title: Breakfast-Skipping and Selecting Low-Nutritional-Quality Foods for Breakfast Are Common among Low-Income Urban Children, Regardless of Food Security Status.
abstract: BACKGROUND
  Universal access to the School Breakfast Program (SBP) is intended to help low-income and food-insecure students overcome barriers to eating breakfast. However, SBP participation is often still low despite universal access. Further information is needed with regard to these children's breakfast behaviors, and in particular breakfast behaviors among youth from food-insecure families, to inform effective breakfast interventions.
  
  
  OBJECTIVE
  The objective of this study was to examine breakfast behaviors among a large sample of urban students with universal access to the SBP and to identify differences in breakfast behaviors among children from food-secure compared with food-insecure households.
  
  
  METHODS
  A cross-sectional study of 821 fourth- through sixth-grade students and their parents from 16 schools was conducted. Students reported the foods/drinks selected and location of obtaining food/drink on the morning of data collection, parents reported household food security status using the 6-item Food Security Survey Module, and the school district provided SBP participation data during the fall semester of 2013. Multivariable linear regression models accounting for school-level clustering were used to examine differences in breakfast behaviors across 3 levels of household food security: food secure, low food secure, and very low food secure.
  
  
  RESULTS
  Students participated in the SBP 31.2% of possible days, with 13% never participating in the SBP. One-fifth (19.4%) of students purchased something from a corner store for breakfast, and 16.9% skipped breakfast. Forty-six percent of students were food insecure; few differences in breakfast behaviors were observed across levels of food security.
  
  
  CONCLUSIONS
  Despite universal access to the SBP, participation in the SBP is low. Breakfast skipping and selection of foods of low nutritional quality in the morning are common, regardless of household food security status. Additional novel implementation of the SBP and addressing students' breakfast preferences may be necessary to further reduce barriers to students obtaining a free, healthful breakfast. This trial was registered at clinicaltrials.gov as NCT01924130.
authors: Departments of Epidemiology and Biostatistics and.
authors: Holly
authors: H
authors: Dykstra
authors: Departments of Epidemiology and Biostatistics and.
authors: Adam
authors: A
authors: Davey
authors: Social and Behavioral Sciences, College of Public Health, and Center for Obesity Research and Education, Temple University, Philadelphia, PA;
authors: Jennifer O
authors: JO
authors: Fisher
authors: Center for Obesity Research and Education, Temple University, Philadelphia, PA;
authors: Heather
authors: H
authors: Polonsky
authors: The Food Trust, Philadelphia, PA; and.
authors: Sandra
authors: S
authors: Sherman
authors: The Food Trust, Philadelphia, PA; and.
authors: Michelle L
authors: ML
authors: Abel
authors: The Food Trust, Philadelphia, PA; and.
authors: Lauren C
authors: LC
authors: Dale
authors: Center for Obesity Research and Education, Temple University, Philadelphia, PA; Weight Watchers International, New York, NY.
authors: Gary D
authors: GD
authors: Foster
authors: Departments of Epidemiology and Biostatistics and Center for Obesity Research and Education, Temple University, Philadelphia, PA; kwbauer@umich.edu.
authors: Katherine W
authors: KW
authors: Bauer
mesh_terms: D001835:Body Weight; D062408:Breakfast; D002648:Child; D002664:Child Nutritional Physiological Phenomena; D002755:Choice Behavior; D003430:Cross-Sectional Studies; D005247:Feeding Behavior; D005260:Female; D005518:Food Preferences; D005523:Food Supply; D006801:Humans; D016014:Linear Models; D008297:Male; D015999:Multivariate Analysis; D009753:Nutritive Value; D011203:Poverty; D012574:Schools; D014505:Urban Population
keywords: School Breakfast Program; breakfast; children; dietary intake; food insecurity