Altering the School Breakfast Environment Reduces Barriers to School Breakfast Participation Among Diverse Rural Youth

Partnerships and Community Engagement Key to Policy, Systems, and Environmental Achievements for Healthy Eating and Active Living: a Systematic Mapping Review

INTRODUCTION

Policy, systems, and environmental (PSE) change approaches frequently address healthy eating and active living (HEAL) priorities. However, the health effects of PSE HEAL initiatives are not well known because of their design complexity and short duration. Planning and evaluation frameworks can guide PSE activities to generate collective impact. We applied a systematic mapping review to the Individual plus PSE Conceptual Framework for Action (I+PSE) to describe characteristics, achievements, challenges, and evaluation strategies of PSE HEAL initiatives.

METHODS

We identified peer-reviewed articles published from January 2009 through January 2021 by using CINAHL, Web of Science, MEDLINE, PsycINFO, and CAB Abstracts databases. Articles describing implementation and results of PSE HEAL initiatives were included. Activities were mapped against I+PSE components to identify gaps in evaluation efforts.

RESULTS

Independent reviewers examined 437 titles and abstracts; 52 peer-reviewed articles met all inclusion criteria. Twenty-four focused on healthy eating, 5 on active living, and 23 on HEAL. Descriptive analyses identified federal funding of initiatives (typically 1-3 years), multisector settings, and mixed-methods evaluation strategies as dominant characteristics. Only 11 articles reported on initiatives that used a formal planning and evaluation framework. Achievements focused on partnership development, individual behavior, environmental or policy changes, and provision of technical assistance. Challenges included lack of local coalition and community engagement in initiatives and evaluation activities and insufficient time and resources to accomplish objectives. The review team noted vague or absent descriptions of evaluation activities, resulting in questionable characterizations of processes and outcomes. Although formation of partnerships was the most commonly reported accomplishment, I+PSE mapping revealed a lack of engagement assessment and its contributions toward initiative impact.

CONCLUSION

PSE HEAL initiatives reported successes in multiple areas but also challenges related to partnership engagement and community buy-in. These 2 areas are essential for the success of PSE HEAL initiatives and need to be adequately evaluated so improvements can be made.

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.

Addressing Equity in Rural Schools: Opportunities and Challenges for School Meal Standards Implementation

BACKGROUND

Few studies examine why rural public schools have weaker policies and practices related to school nutrition environments compared to their urban counterparts. It is important to understand this disparity because federal school meal standards aim for children to access health-promoting nutrition environments. In this study, we identify challenges and opportunities for the implementation of school meal standards in rural high schools.

METHODS

We interviewed 38 rural school professionals from 22 high schools across 7 states. School professionals included food service directors, principals, school nurses, and teachers. Team coding in Atlas.ti Qualitative Data Analysis software v8 and principles of comparative analysis were employed to generate themes related to challenges and opportunities.

RESULTS

Overall, school professionals described improvements with implementation experiences and student acceptance over time. Key challenges included the negative influences of home and community food environments and limited staff size and capacity. Key opportunities involved joining co-ops to enhance purchasing power, leveraging state technical assistance, and forming external partnerships.

CONCLUSIONS

This study offers insights from a broad range of rural school professionals' implementation experiences. The findings can inform governments and technical assistance agencies working with rural schools and school districts to facilitate implementation and sustainability of initiatives.

The Family as an Actor in High School Students' Eating Habits: A Qualitative Research Study

In order to discover family conceptions and their difficulties with regard to healthy eating habits during the school day, a qualitative study framed in the phenomenological, exploratory, and explanatory perspective has been carried out to detect and describe the aspects and interrelationships that shape the study phenomenon. The researchers performed triangulation techniques and information analysis support with the Atlas-ti programme. As participants, the students' parents belonging to public secondary education high schools in Huelva, and the capital and its province were included. The participants were intentionally chosen based on established selection and segmentation criteria. Four main categories were obtained from the triangulated analysis. Healthy breakfast, school snack, school cafeteria, and promotion of healthy food measures. Other subcategories were established within them. Families are well aware of the composition of a healthy breakfast, although this is often not translated into practice. Lack of time, comfort and market influence are the main challenges they encounter for their children to acquire healthy habits. The maintenance of healthy habits, their responsibility and control on behalf of the family, and promoting fruit consumption and healthy products from the part of the centre and its cafeteria were highlighted as improvement proposals.

Food Consumed by High School Students during the School Day

The development of healthy eating habits in adolescence is perceived as an effective strategy to avoid health problems in adulthood. The involvement of educational centres' governing boards, as well as the Educational State and Regional Administrations', may be necessary to create healthy food environments during the school day. The objective of this study is to identify the relationship between students' eating habits during the school day and sociodemographic, family and physical activity variables, as well as the existence of a school cafeteria. For this, a cross-sectional study in a stratified random sample of 8068 students of Public Secondary Education High Schools of Andalusia (Spain) has been carried out. The results show that students who are 14 years old or older are more likely to skip breakfast at home (odds ratio (OR): 1.81, 95% confidence interval (CI): 1.55-2.12) than those under this age. Students whose mothers do not have a university education are more likely to consume incomplete breakfasts (OR: 1.83, 95% CI: 1.26-2.65). Snacks with sweets (OR: 1.93, 95% CI: 1.67-2.23), candy in general (OR: 2.75, 95% CI: 2.38-3.19), and bagged crisps (OR: 3.06, 95% CI: 2.65-3.54) were more likely to be consumed in schools with a cafeteria. The factors that significantly influence the eating habits of secondary students in Andalusia include age, sex, parental level of education, physical activity and the existence of a cafeteria.

Do High School Students Participate in Second Chance Breakfast Programs?

BACKGROUND

Breakfast consumption often decreases as youth get older. The School Breakfast Program (SBP) provides an opportunity to intervene and increase breakfast consumption, especially among high school students.

METHODS

Project breakFAST implemented an expanded breakfast service at 12 high schools. In this longitudinal evaluation, school administrators provided SBP participation and demographic data on all ninth and 10th graders for two full consecutive school years. Students screened for eating breakfast <3 times/week were randomly selected to participate in the cohort study. The cohort completed a survey on perceived barriers, benefits, and breakfast habits.

RESULTS

At baseline, all 12 schools had only traditional before school cafeteria SBP service. Mean participation was 16.3% and ranged from 7.9 to 38.1%. After the intervention, there was an increase in participation to 25.7% (p = .004) ranging from 14.1 to 47.5%. There was no change in breakfast participation before school (13.3%, p = .06). Students who traveled to school by car, bike, or walking at baseline were 4.5% less likely to participate in second chance breakfast at follow-up than those who took the bus to school (p = .006).

CONCLUSION

Second chance breakfast is an option for increasing high school breakfast participation, especially for those riding the bus.

Adolescents' Weight Management Goals: Healthy and Unhealthy Associations with Eating Habits and Physical Activity

BACKGROUND

This study aims to quantify associations between one's weight management goal and eating behaviors and physical activity among teenagers.

METHODS

Weighted logistic regressions were performed predicting healthy behaviors from weight goal separately for boys and girls while controlling for age, body mass index, socioeconomic indicators, school type, and region using data from the 2010 to 2011 Enquête québécoise sur la santé des jeunes du secondaire, a survey of a representative sample of Quebec adolescents (N = 32,040).

RESULTS

About 18%, 31%, 19%, and 34% of boys and 32%, 34%, 5%, and 25% of girls were respectively trying to lose weight, maintain their weight, gain weight, and not trying to do anything about their weight. Trying to lose weight was associated with lower likelihood of eating breakfast daily (boys: odds ratio [OR] = 0.72; 95% confidence interval [CI] = 0.61, 0.84 girls: OR = 0.61; 95% CI = 0.54, 0.70). Among girls, trying to lose weight was also associated with higher likelihood of consuming at least 5 portions of fruits and vegetables (OR = 1.20; 95% CI = 1.04, 1.37), lower likelihood of drinking sugar-sweetened beverages daily (OR = 0.77; 95% CI = 0.66, 0.90). Each weight-related goal was associated with unhealthy behaviors but most of them were also associated with adoption of healthier ones.

CONCLUSION

Having a weight related goal cannot inherently be thought of as health promoting goal.

Breakfast Is Brain Food? The Effect on Grade Point Average of a Rural Group Randomized Program to Promote School Breakfast

BACKGROUND

Adolescents frequently miss breakfast which may impact cognitive, academic, and health outcomes. This analysis describes the effect of a trial to assess school level changes to increase breakfast consumption on grade point average (GPA).

METHODS

Sixteen rural Minnesota high schools were randomized to a policy and environmental change intervention or delayed intervention (control) group. Baseline screening identified, randomly selected and enrolled 9th and 10th grade students who eat breakfast ≤3 times per school week for assessment. Mean unweighted GPA was provided by 13 schools for 636 students. Student-level and administrative data were used for sociodemographic and free or reduced-price meals (FRPM). Linear mixed models and latent class analysis (LCA) were used to assess change in GPA.

RESULTS

Students were 54% female, 76% white, and 34% received FRPM. Unweighted cumulative GPA mean = 2.82 (0.78) at baseline. There was no significant intervention effect on GPA postintervention or 1-year follow-up. LCA revealed two classes: "higher" (N = 495) and "lower" (N = 141) resource. There was an intervention effect among low-resource students from baseline to 1-year post only among the control condition (delayed intervention).

CONCLUSIONS

In combination with the full study results, increasing breakfast consumption may have an impact particularly for low resource students.

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

BACKGROUND

Many students experience challenges participating in the School Breakfast Program (SBP) when breakfast is served before school in the cafeteria. Serving breakfast free to all students or offering innovative breakfast serving models, such as breakfast in the classroom (BIC), grab n' go, or second chance breakfast, may encourage higher SBP participation rates.

OBJECTIVE

To examine the association between offering breakfast free to all students as well as breakfast serving model with student participation in the SBP in October 2017 among public schools in North Carolina.

DESIGN

Cross-sectional study using data from the North Carolina Department of Public Instruction.

PARTICIPANTS/SETTING

This study included data from 2,285 North Carolina public schools who served breakfast in October 2017 with 1,445,287 students.

MAIN OUTCOME MEASURES

The main outcome measures are the odds of a student participating in the SBP among students overall, students eligible for free or reduced-price (FRP) meals, and students not eligible for FRP meals.

STATISTICAL ANALYSES PERFORMED

Multiple logistic regression assessed the association between offering breakfast free to all students and breakfast serving model with the probability of participating in the SBP (number of students participating out of number of students enrolled) for students overall, eligible for FRP meals, and not eligible for FRP meals. Statistical models were stratified by school type (elementary, middle, and high schools).

RESULTS

Breakfast serving models positively associated with SBP participation were BIC and BIC plus grab n' go for elementary and high school students and grab n' go and second chance for middle and high school students (P<0.05). Serving breakfast free to all students was positively associated with SBP participation alone and in combination with BIC, second chance, and BIC plus grab n' go (P<0.05).

CONCLUSIONS

Serving breakfast free to all students and breakfast serving model were associated with SBP participation, and different relationships existed for different school levels.

An Economic Analysis of Updating and Expanding School Breakfast Program Offerings in High Schools

BACKGROUND

School breakfast is an important nutritional component of a student's day. Many schools operate a school breakfast program, but high schools have low rates of participation. This study aimed to investigate the economic impact on school food service, of expanding the school breakfast program to increase participation in high schools.

METHODS

Ten rural high schools participated in the economic analysis of expanding their school breakfast program. Schools provided data on costs of daily operation and start-up costs. Analyses calculated the daily breakeven point, revenue, cost, and days needed to recoup costs.

RESULTS

Schools sold enough breakfast meals to break even on daily costs of operating an expanded program. Schools saw daily profits ranging from $196-$432 and recouped costs associated with expanding the breakfast program within 15-46 days.

CONCLUSIONS

Expanding the school breakfast program can be economical for schools, while increasing student exposure to the health and academic benefits of school breakfast.