School Breakfast Programs: Perceptions and Barriers

Elaine McDonnell, MS, RD, LDN; Claudia Probart, PhD, RD; J. Elaine Weirich, MEd; Terryl Hartman, MPH, PhD, RD; and Patricia Birkenshaw, MA

Purpose/Objectives
The purpose of this research was to identify perceptions and barriers related to the initiation and promotion of the School Breakfast Program (SBP).

Methods
This research used a series of nine focus groups with school administrators, school foodservice directors, parents, and students.

Results
Disparities were found in perceptions among the groups. Although school administrators expressed concerns about costs and staffing, school foodservice directors did not identify these issues as major barriers. Scheduling and timing issues related to conflicting events and bus schedules were raised by several groups. The concern that offering a school breakfast program oversteps the bounds of school responsibility and could interfere with parental roles was identified as a barrier by all groups, as was the perception that the SBP is primarily intended for low-income students. Despite the fact that meals offered through the SBP must meet federal nutrition standards, support for the program waned among parents and school administrators if they perceived that only foods of low nutritional value were being served. Students expressed interest in a wide variety of foods, with a corresponding range of nutritional values. Although school administrators and school foodservice directors recognized parents as strong forces for change within schools, parents did not identify a role for themselves in the initiation of a school breakfast service. Several foodservice directors felt that their opinions concerning school meals programs were not highly valued in their districts.

Applications
The results of this research suggest that school foodservice directors may improve the likelihood of success in initiating school breakfast if they identify a key individual who will support the program and act as its advocate, begin the program as a pilot, survey students about food preferences, serve healthy food options, market the program to all audiences, and identify other school foodservice directors with successful programs who might have suggestions for overcoming barriers.

Importance of Breakfast
Eating breakfast has been shown to have positive effects on diet, health, and
cognition (Nicklas, Reger, Myers, & O'Neil, 2000 ; Pollitt & Mathews, 1998; Resnicow, 1991). While children who eat breakfast have better overall diet quality, as assessed by the U.S. Department of Agriculture's (USDA) Healthy Eating Index (Basiotis, 1999), the rate of school-aged children skipping breakfast has been shown to range between 5% and 31% (Nicklas, Bao, Webber, & Berenson, 1993; Nicklas, Farris, Bao, & Berenson, 1995). It has been reported that skipping breakfast or consuming a nutritionally inadequate breakfast is associated with dietary inadequacies that are not compensated for through other meals (Hanes, Vermeersch & Gale, 1984; Morgan et al., 1986; Nicklas, Bao, & Berenson, 1993; Skinner, Salvetti, Ezell, Penfield, & Costello, 1985.) The availability of breakfast in school increases the likelihood that low-income children will eat breakfast (Devaney & Stuart, 1998). In addition, low-income children who participate in the School Breakfast Program (SBP) have been shown to have better overall diet quality than those who eat breakfast at home and those who skip breakfast (Basiotis, 1999).

Children’s breakfast consumption also is inversely related to body weight and total blood cholesterol levels, two risk factors for cardiovascular and other chronic diseases (Resnicow, 1991). Researchers have reported that hungry children and those at-risk for hunger suffer from impaired mental function and increased hyperactivity (Murphy et al., 1998). Hungry children have been found to be more likely to have clinical levels of psychosocial dysfunction than those who are not hungry. Anxiety and aggression, in particular, have been found to be closely associated with hunger (Kleinman et al., 1998).

One study of children from a variety of socioeconomic backgrounds has shown that those who eat breakfast at school perform better on standardized tests than those who skip breakfast or eat at home (Basiotis, 1999). Others have confirmed the positive effects on academic performance, as well as reduced rates of absenteeism and tardiness associated with participation in school breakfast (Meyers, Sampson, Weitzman, Rogers, & Kayne, 1989; Murphy et al., 1998).

Participation in School Breakfast
Participation in the SBP has grown slowly but steadily over the years. In 1970, an average of 500,000 children per day participated; in 1980, this number rose to 3.6 million. The program continued to grow and in 1990 it reached 4.1 million children. For the 2002-03 school year, 8.2 million children participated in the SBP (USDA, 2002). Despite the reported benefits, rates of participation in the SBP are significantly lower than those of the National School Lunch Program (NSLP). Compared to the 8.2 million children participating in school breakfast during the 2002-03 school year, 27.8 million participated in the NSLP (Food Research and Action Center, 2003).

Barriers to School Breakfast Programs
Despite the benefits of school breakfast, barriers to implementation, as identified by state officials who oversee the SBP, have been reported (Food Research and Action Center, 2002). Officials identified "school buses arrive too late" as the top barrier, selected by 74% of respondents. Other strong barriers included student unwillingness or inability to arrive at school early, opposition from teachers and/or administrators to providing breakfast in the classroom, insufficient time provided for students to eat school breakfast, a lack of parent awareness of the academic and behavioral benefits of school breakfast, and a stigma associated with participation.

In another report, students in Fourth, Fifth, and Sixth Grade participating in a universal free breakfast pilot study perceived a lack of time and not being hungry in the morning as barriers to eating breakfast (Reddan, Wahlstrom, & Reicks, 2002). Although certain obstacles have been identified with specific groups, it is unclear if these perceptions are shared by all stakeholders. Understanding shared perceptions of barriers from all groups involved in school breakfast decision-making, delivery, and participation could assist in designing successful educational programs and approaches to promoting school breakfast.

In light of low participation rates in the SBP, despite the reported benefits of the program, the authors conducted a focus group study to investigate issues and barriers related to the initiation and promotion of school breakfast, and to compare the perceptions of these barriers among a variety of stakeholders.

Nine focus groups were conducted with targeted stakeholders, including school business officials, school principals, school foodservice directors, parents, and students to provide insights into their perceptions of barriers related to the initiation and promotion of SBPs. The focus group series, following the methodology outlined by Krueger (1988), was conducted in Pennsylvania with a total of 73 individuals selected from throughout the state. Each focus group ranged from 6 to 11 participants and each session lasted approximately 45 to 60 minutes. This study was approved by the Institutional Review Board of the Pennsylvania State University.

One focus group was conducted with school business officials (n=9), and two focus groups were conducted with each of the remaining four groups, which included principals (n=14), school foodservice directors (n=20), parents (n=13), and students (n=17). These groups were selected to represent the variety of perspectives that stakeholders have concerning issues related to school breakfast. They also represented those groups most influential in decisions regarding participation in school breakfast, at both the individual and school levels. Recruitment for the focus groups occurred through invitations using registration lists for conferences, meetings, and courses. Conference and meeting organizers and course instructors provided these lists. The focus group invitations did not specifically identify the topic of discussion in order to prevent sample bias. A nominal financial incentive was provided for participation.

Each focus group was facilitated by a trained moderator who had at least one assistant moderator taking notes. Sessions were audiotaped to ensure the complete collection of information. Following each focus group session, the moderator and assistant moderator discussed impressions of the focus group findings. The focus group tapes were transcribed, and summaries were prepared, distributed, and discussed among the research team. A series of codes was developed, with each unique concept identified in the focus groups assigned a different code. Focus group transcripts were coded by one member of the research team, and then verified by a second coding conducted by another researcher. Coded transcripts were analyzed using the qualitative analysis software program, Atlas.ti (Scientific Software Development, 1997). This program was used to identify the major concepts conveyed in each focus group.

Due of the variety of audiences participating in the focus groups, four sets of related questions were developed: one for school personnel (school foodservice directors, principals, and business officials), one for parents, one for high school students, and one for middle school students.

The demographic characteristics of the focus group participants can be found in Table 1. Similarities and differences in perceptions of barriers to increasing school breakfast participation became clear from the focus groups. Themes, as discussed in terms of similarities and differences, included issues related to program costs, scheduling and timing, responsibilities, social opportunities, stigma associated with participation, foods offered, and roles for parents.

Table 1: Focus Group Participants' Demographic Information
School Administrators
Job Title
Principal	14
Business Manager	9
Gender
Male	12
Female	11
School District Setting
Urban	1
Suburban	9
Rural	13
SBP Presence
Number with SBP in at least one school in district	21
Number with SBP in all schools in district	10
School Foodservice Directors
Gender
Female	20 (all)
School District Setting
Urban	4
Suburban	7
Rural	8
SBP Presence
Number with SBP in at least one school in district	17
Number with SBP in all schools in district	14
Parents
Gender
Female	13 (all)
School District Setting
Urban	1
Suburban	10
Rural	2
Students
Gender
Male	8
Female	9
Number of days/week students buy breakfast in the school cafeteria
0 days/week	14
1 days/week	1
2 days/week	1
3 days/week	0
4 days/week	0
5 days/week	1

Program Costs
School administrators (business officials and principals) expressed concerns about costs related to the establishment and implementation of a school breakfast program. While the school foodservice directors did not identify cost as a barrier, they recognized that administrators perceived that school breakfast service would involve costs, and that this perception could be an obstacle in initiating a program. The school foodservice directors recognized that they might incur expenses related to increased staff time, but they did not view this as a major barrier and discussed methods for keeping costs to a minimum. In contrast, administrators expressed concerns about increasing cafeteria staff members' time, which would require benefits to be paid and potentially result in significant costs. Administrators also expressed difficulties in identifying administrative staff willing to supervise the program, as well as cafeteria staff willing to work during breakfast hours. School foodservice directors did not identify these issues as barriers.

Scheduling/Timing
School administrators identified scheduling and timing as critical factors in initiating and promoting school breakfast. Problems were mentioned involving coordination of bus schedules to allow students to arrive at school in time to eat breakfast. It was perceived that the initiation of a school breakfast program might require cuts in instructional time, an option deemed unacceptable. Administrators noted that a variety of school activities often are conducted during pre-class time, further complicating the morning schedule and presenting another barrier to school breakfast. The school foodservice directors concurred with the need for students to have adequate time to eat in order to have a successful program. They expressed frustration about events being scheduled during pre-class breakfast time, which they agreed decreased participation in the program. Students also viewed time as an important issue, indicating a reluctance to participate in school breakfast if it would require them to arrive at school earlier than usual; thus, cutting into sleep time.

Responsibility
Some school administrators felt that offering school breakfast overstepped the bounds of school responsibility and could interfere with parental responsibilities. One focus group participant noted:

"Are we overstepping into a family role by doing breakfast? It’s really stepping outside of the educational timeframe that’s causing the breakfast program to pass or fail."

Even those administrators who did not share this particular sentiment recognized that some members of their communities felt this way. While school foodservice directors agreed that the issue of responsibility is a barrier to school breakfast, they did not share this sentiment. Similarly, parents participating in the focus group did not identify with this philosophical viewpoint, but did recognize it as a potential barrier to school breakfast programs, especially if people in school decision-making positions held this opinion. One of the students expressed an opinion of school breakfast participants that seemed to support the view that breakfast is a parental responsibility.

"Mostly they [students participating in school breakfast] are the people who are either short on time, don’t get attention from their parents, or are too lazy to make breakfast."

Social Opportunities
Participants from each focus group identified the importance of social aspects of school breakfast. School administrators commented that school breakfast facilitates positive interactions between students and supervising teachers. One partcipant commented:

"Teachers assigned to supervise breakfast find themselves becoming more involved with the kids… to some degree almost acting in a form of surrogate parents, seeing what the kids’ needs are, trying to take care of those."

School foodservice directors observed social relationships between students and cafeteria staff and reported that staff attitudes and interactions with students can affect participation. They mentioned that positive, friendly attitudes exhibited by cafeteria staff contribute to high participation. Parents speculated that breakfast might be a more relaxed social time for students compared to lunch. Students also stressed the social aspect of the program, indicating that they would be interested in participating if the school breakfast period was a relaxed time during which they could socialize with friends. Clearly, all groups perceive social aspects of the program as important.

Stigma
In several groups, discussions arose about the stigma associated with participation in school breakfast. This stigma is associated with the perception that school breakfast is intended for low-income students. Although procedures are in place to avoid overtly identifying students as free or reduced-price participants, as one school business official explained, the stigma still exists:

"Well, they don’t necessarily know who’s 'free and reduced.' They know who’s poor and who isn’t poor."

Some administrators expressed the belief that school breakfast is primarily intended for low-income students. Parents speculated that the stigma might be a barrier to participation. A few students confirmed this stigma. When asked if it is "cool" to eat breakfast at school, the response of a student who is a regular participant indicated that she might sense negative connotations associated with participation:.

"I don’t really care what people think. I’m going to eat."

The group of students consisting mainly of non-participants identified students who participated in breakfast as "tough guys" and the "detention crew." Foodservice directors did not mention a stigma associated with school breakfast.

Foods Offered
School administrators and parents expressed concerns that students would not choose nourishing food options for breakfast. Despite the fact that meals offered through the SBP are required to meet federal nutrition standards, support for school breakfast waned among parents and school administrators if they perceived that only foods of low nutritional value were being offered. Interestingly, students expressed a desire for a wide variety of foods, with a range of nutritional values (e.g., cereal, toaster pastries, bagels, fresh fruit, French toast, scrambled eggs, and doughnuts). School foodservice directors validated that while high-sugar breakfast cereals are popular choices, a variety of foods are both offered and purchased.

Roles for Parents
Administrators and school foodservice directors identified parents as highly influential in the decision to offer breakfast at school. A school business official described his perceptions of the role for parents:

"I think if the groundswell came from the parents, complaining that they don’t have one [a breakfast program] or they wanted a more enhanced one, I think that would spur movement in a district more than probably anything."

In contrast, few parents were able to envision or express a role for themselves in the initiation of SBPs.

Other Issues
Several other issues were identified by the focus groups featuring school foodservice directors. The foodservice directors were not confident that they could convince administrators and teachers of the importance of school breakfast because they felt that their knowledge and opinions were not respected or valued by others in the school environment. They felt that the lack of value placed on their programs and their positions is exhibited by, among other things, cuts in time allocated to the breakfast program and their exclusion from the educational component of the school system.

The school foodservice directors commented on the existence of "peer pressure" among school districts, reporting that their administrators often follow the lead of other specific school districts in implementing changes or new programs. The school foodservice directors and school administrators felt that support for existing programs tends to grow over time, as the benefits of the program are recognized.

In summary, key disparities were found in perceptions among the groups. Although school administrators expressed concerns about costs and staffing, school foodservice directors did not identify these issues as barriers. Despite the fact that meals offered through the SBP must meet federal nutrition standards, support for the program waned among parents and school administrators if they perceived that only foods of low nutritional value were being served. Although parents speculated that students would not choose healthy foods for breakfast, students expressed interest in a wide variety of foods, with a range of nutritional values. School administrators and school foodservice directors recognized parents as strong forces for change within schools, however, few parents identified a role for themselves in the initiation of a school breakfast service.

Nine focus groups conducted with stakeholders in the educational environment showed evidence of disparities related to their perceptions of barriers to increasing school breakfast participation. Research identifying perceived barriers to school breakfast programs is limited, and no previous research has compared perceptions of these barriers by various stakeholders. This research identified key concepts and disparities that could present an entry point for intervention and education. Differences were found in various areas, including program costs, scheduling and timing, philosophical issues relating to school or parent responsibilities, social opportunities, stigma associated with participation, food quality, and the roles available for parents. In addition, school foodservice directors noted issues specific to their roles in the school environment.

Certain limitations are inherent in focus group research. Only one focus group was conducted with business managers, but because of the similarity in responses with those of the principals, results were discussed in combination. Perceptions expressed by focus group participants do not necessarily represent those of the majority of their colleagues or peers and, therefore, cannot be generalized as the opinion of the larger population. This research does, however, provide critical insights into perceived barriers to school breakfast programs, as well as offer a comparison of those perceptions among key stakeholders. Additional research is needed to expand on these findings and to determine specific, effective methods to facilitate the uniform support of school breakfast programs.

Issues related to management of school breakfast programs, such as scheduling, timing, and cost, were considered to be major barriers by administrators. School foodservice directors recognized this perception by administrators, but felt that creativity and experience could overcome them. Alternative programs have been created to address these difficulties, such as "Grab ‘n' Go Breakfast," "Breakfast After 1st Period," and "Breakfast in the Classroom." Sharing information about these and other successful breakfast programs could help administrators and school foodservice directors work together to overcome barriers to school breakfast. Similarly, funding sources may be available to assist with program start-up or operation. Sharing ideas and sources of funding can help overcome issues related to cost.

Concerns related to school or parental responsibilities are difficult to address directly. However, statistics on the number of children from all walks of life who start the day without breakfast, and the health and cognitive issues related to skipping breakfast are compelling. Awareness and motivational media such as videotapes, resource lists, and governmental and other Web sites with relevant statistics could be provided to school foodservice directors and parent groups who are attempting to initiate or expand breakfast programs. These tools could be used to present the case to school decision-makers to help them become aware of the need for breakfast at school.

Among both parents and school administrators, support for school breakfast waned if they perceived that only foods of low nutritional value were being served. Education may be needed to help these groups understand that school breakfasts must meet federal nutrition standards (no more than 30% of calories come from fat; less than 10% of calories from saturated fat; and one-fourth of the Recommended Dietary Allowance for protein, calcium, iron, vitamins A and C, and calories).

The barrier of stigma associated with school breakfast might best be solved by linking it with positive social benefits, which were reported by a majority of the focus group participants in this study. If a school’s culture supports school breakfast through creative activities, all students would be encouraged to participate, thus eliminating the stigma that school breakfast is only for low-income children. Examples of such activities include principals and teachers eating with students, music in the cafeteria, and the establishment of an atmosphere conducive to socializing. The alternative breakfast service methods mentioned above, as well as a Universal Breakfast program, can make school breakfast the norm for all students.

Although school administrators and school foodservice directors recognized parents as a strong force for change within schools and districts, parents did not recognize this role for themselves. Parents could be encouraged to play an active role in school decision-making, especially related to nutrition issues, such as school breakfast. A variety of approaches may be effective in this effort, including providing information on parent involvement strategies, as well as resources related to nutrition and health. Efforts also are needed to encourage stronger relationships between parents and school foodservice personnel so they can form partnerships that help each other create positive nutrition environments.

School foodservice directors expressed a lack of confidence in their abilities to persuade others in the school environment about the benefits of breakfast programs. They also perceived a general lack of value placed on school meals programs and school foodservice personnel. A variety of educational programs and materials could be identified for the purpose of expanding the role of the school foodservice director into the classroom and the community. Such efforts could enhance the status of school foodservice directors, as well as the school meals programs. Mentoring and train-the-trainer programs offer excellent vehicles for sharing success stories. Using these models, school foodservice directors who have overcome school breakfast barriers could share their knowledge with their peers and enhance the professionalism of both the trainer and the trainee.

While school foodservice directors who participated in the focus groups were supportive of school breakfast, efforts may be needed to promote the program to those showing less enthusiasm. Based on results of the focus groups, specific recommendations for school foodservice personnel include the following:

• Identify a key individual in the school district who will support the program and act as an advocate.
  
• Consider beginning the program as a pilot.
  
• Survey students about food preferences.
  
• Serve healthy food options.
  
• Market the program to all audiences.
  
• Identify other school foodservice directors with successful programs who might have suggestions for overcoming barriers.
  
• Search for resources and materials to use in the classroom and community to promote the health and learning benefits of the School Breakfast Program and good nutrition in general. Recommended Web sites include those of the Food and Nutrition Information Center, Team Nutrition, the School Nutrition Association (formerly American School Food Service Association), and Project PA.

Other materials that can be used to initiate or increase participation in breakfast include the following:

• Expanding Breakfast Manual and Video Kit (National Dairy Council and Child Nutrition Foundation) – available through the SNA Emporium.
  
• New Ways to Promote School Breakfast (Florida Citrus Growers) – available through the SNA Emporium.
  
• School Breakfast for First Class Learning (Midwest 5-Star Child Nutrition Task Force) – available from the National Food Service Management Institute.

Despite the reported benefits of the SBP, rates of participation in the program are significantly lower than those in the NSLP. This research identified barriers to the initiation and promotion of school breakfast and found disparities in perceptions of obstacles among different groups. Understanding these perceived barriers among key stakeholders provides an entry point for education and the development of common visions for successful school breakfast programs.

This project was funded by the Pennsylvania Department of Education, Division of Food and Nutrition, with federal State Administrative Expense funds provided by the Food and Nutrition Service, U.S. Department of Agriculture.

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McDonnell is a coordinator for Project PA for the Department of Nutritional Sciences at Pennsylvania State University. Probart is director of Project PA and associate professor in the Department of Nutritional Sciences at Pennsylvania State University in State College, PA. Weirich is manager of Project PA for the Department of Nutritional Sciences at Pennsylvania State University in State College, PA. Hartman is assistant professor in the Department of Nutritional Sciences and Pennsylvania State University in State College, PA. Birkenshaw is state director for Child Nutrition Programs for the Pennsylvania Department of Education, Division of Food and Nutrition in Harrisburg, PA.