research Unit, School of Population Health, Faculty of Medicine & Health Sciences, The University of Auckland, Private Bag 92019, Auckland 1142, New Zealand Full list of author information is available at the end of the article function (including memory), academic performance, school attendance, psychosocial function and mood in children and young people [4,5]. Conversely, breakfast consumption is associated with a range of positive out- comes, including better school attendance, academic performance, nutrient intake, fitness, and healthier body weight [6-8]. Breakfast contributes substantially to daily energy and nutrient intake. Breakfast provides 16% of New Zealand children’s daily energy intake, around one-third of cal- cium, iron, thiamine, riboflavin and folate intakes, and © 2010 Ni Mhurchu et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.