Decrease In Stigma Research Articles

Decrease in Stigma Towards Mental Illness in Portuguese Medical Students After a Psychiatry Course.

Stigma towards mental illness is considered a key obstacle to the provision of medical care to psychiatric patients. This is not only present in the general population but also among healthcare professionals. Therefore, medical students could be a target population for stigma prevention measures. The aim of this study is to assess the evolution of the attitudes of medical students from the Faculty of Medicine of the University of Coimbra towards psychiatric patients, before and after attending Psychology and Psychiatric courses. Students from the third and fourth years of the integrated Master's degree in Medicine in the Faculty of Medicine of the University of Coimbra were asked to complete four questionnaires. The surveys were distributed before and after the attendance of the courses. There was a statistically significant decrease of the stigma scores (p = 0.025) between the two measurements (38.16 initially, 36.72 on the second moment). The baseline level of stigma was found to be negatively associated with empathy (rP = -0.477) and with the type of personality, with higher levels of openness to new experiences being associated with lower levels of initial stigma (rP = -0.357). Overall, the students' attitudes towards patients with mental illness were positive, with a decrease of the stigma value from the first to the second semester. This corroborates the hypothesis that education and contact with people with a mental condition could shape positive changes in attitudes and discrimination against those patients. Our results emphasise the importance of implementing programs inside medical schools in order to reduce stigma among future doctors.

Specialization Within a Specialty: Advanced Practice Psychiatric Nursing Pathways for the Greatest Good.

Dr. Hildegard Peplau's theory on the primacy of the therapeutic interpersonal relationship remains central to the role of the psychiatric-mental health advanced practice nurse (PMH APN). In 1989, Peplau published her thoughts on how World War II (WWII) shaped early PMH APN practice. Following WWII and the return of hundreds of thousands of previously mentally healthy service members with combat-related psychiatric symptoms and disorders, the prevailing societal beliefs about mental illness began to shift from an innate/inherited etiological perspective to a broader appreciation of the additional contributions of social and environmental factors to mental well-being. With that awareness came a decrease in stigma and a shift from housing patients in psychiatric hospitals to treating them in community settings. The coronavirus 2019 (COVID-19) pandemic has likewise affected societal beliefs through exposure to the mental toll of massive infection rates, loss of life, social isolation, and other downstream consequences. During these times of crises, psychiatric nurses and educators are challenged to provide innovative solutions to meet the increased demands for psychosocial care. [Journal of Psychosocial Nursing and Mental Health Services, 59(10), 13-18.].

Perceived unit climate of support for mental health as a predictor of stigma, beliefs about treatment, and help-seeking behaviors among military personnel.

Employees in high-risk occupations can experience stigma associated with developing mental health problems and getting treatment for problems that can oftentimes be attributed to traumatic events encountered at work. The present study examined the perceived unit climate of support for mental health as a predictor of changes (over the course of 3 months) in the perceived stigma associated with seeking treatment, positive and negative attitudes toward treatment seeking, and a preference for handling mental health problem oneself, as well as talking with fellow unit members and a mental health professional about a mental health problem. Active-duty military personnel (N = 349 at Time 1, N = 112 matched at Time 2) completed measures assessing unit climate and individual beliefs about treatment at two points in time separated by 3 months. The results of structural equation modeling revealed strong evidence for perceived unit climate of support for mental health at Time 1 predicting a change in perceived stigma and attitudes toward treatment seeking at Time 2. A more positive perceived unit climate of support was associated with decreases in stigma, more positive attitudes toward treatment seeking, and less negative attitudes toward treatment seeking. Among those soldiers with a mental health problem (N = 164), a more positive perceived unit climate for mental health was associated with a greater likelihood of talking with a fellow unit member about the problem and receiving mental health treatment. Implications of the results for unit-level interventions in high-risk occupations are discussed. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

A Qualitative Study of Effectiveness of Hospital Based Parental Support Group in Managing Autism Spectrum Disorder

Management of autism spectrum disorder (ASD) involves long term intensive behavioural and educational therapies. Facilities for management of ASD are very meagre in India. Children with ASD pose tremendous burden and challenges for parents. Parents require support and guidance for managing their children’s problems. Thus, parent training in ASD can be an effective strategy for management of this enduring condition and is hereby described in this paper. Parent training in group setting was delivered once a month in department of Psychiatry of a tertiary care centre of North India. It was conducted by a trained psychiatrist, psychologist and social worker. In depth interviews were conducted for N = 12 parents who attended the sessions regularly for more than 6 months. Their narratives were noted down and qualitative analysis was done. Analysis revealed that the group parent training was helpful in multiple areas. The sessions gave support to parents in several ways such as increase in their knowledge, decrease in stigma and stress. With the help of professionals and other parents, they became more skilled in handling behaviour problems and learned techniques for enhancing their children’s communication and social interaction. Group parent intervention delivered at a frequency of once per month was highly beneficial for parents and their children with ASD. Group parent training can be an effective model for management of ASD in low resource settings.

Mental health stigma and undergraduate nursing students: A self-determination theory perspective

BackgroundClinical placements are essential in preparing students for professional practice. Given the serious negative impact of stigma on people with lived experiences of mental illness, it is essential to explore whether the educational setting of a clinical placement can influence mental health stigma. AimsUsing a Self-Determination Theory lens, this study aimed to examine whether the educational setting of a clinical placemen influences the stigma of undergraduate nursing students toward people with lived experiences of mental illness. DesignQuasi-experimental; pre-test post-test. MethodsNinety-nine undergraduate students enrolled in an accredited nursing program within Australia completed two surveys pre- and post-clinical placement. The surveys measured the educational setting (learning climate) and mental health stigma (social distance). FindingsStudents who partook in an Autonomy-Supportive mental health clinical placement reported a significant decrease in stigma from pre-to-post placement, whereas the Balanced/Neutral group reported a significant increase in stigma from pre-to-post-placement. DiscussionThe findings of this research have considerable implications for nursing facilitators and preceptors. Those that support autonomy amongst future nursing professionals are more likely to positively influence students’ mental health stigma. Those who do not promote an autonomy-supportive setting may actually worsen mental health stigma. ConclusionThe educational setting in which a clinical placement occurs can influence nursing students’ mental health stigma.

The Impact of Sports Activities on the Decrease of PLWHA Stigma and Social Values

Sports activities are activities that can be carried out by all groups with the aim of improving the quality of life in terms of physical fitness and psycho-social well-being. People who suffer from HIV/AIDS often get negative stigma and changes in social values. This study was aimed at determining the decrease in stigma and changes in the social value of PLWHA (people with HIV / AIDS) through futsal Rumah Cemara Bandung sports activities. The method used in this study was a comparative causal method (ex-post facto). Design of the study used criteria group. The technique of sampling in this study used convience sampling technique. The sample of this study consisted of 20 people divided into two groups: 10 PLWHA who were active in sports and 10 PLWHA who were not active in sports. Data collection process was conducted through face-to-face interview and structured questionnaire. Based on validity and reliability tests, researchers used an adopted questionnaire and discussed the questionnaire with the expert. Data analysis was conducted by using SPSS version 23 employing independent sample T-test. The results of this study indicate a decrease in stigma and changes in social values seen from T test with tcount ttable. The conclusions from the Stigma calculation was 3.439 2.10092 and Social Value was 3.730 2.10092. The result concludes that sports activities have an effect on reducing the stigma and changes in the Social Value of PLWHA.

Ebola virus disease-related stigma among survivors declined in Liberia over an 18-month, post-outbreak period: An observational cohort study.

BackgroundWhile qualitative assessments of Ebola virus disease (EVD)-related stigma have been undertaken among survivors and the general public, quantitative tools and assessment targeting survivors have been lacking.Methods and findingsBeginning in June 2015, EVD survivors from seven Liberian counties, where most of the country’s EVD cases occurred, were eligible to enroll in a longitudinal cohort. Seven stigma questions were adapted from the People Living with HIV Stigma Index and asked to EVD survivors over the age of 12 at initial visit (median 358 days post-EVD) and 18 months later. Primary outcome was a 7-item EVD-related stigma index. Explanatory variables included age, gender, educational level, pregnancy status, post-EVD hospitalization, referred to medical care and EVD source. Proportional odds logistic regression models and generalized linear mixed-effects models were used to assess stigma at initial visit and over time. The stigma questions were administered to 859 EVD survivors at initial visit and 741 (86%) survivors at follow-up. While 63% of survivors reported any stigma at initial visit, only 5% reported any stigma at follow-up. Over the 18-month period, there was a significant decrease in stigma among EVD survivors (Adjusted Odds Ratio [AOR], 0.02; 95% Confidence Interval [CI], 0.01–0.04). At initial visit, having primary, junior high or vocational education, and being referred to medical care was associated with higher odds of stigma (educational level: AOR, 1.82; 95%CI, 1.27–2.62; referred: AOR, 1.50; 95%CI, 1.16–1.94). Compared to ages of 20–29, those who had ages of 12–19 or 50+ experienced lower odds of stigma (12–19: AOR, 0.32; 95%CI, 0.21–0.48; 50+: AOR, 0.58 95%CI, 0.37–0.91).ConclusionsOur data suggest that EVD-related stigma was much lower more than a year after active Ebola transmission ended in Liberia. Among survivors who screened negative for stigma, additional probing may be considered based on age, education, and referral to care.

Exploring Mechanisms of Narrative Persuasion in a News Context: The Role of Narrative Structure, Perceived Similarity, Stigma, and Affect in Changing Attitudes

Two exploratory studies demonstrate, for the first time, that narrative persuasion can diminish the stigma attached to social groups featured in journalistic narratives. Study 1 shows narrative format improves stigma toward Syrian refugees indirectly through narrative engagement, perceived similarity, and meaningful affect. Decreases in stigma also improved attitudes toward refugees. Study 2 replicates these findings against a separate participant pool, an additional story topic, and compares changes in engagement, stigma, and attitude to a non-narrative fact sheet and a control condition. A preregistered third study seeks to validate the finding that narratives can elicit destigmatization and disentangle the roles of story exemplars from story structure.

Preliminary analysis of quality of life (QOL) before and after surgery for female genital fistula. A prospective cohort study

Aims: To describe the characteristics of women who come for repair of FGF, assess their QOL before & after surgery and estimate factors associated with improved quality of life.
 Methods: All women who came to LAMB for FGF repairin 2016 and 2017 were interviewed on admission and called for a follow-up visit 6 months after successful surgery. Sociodemographic, obstetric, and fistula-related information was collected on admission. Health related QOLwasmeasured using the 36-item short form (SF-36), and perception of stigma and discrimination were assessed on admission and at follow-up.
 Results: A total of 72 women were included.Mean age was 40.1 years, 49% had no education, and 42% were in the poorest wealth quintile.The mean stigma score (out of 7)went from 3.79 to 1.40 post surgery (p<0.001) and the mean discrimination score (out of 5)went from 2.2 to 0.4 (p<0.001). The mean score for all eight of the general health categories increased significantly after surgery (p<0.01 to 0.001). Poor women started lower but showed evidence of greater improvement in health related QOL compared to richer women (p<0.05)) and some evidence of greater improvement in discrimination (p<0.1). Women with no education had a larger decreasein perceived stigma (p= 0.03) compared to the educated.
 Conclusions: Surgery for FGF improves quality of life, with poor women showing greater increase in health related QOL and uneducated women reporting a greater decrease in stigma. Further multivariable analysis is needed to determine which factors remain associated with improved QOL.

Examining the Impact of This Is My Brave on Mental Illness Stigma and Willingness to Seek Help: A Pilot Study.

This Is My Brave (TIMB) is a contact-based mental illness stigma reduction program, set in theaters, meant to reduce stigma, increase beliefs about empowerment and recovery, and improve attitudes towards treatment seeking for mental health concerns. The authors conducted the first empirical evaluation of TIMB using a pre-post survey design. Approximately 481 audience members of TIMB performances were invited to complete a survey of stigmatizing attitudes towards mental illness, beliefs about recovery and empowerment, and willingness to seek treatment at pre-and post-performance. Analyses of responses from 372 participants using paired samples t-tests revealed changes in the desired direction on all variables from pre-test to post-test. Audience members experienced a decrease in stigma, improvements in beliefs about recovery and empowerment, and greater willingness to seek treatment. TIMB is a promising stigma-reduction program and there is a need for a more detailed investigation of the program's impact using more rigorous methodology.

Developments in Social and Clinical Research and Treatment of Gender Dysphoria Relevant for Sexuality Experts

Gender dysphoria (GD) previously called gender identity disorder (GID), refers to a discomfort with one’s gender assigned at birth and persistent identification with the opposite gender. Individuals who have gender dysphoria typically have an experienced gender identity that differs significantly from the physical, biological or assigned gender at birth, and may consider changing their gender role, and feminize or masculinize their body to achieve greater comfort with their self and identity, thereby identifying as transgender. The second author was a pioneer psychologist/sex therapist serving as a consultant for patients seeking transgender surgery, to assess their emotional status. Patients with this issue have presented to sexuality experts in increased numbers, an increasing number of plastic surgery centers now offer services, the approach has evolved, and several social factors have affected traditional stigma and silence. In an historic move, the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) published in 2013 removed “gender identity disorder” as a diagnosis, and changed this to “gender dysphoria”. This removed “gender identity” as an illness to treat and, affirmed gender identity as “diversity”. Since then, gender identity was no longer assessed along a continuum of normal or abnormal. The number of sexuality experts seeing such patients has increased. Public places, college campuses and even businesses have responded to this and other trends, with unisex services and approaches. With increased publicity about transgender persons, (e.g., the legendary Olympic icon Bruce Jenner’s transition to Caitlin), public attitudes have led to increased awareness and some decrease in stigma.

Reducing Mental Health Stigma : The Relationship between Knowledge and Attitude Change

The Relationship between Knowledge and Attitude Change: The impact of how knowledge can effect attitude change is important in order to understand the consequences for stigma. The relationship between increasing subject knowledge of mental health and attitude change was explored. The sample comprised 39 students (18 male and 21 female)from a university in the West Midlands. Participants’ level of knowledge and stigma were recorded through pre- and post-tests using the Mental Health Knowledge Schedule (MAKS), Community Attitudes toward the Mentally Ill (CAMI) and the Opinions about Mental Illness (OMI) scale. Information about mental illness was provided between conditions followed by a distractor task. Responses were calculated and combined to give an overall score. A sign test with continuity correction was used to see whether there was a difference in attitudes. The pre- and post-test conditions were scored. Results demonstrate a statistically significant median decrease in stigma in the post-test condition (p = 0.03). Therefore, this research provides support for the success of providing knowledge and information about mental illness in order to reduce stigma.

Can a clinical placement influence stigma? An analysis of measures of social distance

BackgroundThe way people who experience mental illness are perceived by health care professionals, which often includes stigmatising attitudes, can have a significant impact on treatment outcomes and on their quality of life. ObjectiveTo determine whether stigma towards people with mental illness varied for undergraduate nursing students who attended a non-traditional clinical placement called Recovery Camp compared to students who attended a ‘typical’ mental health clinical placement. DesignQuasi-experimental. ParticipantsSeventy-nine third-year nursing students were surveyed; n=40 attended Recovery Camp (intervention), n=39 (comparison group) attended a ‘typical’ mental health clinical placement. MethodsAll students completed the Social Distance Scale (SDS) pre- and post-placement and at three-month follow-up. Data analysis consisted of a one-way repeated measures analysis of variance (ANOVA) exploring parameter estimates between group scores across three time points. Two secondary repeated measures ANOVAs were performed to demonstrate the differences in SDS scores for each group across time. Pairwise comparisons demonstrated the differences between time intervals. ResultsA statistically significant difference in ratings of stigma between the intervention group and the comparison group existed. Parameter estimates revealed that stigma ratings for the intervention group were significantly reduced post-placement and remained consistently low at three-month follow-up. There was no significant difference in ratings of stigma for the comparison group over time. ConclusionsStudents who attended Recovery Camp reported significant decreases in stigma towards people with a mental illness over time, compared to the typical placement group. Findings suggest that a therapeutic recreation based clinical placement was more successful in reducing stigma regarding mental illness in undergraduate nursing students compared to those who attended typical mental health clinical placements.

Association Between Participation in HIV/ AIDS Peer Group, Stigma, Discrimination, and Quality Life of People Living with HIV/ AIDS

Background: The quality of life of people living with HIV/ AIDS (PLH) is of public health concern and calls for attention. The quality of life of PLH may be affected by stigma and discrimination. Peer group of PLHs may have an important role in improving the quality of life of PLHs. This study aimed to investigate the association between participation in HIV/ AIDS peer group, stigma, discrimination, and quality of life of PLHs. Subjects and Method: This was an analytic and observational study with cross sectional design. This study was conducted in Tulungagung, East Java, from November, 2016 to January, 2017. A total of 65 PLHs participating in HIV/ AIDS peer group and 35 PLHs not participating in HIV/ AIDS peer group were selected for this study by fixed exposure sampling. The dependent variable was quality of life of PLHs. The independent variables were participation in HIV/ AIDS peer group, stigma, and discrimination. The data were collected by a set of questionnaire and analyzed by path analysis model. Results: Participation in HIV/ AIDS peer group (b=0.27; p=<0.001), social support (b=0.43; p=<0.001), and family support (b=0.18 p=0.021), had positive associations with a decrease in stigma and discrimination towards PLHs. Higher income (b=0.33; p=0.026), higher education level (b=0.21; p=<0.001), less stigma and discrimination (b=0.33; p=<0.001), had positive associations with quality of life of PLHs. Core self evalution showed positive association with quality of life of PLHs (b=0.31; p=<0.001). Conclusion: Participation in HIV/ AIDS peer group, social support, and family support, are positively associated with a decrease in stigma and discrimination towards PLHs. Higher income, higher education, less stigma and discrimination, are positively associated with quality of life of PLHs. Core self evalution is positively associated with quality of life of PLHs. Keywords: HIV/ AIDS peer group, stigma, discrimination, social support, family support, quality of life Correspondence: Mia Ashari Kurniasari. Masters Program in Public Health, Sebelas Maret University, Surakarta. Email: Deandagelis@gmail.com. Mobile: 0851216175293. Journal of Epidemiology and Public Health (2016), 1(2): 125-132 https://doi.org/10.26911/jepublichealth.2016.01.02.06

Does mental health stigma change across the deployment cycle?

Prior research on mental health stigma in military personnel has been cross-sectional. We prospectively examined the course of perceived mental health stigma in a cohort of deployed U.S. combat Marines. Participants (N = 768) were assessed 1 month before a 7-month deployment to Afghanistan, and again at 1, 5, and 8 months postdeployment. We also examined three predictors of the course of stigma: post-traumatic stress disorder symptom severity, vertical and horizontal unit cohesion, and mental health treatment utilization while deployed. Perceptions of stigma remained largely stable across the deployment cycle, with latent growth curve analyses revealing a statistically significant but small decrease in stigma over time. Lower post-traumatic stress disorder symptoms and greater perceived vertical and horizontal support predicted decreases in stigma over time, whereas mental health treatment utilization in theater did not predict the course of stigma. Perceived stigma was low and largely stable over time.

Abortion providers, stigma and professional quality of life

ObjectivesThe Providers Share Workshop (PSW) provides abortion providers safe space to discuss their work experiences. Our objectives were to assess changes in abortion stigma over time and explore how stigma is related to aspects of professional quality of life, including compassion satisfaction, burnout and compassion fatigue for providers participating in the workshops. Study DesignSeventy-nine providers were recruited to the PSW study. Surveys were completed prior to, immediately following and 1 year after the workshops. The outcome measures were the Abortion Provider Stigma Survey and the Professional Quality of Life (ProQOL) survey. Baseline ProQOL scores were compared to published averages using t tests. Changes in abortion stigma and aspects of professional quality of life were assessed by fitting a two-level random-effects model with repeated measures at level 1 (period-level) and static measures (e.g., demographic data) at level 2 (person-level). Potential covariates included age, parenting status, education, organizational tenure, job type and clinic type (stand-alone vs. hospital-based clinics). ResultsCompared to other healthcare workers, abortion providers reported higher compassion satisfaction (t=2.65, p=.009) and lower burnout (t=5.13, p<.0001). Repeated-measures analysis revealed statistically significant decreases in stigma over time. Regression analysis identified abortion stigma as a significant predictor of lower compassion satisfaction, higher burnout and higher compassion fatigue. ConclusionsParticipants in PSW reported a reduction in abortion stigma over time. Further, stigma is an important predictor of compassion satisfaction, burnout and compassion fatigue, suggesting that interventions aimed at supporting the abortion providing workforce should likely assess abortion stigma. ImplicationsStigma is an important predictor of compassion satisfaction, burnout and compassion fatigue among abortion care providers. Therefore, strengthening human resources for abortion care requires stigma reduction efforts. Participants in the PSWs show reductions in stigma over time.

Characteristics linked to the reduction of stigma towards schizophrenia: a pre-and-post study of parents of adolescents attending an educational program

BackgroundThe stigma of schizophrenia constitutes a major barrier to early detection and treatment of this illness. Anti-stigma education has been welcomed to reduce stigma among the general public. This study examined the factors associated with the effectiveness of a web-based educational program designed to reduce the stigma associated with schizophrenia.MethodsUsing Link’s Devaluation-Discrimination Scale to measure stigma, the effect of the program was measured by the difference in pre- and post-program tests. In the present study, we focused on program participants whose stigma towards schizophrenia had considerably improved (a reduction of three points or more between pre- and post-program tests) or considerably worsened (an increase of three points or more). The study participants were 1,058 parents of middle or high school students across Japan, including 508 whose stigma had significantly decreased after the program and 550 whose stigma had significantly increased. We used multiple logistic regression analysis to predict a considerable reduction in stigma (by three or more points) using independent variables measured before exposure to the program. In these models, we assessed the effects of demographic characteristics of the participants and four measures of knowledge and views on schizophrenia (basic knowledge, Link’s Devaluation-Discrimination Scale, ability to distinguish schizophrenia from other conditions, and social distance).ResultsParticipants’ employment status, occupation, basic knowledge of schizophrenia, pre-program Link’s Devaluation-Discrimination Scale score, and social distance were significant factors associated with a considerable decrease in the stigma attached to schizophrenia following the educational program. Specifically, full-time and part-time employees were more likely to experience reduced stigma than parents who were self-employed, unemployed, or had other employment status. Considerable decreases in stigma were more likely among parents working in transportation and communication or as homemakers than among other occupational groups. In addition, parents with higher pre-program levels of stigma, lower basic knowledge, or lower social distance were more likely to have reduced levels of stigma.ConclusionsBased on the regression analysis results presented here, several possible methods of reducing stigma were suggested, including increasing personal contact with people with schizophrenia and the improvement of law and insurance systems in primary and secondary industries.

Intangible outcomes from a policy change: using contingent valuation to quantify potential stigma from a cannabis offence

Objective New policies are increasingly required to be evaluated. One form of evaluation is a cost–benefit analysis where inputs and outcomes are all valued monetarily. However, intangible outcomes are often not included in these evaluations as they are perceived to be too difficult to value. The aim of this paper is to value one of the intangible benefits (decrease in stigma) from a potential change in drug policy using contingent valuation.

Identifying self-perceived HIV-related stigma in a population accessing antiretroviral therapy

This study identifies factors associated with self-perceived HIV-related stigma (stigma) among a cohort of individuals accessing antiretroviral therapy in British Columbia, Canada. Data were drawn from the Longitudinal Investigations into Supportive and Ancillary Health Services study, which collects social, clinical, and quality of life (QoL) information through an interviewer-administered survey. Clinical variables (i.e., CD4 count) were obtained through linkages with the British Columbia HIV/AIDS Drug Treatment Program. Multivariable linear regression was performed to determine the independent predictors of stigma. Our results indicate that among participants with high school education or greater the outcome stigma was associated with a 3.05 stigma unit decrease (95% CI: −5.16, −0.93). Having higher relative standard of living and perceiving greater neighborhood cohesion were also associated with a decrease in stigma (−5.30 95% CI: −8.16, −2.44; −0.80 95% CI: −1.39, −0.21, respectively). Lower levels of stigma were found to be associated with better QoL measures, including perceiving better overall function (−0.90 95% CI: −1.47, −0.34), having fewer health worries (−2.11 95% CI: −2.65, −1.57), having fewer financial worries (−0.67 95% CI: −1.12, −0.23), and having less HIV disclosure concerns (−4.12 95% CI: −4.63, −3.62). The results of this study show that participants with higher education level, better QoL measures, and higher self-reported standards of living are less likely to perceive HIV-related stigma.

Not Just for Poor Kids: The Impact of Universal Free School Breakfast on Meal Participation and Student Outcomes

This paper examines the impact of the adoption of a universal free breakfast policy on student breakfast participation, attendance, and academic achievement. We examine a 2003 New York City policy change that made school breakfast free for all students regardless of income while increasing the price of lunch for those who pay full price. Using a difference-in-difference estimation strategy, we derive plausibly causal estimates of the policy’s impact by exploiting within and between group variation in school meal pricing before and after the policy change. We conduct school-level analyses of the policy’s impact on breakfast participation, and student-level analyses to explore the impact on attendance and test scores. Our estimates suggest that universal free breakfast increased breakfast participation both for students who experienced a decrease in the price of breakfast and for free-lunch eligible students who experienced no price change. The latter suggests that universal provision may alter behavior through mechanisms other than price, perhaps through a decrease in stigma, highlighting the potential merits of universal provision over and above targeted services. Our analysis also suggests that the policy change had a small positive effect on attendance for black and Asian students.