Qualitative Analysis Of Students’ Breakfast Habits And School Breakfast Participation In Two Public School Districts

Evidence from observational (Nicklas et al., 1993; Ptomey et al., 2016) and experimental studies (Wyon et al., 1995; Adolphus et al., 2013) supports the importance of breakfast for dietary intake and academic performance. Children who regularly eat breakfast may also have healthier body weights (Affenito et al., 2005; Fiore et al., 2006) and reduced insulin resistance (Donin et al., 2014; Karatzi et al., 2014). School Breakfast Programs (SBPs) can have positive effects on academic performance (Adolphus et al., 2013; Kleinman et al., 2002), diet quality (Ritchie et al., 2016), and school attendance (Anzman-Frasca et al., 2015). Despite these benefits of breakfast consumption, breakfast skipping is common among school-aged children (Dykstra et al., 2016; Hearst et al., 2016). Participation in the United States Department of Agriculture’s (USDA) National SBP is low, relative to participation in the National School Lunch Program (Food Research & Action Center, 2018). According to the School Nutrition Dietary Assessment Study-IV, factors associated with SBP participation included: lower grade level; eligibility for free or reduced-price meals; and lower meal price among students ineligible for free or reduced-price meals (USDA, 2012). However, few studies have examined determinants of breakfast consumption in general (Olsta, 2013; Reddan et al., 2002; Sweeney & Horishita, 2005), or participation in SBPs in particular (Sabol et al., 2011; Bailey-Davis et al., 2013) among U.S. children and adolescents. This qualitative study was designed to identify the factors influencing breakfast consumption and SBP participation among students in grades 1-12 in two Connecticut school districts.

METHODS

Sample

Four school districts were invited to participate. Superintendents of two districts (referred to as Districts A and B) granted approval. The study was approved by the Griffin Hospital Institutional Review Board. In 2017, 12 focus groups were held with 11 in District A (nine in elementary schools, one in a middle school, and one in a high school) and one focus group in District B’s middle school. Characteristics of school districts and study participants are presented in Table 1. Students were included if they: (1) were enrolled in a participating school; (2) were invited by a teacher or administrator; (3) provided signed parental consent and their written or verbal assent, as appropriate for age; and (4) were present in school on the day of the focus group.

Data Collection

School administrators asked teachers to identify students who were willing to share their opinions and diverse in race/ethnicity, gender, and academic performance. Each focus group included 5 to 11 students from two or three grade levels and ranged in length from 30 to 60 minutes. Two researchers served as facilitator and note-taker, respectively. They jointly developed an interview guide based on a literature review and input from the districts’ school foodservice directors. Key questions included:

• If you eat/don’t eat breakfast every day or almost every day, why/why not?
• If you eat breakfast on days that you go to school, do you usually eat breakfast at home or at school? Why?
• How could your school make school breakfast better?

Follow-up questions varied depending on students’ responses. Sessions were audio recorded and transcribed. Each participant’s grade level and gender were noted, but not race or ethnicity, to minimize the collection of personal information.

Data Analysis

NVivo 11 software was used to code transcripts. Two independent coders, including the focus group facilitator, assigned codes to participant statements based on their content. Codes generated by each coder were compared and discussed until agreement was reached on a final set of codes. Each coder then re-coded the transcripts using the established codebook. Codes were compared again, with any discrepancies reviewed and resolved, and collapsed into themes based on how they related to our research questions. Responses in each theme were reviewed to determine whether some categories were populated more by comments from students in elementary (grades 1-6), middle (grades 7-8), or high school (grades 9-12).

RESULTS AND DISCUSSION

Themes

A total of 105 students participated. Distributions by grade level and gender are presented in Table 1.

Students’ comments were organized into four themes: (1) reasons for eating breakfast, (2) reasons for skipping breakfast, (3) reasons for not participating in the SBP, and (4) opportunities to improve school breakfast. Within each theme, subthemes were identified (14 total). The themes and subthemes summarized below are outlined in Table 2, which includes examples of quotes related to each theme

 

 

.

Reasons For Eating Breakfast

Most elementary school students reported eating breakfast every day or almost every day. Many middle and high school students reported not eating breakfast regularly. Across grade levels, the most commonly mentioned reasons for eating breakfast were: parental influence, hunger, desire to avoid physical symptoms (e.g., fatigue, upset stomach, headache), and desire to improve school performance. Parental influence and/or desire to improve energy levels were important among elementary students.

Reasons For Skipping Breakfast

Main reasons for skipping breakfast, as reported by middle and high school students, included lack of hunger and inadequate time. Younger children generally reported feeling hungry and wanting to eat in the morning, whereas older children more often said they were not hungry. Many middle and high school students who skipped breakfast described feeling rushed and having little time to eat breakfast on school days.

Reasons For Not Participating In Sbps

More students preferred eating breakfast at home rather than at school. The top reasons were distaste for and/or distrust of school foods, followed by cost. Many also mentioned inadequate time to eat at school, and perceived school food as unhealthy or “junk.”

Dislike of school foods was frequently noted in generic terms (e.g., “I don’t really like the food”). Specific reasons for disliking school foods included a perception that they were low in quality, less good than foods at home, or “fake.” Students at all grade levels were concerned about the cost of school meals. Many students in elementary schools, and some in middle schools, felt that school breakfast foods were unhealthy. In contrast, high school students expressed less concern about the healthfulness of school breakfast. Some said that efforts to provide healthful foods such as whole grain products were “a turn off” and that students should be able to decide whether or not to eat healthfully at school.

Middle and high school students frequently expressed a distrust of school foods. Paradoxically, although some complained about schools’ heavy reliance on packaged foods, they also often chose these foods at school because they seemed “safer.” Students at all grade levels shared stories of discovering non-food items in in their foods (e.g. hair, plastic, a bug, “pink fuzz” resembling insulation) and discovering that items were expired or spoiled. Among the food quality complaints were incidents of curdled milk, undercooked cheeseburgers, and discolored salami.

For elementary and middle school students, inconvenience was also a barrier to SBP participation. Some students reported feeling too rushed to eat at school, while others said they had more important things to do, such as talking to teachers or friends or getting organized for class. Students also mentioned late buses, cafeteria lines, long walking distances to the foodservice area, and a perception that eating in the classroom could be messy.

While some students said they would eat school breakfast when their preferred foods were served (e.g. breakfast sandwiches or “brownie bars”), more students reported eating breakfast at school when hungry and lacking other options due to time constraints at home. However, some students made positive comments about school breakfast. For example, a female student in grade 4 said: “Everyone thinks [the apple strudel] disgusting, but I think it’s really good….And then, ometimes, they’ll have new things, so I mean, whatever there is, I usually just have it.”

Opportunities To Improve School Breakfast

A common suggestion for improvement was greater variety of food choices. Students expressed a desire for more options (e.g., varieties of fruits, bagels, and beverages) and opportunities to customize meals (e.g., by selecting breakfast sandwich or bagel toppings). Many students, especially in middle and high school, prioritized “freshly made,” “cooked,” “good quality,” “real” foods over those that were “packaged,” “frozen,” or “wrapped.” Several elementary and middle school students wanted healthier options, such as fresh fruits not already offered (e.g., melon, berries, mango), Cheerios, and eggs.

Discussion Of Findings

Prior qualitative studies of students in grades 4 and 5 in Alabama (Sabol et al., 2011) and grades 6 to 8 in Philadelphia (Bailey-Davis et al., 2013) suggested that SBP participation was influenced by: belief that breakfast is important; dislike of foods offered; cost; stigma; and time. Sabol et al. and Bailey-Davis et al. reported that students ate breakfast to improve concentration or prevent feeling sick, and that distrust of school food was prevalent. These findings are similar to ours, with the exceptions of themes concerning cost and stigma. Sabol et al. reported cost as a concern for parents, but not students. In our study, students themselves cited cost as a barrier to SBP participation. Sabol et al. and Bailey-Davis et al. found that stigma associated with SBP participation was important, but this issue was absent from all focus group discussions in our study. Our findings also generally agreed with those of previous quantitative surveys that reported lack of time and lack of hunger as reasons for skipping breakfast (Olsta, 2012; Reddan et al., 2002; Shaw, 1998; Sweeny & Horishita, 2005) and belief that breakfast provides energy and improves ability to pay attention in school (Reddan et al., 2002).

Conclusions And Application

While our results are consistent with prior research on breakfast consumption and SBP participation among school-aged children, they also provide new information about potential commonalities and differences between age groups.
Across grade levels, our study participants perceived that school meals were often made from processed foods and were low in quality. They wanted more foods to be cooked from scratch, a recommendation similar to those made in previous focus group studies with high school students (Asada et al., 2017; James, Rienzo, & Frazee, 1996) Prior studies designed to improve staff culinary training and increase scratch cooking have shown associations with improved nutrient profiles of school meals served (Cohen et al., 2012; Schober et al., 2016), Although scratch cooking requires more labor, one study suggested that total food and labor costs of scratch-cooked entrees may not exceed those of entrees requiring no scratch cooking (Woodward-Lopez et al., 2014).

Another consistent theme across age groups was lack of time or lack of hunger as a reason for skipping breakfast at the middle and high school level. Breakfast was served at “grab-and-go” carts in elementary schools in District A, but the cafeteria was the only place where middle and high school students could get breakfast. School foodservice administrators could consider adopting other school breakfast service models, such as longer service hours and/or breakfast in the classroom. Among high school students, “grab-and-go” carts (Larson et al., 2018; Olsta, 2013) and expanded cafeteria hours (Olsta, 2013) have increased SBP participation rates. Notably, while high school students in our study did have access to breakfast over an extended time, many reported not taking advantage of it, suggesting that addressing the timing alone may be insufficient to increase SBP participation. When planning “grab-and-go” meals, it is important to recognize that students may still expect these meals to be made onsite using fresh foods.

Lack of time and hunger in the morning among middle and high school students may be related to early school start times and changes in circadian rhythms that occur during puberty
(Hagenauer et al., 2009). A delay of 1-3 hours in the circadian phase and timing of sleep in adolescents has been observed, peaking between the ages of 15 and 21 (Hagenauer et al., 2009). For many teens, just as they naturally shift their sleep later in the evening, they are required to be at school earlier in the morning. The high school attended by our participants in District A started at 7:40am, whereas elementary schools started at 9:00am. The impact of later school start times on SBP participation has not yet been investigated and could be explored in future research.

School nutrition professionals may use the findings of our study to inform their SBP marketing efforts. For example, messaging to elementary school students and their parents should emphasize the importance of breakfast to “start the day” and the nutritional value of school breakfasts. On the other hand, when targeting middle and high school students, it may be more effective to de-emphasize nutrition and to instead highlight the freshness and quality of foods. When cooking foods to order is not feasible, school nutrition professionals may consider assembling items at the time of purchase or offering students the opportunity to choose their own sandwich or salad toppings.

Due to the nature of focus group research, this study had inherent limitations. Although school administrators and teachers were asked to invite a representative group of students to participate, participants may have differed in important ways from other students. Additionally, some participants were more engaged than others in the discussions; therefore, their opinions are overrepresented in the analysis.

While the results of our study cannot be generalized to other settings and populations, when considered in conjunction with the strikingly similar findings of other studies, they can be used to inform practices in SBPs. Attention to student perceptions of food quality and freshness should be paramount at every grade level. While participants’ comments in this study were not always factually correct—for example, claims that the food was “fake” or that meat was undercooked—they reflect a pervasive perception among students about school food that influences their likelihood of participating in school meal programs. Making school breakfast more convenient and ensuring adequate time for students to eat when hungry (which may be later for older students) are also strategies that could reduce barriers, but these strategies alone will be insufficient without also addressing students’ negative attitudes towards school meals.