School staff, parent and student perceptions of a Breakfast in the Classroom model during initial implementation.

OBJECTIVE: To understand perspectives of stakeholders during initial district-wide implementation of a Breakfast in the Classroom (BIC) model of the School Breakfast Program. DESIGN: Qualitative data were collected from twenty-nine focus groups and twenty interviews with stakeholders in a school district early in the process of implementing a BIC model of the School Breakfast Program. SETTING: Ten elementary schools within a large, urban school district in the USA that served predominantly low-income, racial/ethnic minority students. SUBJECTS: Purposively selected stakeholders in elementary schools that had implemented BIC for 3-6 months: students (n 85), parents/guardians (n 86), classroom teachers (n 44), cafeteria managers (n 10) and principals (n 10). RESULTS: Four primary themes emerged, which were interpreted based on the Diffusion of Innovations model. School staff had changed their perceptions of both the relative disadvantages and costs related to time and effort of BIC over time; the majority of each stakeholder group expressed an appreciation for BIC; student breakfast consumption varied from day to day, related to compatibility of foods with child preferences; and stakeholders held mixed and various impressions of BIC's potential impacts. CONCLUSIONS: The study underscores the importance of engaging school staff and parents in discussions of BIC programming prior to its initiation to pre-emptively address concerns related to cost, relative disadvantages and compatibility with child preferences and school routines/workflow. Effectively communicating with stakeholders about positive impacts and nutritional value of the meals may improve support for BIC. These findings provide new information to policy makers, districts and practitioners that can be used to improve implementation efforts, model delivery and outcomes.

Estimating impacts of a breakfast in the classroom program on school outcomes.

IMPORTANCE: Short-term impacts of breakfast consumption on diet quality and cognitive functioning have been reported, but more evidence is needed to draw causal inferences about long-term impacts of school breakfast on indicators of school engagement and academic achievement. OBJECTIVE: To estimate the impact of a Breakfast in the Classroom (BIC) program on School Breakfast Program participation, school attendance, and academic achievement. DESIGN, SETTING, AND PARTICIPANTS: This quasi-experimental study included a sample of 446 public elementary schools from a large, urban US school district that served predominantly low-income, racial/ethnic minority students. INTERVENTIONS: A total of 257 schools (57.6%) implemented a BIC program during the 2012-2013 academic year, whereas 189 (42.4%) did not. MAIN OUTCOMES AND MEASURES: School- and grade-level data from 2012-2013 and grade-level achievement data from the prior year were collected from school district records across the elementary schools. Hypotheses that a BIC program would improve school breakfast participation at the school level, school attendance at the grade level (kindergarten through sixth grade), and academic achievement at the grade level (second through sixth grades) were tested using propensity score weights to adjust for demographic differences between the BIC and non-BIC schools. RESULTS: The BIC program was linked with increased breakfast participation during the academic year (F10,414=136.90, P<.001), with mean participation rates of 73.7% in the BIC group vs 42.9% in the non-BIC group. The BIC program was also linked with greater overall school attendance rates (95.5% vs 95.3% in the non-BIC group; F1,2772=8.40, P = .004). When performing attendance analyses in the subset of grade levels for which achievement data were available, results were mostly consistent, although there was a group × time interaction (F10,1891=1.94, P=.04) such that differences between least squares means in the BIC vs non-BIC groups did not reach statistical significance at every month. There were no group differences in standardized test performance in math (57.9% in the BIC group vs 57.4% in the non-BIC group; F1,1890=0.41, P=.52) or reading (44.9% in the BIC group vs 44.7% in the non-BIC group; F1,1890=0.15, P=.70). CONCLUSIONS AND RELEVANCE: Findings add to the evidence that BIC can increase school breakfast participation substantially and suggest that it has the potential to improve overall school attendance rates. Additional research is needed to explore the generalizability of these findings and the potential impacts on achievement for longer periods and on additional outcomes, such as weight status.