Increasing Participation in the School Breakfast Program (SBP). Although an increasing number of schools are offering a SBP, participation in this program falls short of its potential. A major obstacle to SBP participation is students' fear of being perceived as poor by their peers. Recognition of the perception of the SBP as a welfare program, the number of students coming to school without eating breakfast, and the benefits of this meal for students' health and academic achievement have led to growing support for a Universal School Breakfast Program.
In a recent position statement, the State Agency Section of the American School Food Service Association recommends that all schools "offer a Universal School Breakfast Program (USBP) that makes school breakfast available to all children at no charge. A growing body of research evidence suggests that school breakfast benefits children by alleviating morning hunger, decreasing student absenteeism, improving student mood and behavior, supporting learning and academic achievement, and improving health." In response to concern regarding low SBP participation by eligible students, the federal government is conducting a three-year School Breakfast Pilot Study in all elementary schools in six school districts beginning in the fall of 2000.
Findings from numerous studies over the past 20 years as well as from recent pilot studies in states such as Minnesota, Maryland, and Massachusetts support the health and academic benefits of consuming breakfast for students. For many children, the availability of a SBP can help relieve hunger and improve their ability to succeed at school. An estimated 8% of U.S. children under 12 years of age experience hunger and insufficient food, while an additional 20% of children may be at risk for these conditions. Studies demonstrate that hunger among low-income children is associated with poor behavioral, emotional, and academic functioning.
The availability of a SBP also has a positive impact on students' nutrient intake and overall dietary quality. The 1993 School Nutrition Dietary Assessment Study found that students who participated in the SBP had higher intakes of calories, calcium, riboflavin, phosphorus, and magnesium than did nonparticipants. Further, studies indicate that SBP meals are nutritionally superior with respect to several nutrients compared to other breakfasts, including those at home. Consuming breakfast at school also improves students' overall diet quality, according to a recent study of 1,295 children between the ages of 6 and 18 years.
A growing body of evidence indicates that consuming breakfast supports children's learning and academic performance. A review of 30 studies conducted over the past two decades indicates that although evidence is not yet conclusive, skipping breakfast interferes with cognition and learning, especially in nutritionally at-risk children. As discussed below, findings of several pilot studies of universally free breakfast programs support the benefits of this program for students' academic performance. These studies also demonstrate that eating school breakfast improves student attentiveness, behavior, health, and attendance, decreases tardiness and illness, and expands options for working families.
When over 1,600 students, mostly from low-income families, participated in a free breakfast program at one public school in Philadelphia and two schools in Baltimore for four months, researchers found that students' math grades, attendance, and punctuality improved. Also, the students were less likely to be depressed, anxious, or hyperactive. The availability of the free breakfast program nearly doubled participation in the school breakfast program (i.e., from 15% to 27%).
Results of a three-year Universal Breakfast pilot study in six elementary schools in Minnesota also indicate significant improvements in students' learning readiness, scholastic achievement (i.e., general increase in reading and math scores), attendance, and behavior (i.e., less aggression, fewer discipline problems, improved attitudes); reduced visits to the nurse's office; a dramatic increase in participation in the program; and less stress for families in the morning. Students, school administrators, teachers, school nurses, and parents all reported benefits of student participation in this program.
Preliminary findings from the Maryland Meals for Achievement project also support a free breakfast program for students. This project was begun in 1998 to determine if providing free breakfast in the classroom to all students at 12 elementary schools would improve their nutrition and academic achievement. Over a two-year period, scores on a state achievement test increased by 22% in the schools offering the free breakfast program, compared to a 13% improvement in the control schools. Attendance increased by an average of two days a year for students in the classroom breakfast schools compared to no change for students in the control schools or state-wide. Students in the classroom breakfast schools experienced other benefits such as reduced tardiness and behavior problems, better attention spans, and fewer complaints of hunger, tiredness, aches, and pains. Also, participation in the school breakfast program tripled once the classroom breakfast program began.
The findings of this study in Maryland are consistent with those of a previous study in Baltimore City. Likewise, preliminary results from a study of a Universal School Breakfast program in five elementary schools and nine middle schools in Boston indicate positive effects on participation levels, students' behavior, and family life.
As data mount regarding the importance of school breakfast in improving students' nutrient intakes and academic achievement, schools need to adopt approaches to reduce barriers to student participation. In addition to offering universal free meals, serving meals in the classroom or kiosks, customer-focused marketing efforts, and coordinated nutrition education within the school environment are other means to increase student participation in school meal programs such as the SBP.
Maintaining Nutrition Integrity.
There is mounting concern among federal government and child nutrition advocates that competing and profit-making foods and beverages sold in schools are driving students away from reimbursable meals. This situation can undermine the nutrition integrity of school meal programs and fail to help students develop lifelong, healthful eating habits. Limited cafeteria space in many schools reduces the likelihood that students will eat a reimbursable school meal. Inadequate serving lines often create long wait periods, driving students to vending machines and snack bars, away from school meals that meet nutrition standards.
Regulations governing the NSLP and SBP prohibit the sale of foods of minimal nutritional value in the school food service area during meal periods. However, these foods can be sold in other areas of the school at any time. For example, soft drinks cannot be sold in the cafeteria during meal times, but they can be sold during meal times in other areas of the school, including immediately outside the cafeteria area.
Limited data are available regarding the extent, type, and nutrient content of competitive foods in schools. However, studies indicate that high schools and middle/junior high schools are more likely to offer these foods than elementary schools. Further, the opportunity to purchase low nutrient competitive foods from school vending machines and school stores is increasing. In terms of nutrient content, a recent study of 24 public middle schools in San Diego, California found that approximately nine out of ten food items sold in school stores were high in fat and/or sugar. More information on the extent and type of foods available throughout the school environment is expected following completion of two new studies, USDA's School Nutrition Dietary Assessment Study II and the Centers for Disease Control's School Health Policies and Programs Study.
Clear evidence that the nutrition goals of school meal programs can be compromised when students have ready access to competitive foods comes from a recent study at the University of Vermont. This investigation of 2,371 children ages 5 to 17 years found that only those children who drank milk at the noon meal met or exceeded recommended dietary calcium intakes for that meal, or for the entire day. In contrast, children who drank soft drinks, juice, tea, or fruit juice at lunch did not meet their daily calcium recommendations. The lunchtime milk drinkers also had higher intakes of nutrients typically low in children's diets such as vitamin A and zinc.
Researchers are concerned that the growing presence of soft drink marketers in schools encourages students to drink these beverages instead of more nutritious choices such as milk with their meals. According to a recent investigation, children who consume more soft drinks are more likely to have low intakes of milk and milk's nutrients such as calcium, riboflavin, and vitamin A than students whose intake of soft drinks is limited. Given the low calcium status of many children, especially those 9 to 18 years, and the importance of adequate calcium intake to maximize peak bone mass and reduce risk for osteoporosis, there is a need to institute a policy to limit children's access to soft drinks in schools. Also, nutrition education messages targeted to children and/or their parents should encourage more healthful beverage choices such as milk in schools. School meals are an important source of calcium for children. In fact, the calcium density of school foods is higher than that of restaurant foods, fast foods, or foods consumed at home.
The issue is not whether schools have vending machines, snack bars, school stores, or cafeteria a la carte items, but rather what foods are available to students. Limiting high fat, low nutrient foods and expanding food selections in these settings to include more healthful choices such as low fat dairy products, fruits, and vegetables can help reinforce a total school environment conducive to healthful eating habits. For example, providing lowfat chocolate milk, a beverage well-liked by students, as an alternative to fruit drinks, soft drinks, or tea in vending machines, snack bars, school stores, or cafeteria a la carte lines can help increase children's intake of calcium, as well as other essential nutrients.
Experts recognize that controlling the sale of foods of low nutritive value, while at the same time offering students foods that they like and that are profitable to schoolsÑas well as creating a nutritionally supportive environment to help students develop healthful eating patternsÑis a challenge. A comprehensive approach shared by school food service staff, teachers, other school staff, students, their parents, and the community is necessary to achieve nutrition integrity wherever and whenever food is served in the school environment.