Serving Breakfast Free to All Students and Type of Breakfast Serving Model Are Associated with Participation in the School Breakfast Program

Experiences participating in federal nutrition assistance programs during the early months of the COVID-19 pandemic: an investigation in Vermont

BACKGROUND

Federal nutrition assistance programs serve as safety nets for many American households, and participation has been linked to increased food security and, in some instances, improved diet quality and mental health outcomes. The COVID-19 pandemic brought new and increased economic, social, and psychological challenges, necessitating inquiry into how nutrition assistance programs are functioning and associated with public health outcomes.

METHODS

Using data from a representative statewide survey administered in Vermont (n = 600) between July and September 2020, we examined participant experiences with major federal nutrition assistance programs: the Supplemental Nutrition Assistance Program (SNAP), the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), and school meal programs. We explored quantitative and qualitative responses regarding perceptions of program utility, and used nearest neighbors matching analyses in combination with bivariate statistical tests to assess associations between program participation and food insecurity, perceived stress, and fruit and vegetable intake as indicators of dietary quality.

RESULTS

One in four respondents (27.3%) used at least one federal nutrition assistance program. As compared to non-participants, we found higher rates of food insecurity among program participants (57.5% vs. 18.1%; p < 0.001), an association that persisted even when we compared similar households using matching techniques (p ≤ 0.001). From matched analyses, we found that, compared to low-income non-participants, low-income program participants were less likely to meet fruit intake recommendations (p = 0.048) and that low-income SNAP and WIC participants were less likely to meet vegetable intake recommendations (p = 0.035). We also found lower rates of perceived stress among low-income school meal participant households compared to low-income non-participants (p = 0.039). Despite these mixed outcomes, participants broadly valued federal nutrition assistance programs, characterizing them as helpful or easy to use.

CONCLUSIONS

We found that federal nutrition assistance programs as a group were not sufficient to address food insecurity and stress or increase fruit and vegetable intake in the state of Vermont during the early months of the COVID-19 pandemic. Nonetheless, participants perceived benefits from participation in these programs. Optimizing the utility of nutrition assistance programs depends on critical examination of their functioning under conditions of great stress.

Alternative School Breakfast Service Models and Associations with Breakfast Participation, Diet Quality, Body Mass Index, Attendance, Behavior, and Academic Performance: A Systematic Review

The United States (US) School Breakfast Program provides Breakfast After The Bell (BATB) to alleviate hunger, provide nutrition, and ensure students have a healthy start to the day. This study aims to review the evidence regarding the impact of BATB on students' diet and academic outcomes, including participation, diet quality and consumption, body mass index (BMI) and weight status, attendance, classroom behavior, and academic performance. The articles were extracted from three electronic databases and published since the start of the literature through December 2022. Studies were peer-reviewed; quantitative research articles or government reports; and conducted in public or private elementary, middle, and high schools. Quality was assessed using the Newcastle-Ottawa Scale. Thirty-seven studies were included in this review. This review found BATB increased school breakfast participation, improved diet quality, and improved classroom behavior particularly among students from racial and ethnic minority backgrounds and students eligible for free or reduced-price meals. The impact of BATB on BMI and weight status, academic achievement and attendance was mixed. This review is particularly timely given free school meals and updated school nutrition standards are being prioritized over the next decade in the US. Thus, it is important to evaluate the nutritional and educational outcomes of BATB. (PROSPERO registration: CRD42021289719).

Alternative Service Methods Associated With Increased Participation in the School Breakfast Program

BACKGROUND

School breakfast programs (SBP) play an important role in reducing food insecurity and helping provide children with adequate nutrition. Using alternative service methods such as breakfast in the classroom, grab and go, and second chance breakfast may increase student participation.

METHODS

We compared the SBP participation of students in 194 Pennsylvania schools that received a mini-grant to support the implementation of an alternative service method to participation in the academic year prior to implementation. In addition, we examined SBP participation in 90 schools that did not receive such a mini-grant to determine the change in participation in these schools over the 2-year period and compared this to the change in participation in schools that did receive a mini-grant.

RESULTS

Overall, SBP participation in schools that received the mini-grant increased over the 2-year study period, a change that was not seen in schools that did not receive the mini-grant. The largest increases were seen in schools that implemented the breakfast in the classroom model.

CONCLUSIONS

Alternative service methods, particularly breakfast in the classroom, are associated with increased participation in the SBP and therefore increase access to adequate nutrition and food security for school children.

Evaluation of Delivering Breakfast After the Bell and Academic Performance Among Third-Grade Children: An Application of the Synthetic Control Method

BACKGROUND

Breakfast after the bell (BAB), an alternative way to deliver breakfast after the school day begins, has been shown to increase participation in the School Breakfast Program. However, BAB occupies time that could otherwise be used for instruction and may affect academic performance. This study examined whether BAB affects math and literacy scores in third grade, an age not adequately studied in earlier literature.

METHODS

Using data on Arkansas students, we compared schools adopting BAB to corresponding "synthetic" control schools by minimizing preadoption differences in observables that can influence test scores.

RESULTS

We found little evidence of positive or negative effects on test scores. We also found little evidence of meaningful program effects over subsamples of schools by district enrollment size and BAB delivery method. Schools that adopted grab-and-go delivery and schools in districts with small enrollments, less than 600 students, showed statistically negative effects on math after BAB adoption. However, these effects were transitory and no longer present by the time the first fully exposed cohort reached third grade.

CONCLUSIONS

BAB can be incorporated into the school day without adversely impacting academic achievement, especially if adopting schools seek input from educators and nutrition personnel already experienced with BAB.

Associations between a Universal Free Breakfast Policy and School Breakfast Program Participation, School Attendance, and Weight Status: A District-Wide Analysis

Breakfast consumption among youth is associated with improved diet quality, weight, cognition, and behavior. However, not all youth in the United States consume breakfast. Participation in the School Breakfast Program (SBP) is also low relative to the lunch program. Universal free breakfast (UFB) policies have been implemented to increase breakfast participation by reducing cost and stigma associated with the SBP. This study examined whether a UFB policy implemented in a school district in the Southeast US was associated with changes in breakfast participation, school attendance, and student weight. A longitudinal study of secondary data was conducted, and a mixed modeling approach was used to assess patterns of change in SBP participation. General linear models were used to assess attendance and student weight change. On average, across schools in the district, there was an increase in breakfast participation of 4.1 percentage points following the implementation of the policy. The change in breakfast participation in schools differed by the percent of students in the school who received school meals for free or at a reduced price, the percent of students of color, and the grade level of the school. Increases in SBP participation were not associated with significant changes in attendance or weight. UFB policies may be effective in increasing participation in the SBP.

Increased School Breakfast Participation from Policy and Program Innovation: The Community Eligibility Provision and Breakfast after the Bell

School meals provide significant access to food and nutrition for children and adolescents, particularly through universal free meal mechanisms. Alongside added nutritional meal requirements under the Healthy, Hunger-Free Kids Act (2010), schools can utilize meal program and policy mechanisms such as the Community Eligibility Provision (CEP) and Breakfast after the Bell (BATB) to increase participation. This study examines longitudinal statewide school-level CEP and BATB adoption and estimates the impact on increased free and reduced-price (FRP) breakfast participation. We find that FRP breakfast participation increased for schools that utilize both CEP and BATB (14-percentage-point increase) and that CEP-participating schools are more likely to use BATB approaches such as breakfast in the classroom, grab-and-go carts, and second-chance breakfast. Additionally, using a conditional Difference-in-Differences (DiD) approach, we find that BATB adoption accounted for a 1.4-percentage-point increase in FRP school breakfasts served (p < 0.05). Study findings can inform policy and school official decision making around the policy and program mechanisms at their disposal to increase school meal participation and student nutrition.

Breakfast and School-Related Outcomes in Children and Adolescents in the US: A Literature Review and its Implications for School Nutrition Policy

PURPOSE OF REVIEW

To identify and review the latest research on the connections between breakfast and school-related outcomes in children and adolescents in the US, and to explore the implications of this research on US school nutrition policy, particularly as it applies to students experiencing or at risk for food insecurity.

RECENT FINDINGS

Although school personnel, parents, and students have positive attitudes about breakfast and its benefits for learning, recent research finds mixed evidence for the role of breakfast in improving objectively measured grades and test scores. Few recent studies examined behavioral outcomes, limiting the ability to draw clear conclusions about breakfast and school behavior. Several studies observed improved attendance with increased school breakfast access and participation, especially when schools offered breakfast at no cost to all students. There are many challenges to studying the connections between breakfast and learning. The recent research on breakfast and academic outcomes is mixed, but there is a growing body of evidence that eliminating fees for both school breakfast and lunch has promise for improving school-related outcomes.

Prevalence of Evidence-Based School Meal Practices and Associations with Reported Food Waste across a National Sample of U.S. Elementary Schools

Providing meals at school is an important part of the hunger safety net for children in the United States and worldwide; however, many children do not receive school meals even when they qualify for federally-subsidized free or reduced-priced meals. This study investigates the prevalence of several evidence-based practices that have previously been shown to increase the reach and impact of school meals. A survey was sent to a national sample of US elementary schools, with items examining practices regarding school breakfast, school lunch, recess, the promotion of meals, nutrition standards, and food waste, during the 2019-20 school year. Almost all schools that offered lunch also offered breakfast. More than 50% used a breakfast service strategy other than cafeteria service, such as grab-and-go breakfast meals. Providing at least 30 min for lunch periods and providing recess before lunch were reported by less than half of schools. About 50% of schools reported using only one or fewer meal promotional strategies (such as taste tests) throughout the school year. Use of more promotional strategies was associated with less reported food waste in a multivariable regression model accounting for school demographic characteristics. Findings show that some evidence-based practices for school meals are being implemented, but many recommendations are not being widely adopted.

Universal School Meals and Associations with Student Participation, Attendance, Academic Performance, Diet Quality, Food Security, and Body Mass Index: A Systematic Review

The school environment plays an important role in children's diets and overall health, and policies for universal free school meals have the potential to contribute to positive child health outcomes. This systematic review evaluates studies examining the association between universal free school meals and students' school meal participation rates, diets, attendance, academic performance, and Body Mass Index (BMI), as well as school finances. The search was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA). A search for studies published in economically developed countries published through December 2020 was performed in PubMed, Education Resources Information Center (ERIC), Thomson Reuters' Web of Science, and Academic Search Ultimate, followed by examining the references in the resultant literature. A total of 47 studies were identified and the Newcastle-Ottawa Scale (NOS) was applied to assess bias. Nearly all studies examining universal free school meals found positive associations with school meal participation. Most studies examining universal free school meals that included free lunch found positive associations with diet quality, food security, and academic performance; however, the findings of studies examining only universal free breakfast were mixed. Research findings were similarly mixed when examining attendance as an outcome. Concerns about adverse outcomes on student BMI were not supported by the literature; in fact, several studies detected a potentially protective effect of universal free school meals on BMI. Research examining the impact of universal free meals on school finances was limited, but suggest that lower-income school districts in the U.S. may have positive financial outcomes from participation in universal free school meal provisions. Additionally, providing free meals to students may be associated with improved household incomes, particularly among lower-income families with children. Further research is needed to examine the financial implications of universal free meals for both school districts and families. Overall, universal free school meals may have multiple benefits for students and countries should consider universal free school meal provisions with strong nutrition guidelines. (PROSPERO registration: CRD42020221782).

The Role of District Wellness Policies in Encouraging Student Participation in the School Breakfast Program, United States

Eating breakfast is associated with better academic performance and nutrition and lower risk of obesity, but skipping breakfast is common among children and adolescents, and participation in the U.S. Department of Agriculture's School Breakfast Program (SBP) is low. This study assessed the association between school district wellness policy provisions coded as part of the National Wellness Policy Study and student SBP participation and acceptance of the breakfasts provided using cross-sectional survey data from the School Nutrition and Meal Cost Study. Separate survey-adjusted multivariable logistic regressions were computed, linking students eating (N = 1575) and liking (N = 726) the school breakfast to corresponding district policy measures, controlling for school and student characteristics. Strong district policy, as opposed to no policy, was associated with significantly higher odds of students eating the school breakfast (odds ratio (OR): 1.86; 95% CI: 1.09, 3.16; p = 0.022), corresponding to an adjusted prevalence of 28.4% versus 19.2%, and liking the school breakfast (OR: 2.14; 95% CI: 1.26, 3.63; p = 0.005), corresponding to an adjusted prevalence of 69.0% versus 53.9%. District policy has the potential to play an important role in encouraging higher levels of SBP participation.

Breakfast in the Classroom Initiative and Students' Breakfast Consumption Behaviors: A Group Randomized Trial

Objectives. To identify the effect of a Breakfast in the Classroom (BIC) initiative on the foods and drinks students consume in the morning.Methods. Sixteen public schools in Philadelphia, Pennsylvania, that provide universal breakfast participated in a group randomized trial to examine the effects of BIC with complementary nutrition promotion between 2013 and 2016. Control schools (n = 8) offered breakfast in the cafeteria before school. Baseline data were collected from 1362 students in grades 4 to 6. Endpoint data were collected after 2.5 years. Students self-reported the foods and drinks they consumed in the morning.Results. At endpoint, there was no effect of the intervention on breakfast skipping. Nearly 30% of intervention students consumed breakfast foods or drinks from multiple locations, as compared with 21% of control students. A greater proportion of intervention students than control students consumed 100% juice, and a smaller proportion consumed sugar-sweetened beverages and foods high in saturated fat and added sugar.Conclusions. A BIC initiative led to improvements in the types of foods and drinks students consumed in the morning. However, the program did not reduce breakfast skipping and increased the number of locations where students ate.

Universal Access to Free School Meals through the Community Eligibility Provision Is Associated with Better Attendance for Low-Income Elementary School Students in Wisconsin

BACKGROUND

Beginning in 2014-2015, schools nationwide have had the option of offering free meals to all students in qualifying schools through the Community Eligibility Provision (CEP). The CEP has been linked to greater likelihood of eating school meals, but little is known about its impact on broader outcomes.

OBJECTIVE

The purpose of this study was to estimate the association between the CEP and school attendance among elementary school students (grades 1 to 5).

DESIGN

This was a quasi-experimental study in which students' attendance records were observed over 1 baseline and 2 follow-up years in a sample of CEP and eligible non-CEP schools.

PARTICIPANTS/SETTING

The participants were elementary school students in Wisconsin during three consecutive school years beginning 2013-2014. The main sample included 92,126 observation-years for students in 37 CEP and 108 eligible non-CEP elementary schools.

INTERVENTION

CEP-participating schools offered breakfast and lunch free to all students through the School Breakfast Program and the National School Lunch Program beginning in 2014-2015.

MAIN OUTCOME MEASURES

The outcome measures were the attendance rate (defined as the percentage of school days attended) and low attendance (defined as attending fewer than 95% of available days) during the first and second implementation years.

STATISTICAL ANALYSES PERFORMED

Difference-in-difference regression models with student fixed effects were estimated, with separate impacts for the first and second CEP years. Models adjusted for time-varying school and student characteristics.

RESULTS

Implementing the CEP had no association with attendance in the initial year. The second year of CEP was associated with a 3.5 percentage point reduction in the percentage of students with low attendance (P=0.045). An association between CEP and attendance was only found for economically disadvantaged students.

CONCLUSIONS

Offering meals free to all students through the CEP may modestly reduce the risk of low attendance among economically disadvantaged students in participating schools.