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Randomized Controlled Trial
. 2019 Jun;119(6):915-922.
doi: 10.1016/j.jand.2018.12.007. Epub 2019 Feb 14.

A Group Randomized Intervention Trial Increases Participation in the School Breakfast Program in 16 Rural High Schools in Minnesota

Marilyn S Nanney, Robert Leduc, Mary Hearst, Amy Shanafelt, Qi Wang, Mary Schroeder, Katherine Y Grannon, Martha Y Kubik, Caitlin Caspi, Lisa J Harnack
Randomized Controlled Trial

A Group Randomized Intervention Trial Increases Participation in the School Breakfast Program in 16 Rural High Schools in Minnesota

Marilyn S Nanney et al. J Acad Nutr Diet. 2019 Jun.

Abstract

Background: Breakfast consumption is associated with better diet quality and healthier weights, yet many adolescents miss breakfast. Nationally, 17.1% of students participate in the School Breakfast Program (SBP). Only 10% of high school students participate.

Objective: Our aim was to evaluate an environmental intervention to increase SBP participation in high schools.

Design: A group randomized trial was carried out from 2012 to 2015.

Participants/setting: Ninth- and 10th-grade students enrolled in 16 rural schools in Minnesota (median 387 students) were randomized to intervention or control condition.

Intervention: A school-based intervention that included two key components was implemented over a 12-month period. One component focused on increasing SBP participation by increasing student access to school breakfast through changes in school breakfast service practices (eg, serving breakfast from a grab-n-go cart in the atrium; expanding breakfast service times). The other component focused on promoting school breakfast through student-directed marketing campaigns.

Main outcome measure: Change in school-level participation in the SBP was assessed between baseline (among ninth and tenth graders) and follow-up (among tenth and eleventh graders). School meal and attendance records were used to assess change in school-level participation rates in the SBP.

Statistical analyses: The Wilcoxon test was used for analysis of difference in change in mean SBP participation rate by experimental group.

Results: The median change in SBP participation rate between baseline and follow-up was 3% (interquartile range=13.5%) among the eight schools in the intervention group and 0.5% (interquartile range=0.7%) among the eight schools in the control group. This difference in change between groups was statistically significant (Wilcoxon test, P=0.03). The intervention effect increased throughout the intervention period, with change in mean SBP participation rate by the end of the school year reaching 10.3% (95% CI 3.0 to 17.6). However, among the intervention schools, the change in mean SBP participation rates was highly variable (range=-0.8% to 24.8%).

Conclusions: Interventions designed to improve access to the SBP by reducing environmental and social barriers have potential to increase participation among high school students.

Trial registration: ClinicalTrials.gov NCT02004977.

Keywords: Adolescents; High school; Rural; School breakfast program participation.

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Conflict of interest statement

Conflict of interest disclose: The authors (Marilyn Nanney, Robert Leduc, Mary Hearst, Amy Shanafelt, Qi Wang, Mary Schroeder, Katherine Grannon, Martha Kubik, Caitlin Caspi, and Lisa Harnack) have no conflicts of interest to disclose.

Figures

Figure 1.
Figure 1.
Mean Percent School Breakfast Program (%SBP) participation by students in grades 9 and 10 at baseline and grades 10 and 11 at follow-up by school for schools participating in the Project breakFAST studya
Figure 2
Figure 2
Change between baseline and follow up in mean % School Breakfast Program (SBP) participationa by students in grades 9 and 10 at baseline and grades 10 and 11 at follow up by month for each experimental group for schools participating in the Project breakFAST study
See this image and copyright information in PMC

References

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    1. Blondin SA, Anzman-Frasca S, Djang HC, Economos CD. Breakfast consumption and adiposity among children and adolescents: an updated review of the literature. Pediatr Obes February 4 2016. - PubMed
    1. USDA Food and Nutrition Service. School Nutrition Dietary Assessment Study-IV Summary of Findings November 2012. USDA Food and Nutrition Service website: https://www.fns.usda.gov/sbp/expanding-your-school-breakfast-program accessed August 15, 2017.
    1. United States Department of Agriculture Food Surveys Research Group. Breakfast in America, 2001–2002 United States Department of Agriculture Food Surveys Group website; https://www.ars.usda.gov/ARSUserFiles/80400530/pdf/DBrief/1_Breakfast_20... Accessed March 6, 2017.
    1. Share our Strength. Increasing School Breakfast Participation 2014; Share our Strength website; https://bestpractices.nokidhungry.org/school-breakfast/increasing-school.... Accessed August 11, 2016.

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