Abstract
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.