title: Exploring the Parents' Attitudes and Perceptions About School Breakfast to Understand Why Participation Is Low in a Rural Midwest State.
abstract: To explore parental attitudes and perceptions about the school breakfast program in a state with low school breakfast participation.
  
  
  
  A cross-sectional study design that used an online survey completed by parents supplemented with district data from a state department of education. The survey included quantitative and qualitative components.
  
  
  
  A rural Midwestern state with low school breakfast participation.
  
  
  
  Parents and caregivers of children in grades 1-12 were recruited through schools to complete a survey (n = 7,209).
  
  
  
  Participation in a school breakfast program.
  
  
  
  A generalized estimating equation model was used to analyze the data and account for the possible correlation among students from the same school district. Open-end survey items were coded.
  
  
  
  Parents identified several structural and logistic barriers in response to open-ended survey items. Factors associated with breakfast participation include perceived benefits, stigma related to those for whom breakfast is intended, and the importance of breakfast.
  
  
  
  Interventions should be designed to test whether changing parent perceptions and decreasing stigma will lead to increased breakfast participation. Policy, systems, and environment changes addressing the structural and logistic barriers also may have the potential to increase participation.
authors.affiliation: Department of Community and Behavioral Health, Public Policy Center, University of Iowa, Iowa City, IA. Electronic address: natoshia-askelson@uiowa.edu.
authors.forename: Natoshia M
authors.initials: NM
authors.lastname: Askelson
authors.affiliation: Department of Health Policy and Management, Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, IN.
authors.forename: Elizabeth H
authors.initials: EH
authors.lastname: Golembiewski
authors.affiliation: Department of Biostatistics, University of Iowa, Iowa City, IA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Ghattas
authors.affiliation: North Liberty Food Pantry, North Liberty, IA.
authors.forename: Steven
authors.initials: S
authors.lastname: Williams
authors.affiliation: Iowa Department of Education, Des Moines, IA.
authors.forename: Patti J
authors.initials: PJ
authors.lastname: Delger
authors.affiliation: Iowa Department of Education, Des Moines, IA.
authors.forename: Carrie A
authors.initials: CA
authors.lastname: Scheidel
mesh_terms: D000328:Adult; D062408:Breakfast / Q000523:psychology*; D002648:Child; D002664:Child Nutritional Physiological Phenomena; D003430:Cross-Sectional Studies; D005247:Feeding Behavior; D005522:Food Services / Q000706:statistics & numerical data*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D015146:Midwestern United States / Q000453:epidemiology; D010290:Parents / Q000523:psychology*; D012424:Rural Population; D012574:Schools / Q000706:statistics & numerical data; D013334:Students / Q000706:statistics & numerical data
keywords: children; nutrition; rural; school meals