Experts agree that improving the whole school food environment is an important strategy to confronting the obesity epidemic, yet the National School Breakfast Program (SBP) is a neglected area in the research literature. Unlike the school lunch program, participation in the SBP appears to uniquely protect against excessive weight gain. However, the SBP is underutilized nationally and less than half of low-income children participate. Currently, only 17.1% of students nationally participate in the SBP and participation decreases as grade levels increase with only 10.1% participation among high school students. Implementation and evaluation of strategies that expand and promote the SBP is a priority among national sponsors of school meals and anti-hunger advocates. The goals of this intervention study are to implement best practice strategies to expand and promote the SBP and test the impact upon 1) student participation rates, based on reimbursable meals served, 2) overall student caloric intake and diet quality and 3) body mass index and percent body fat in a random sample of 800 high school students in 16 rural Minnesota school districts. Best practice strategies drawn from federal and industry sources to expand SBP participation include improving access through school-wide policy and practice implementation (i.e., grab-n-go menu, service in the atrium) and promote participation by addressing normative and attitudinal beliefs through a school-wide SBP marketing campaign (i.e., foods taste good, school breakfast is for all students) and providing positive interactions that encourage eating school breakfast with social support from peers and school personnel (i.e., eating in the hallway, classroom). University Extension staff living in and serving the schools and communities will assist school food service directors with all aspects of SBP best practice implementation. This work is important because breakfast eating is positively associated with healthier weights, diet quality and academic performance among children and adolescents. The focus on rural schools is of particular importance as significantly fewer healthy food policies and practices exist in small town and rural schools than in urban or suburban schools. Furthermore, obesity rates among rural youth are as much as 50 percent higher than their urban counterparts. A team of investigators with expertise in successful implementation of multi- school trials, school-level interventions, and state of the art youth diet and anthropometry measures propose the following aims.

Public Health Relevance

The goals of this intervention study are to implement best practice strategies to expand and promote the school breakfast program and test the impact upon student participation rates, total diet and body mass index and percent body fat in a random sample of 800 high school students in 16 rural Minnesota school districts.

National Institute of Health (NIH)
National Heart, Lung, and Blood Institute (NHLBI)
Research Project (R01)
Project #
Application #
Study Section
Community-Level Health Promotion Study Section (CLHP)
Program Officer
Boyington, Josephine
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
University of Minnesota Twin Cities
Family Medicine
Schools of Medicine
United States
Zip Code
Caspi, Caitlin Eicher; Wang, Qi; Shanafelt, Amy et al. (2017) School Breakfast Program Participation and Rural Adolescents' Purchasing Behaviors in Food Stores and Restaurants. J Sch Health 87:723-731
Larson, Nicole; Wang, Qi; Grannon, Katherine et al. (2017) A Low-Cost, Grab-and-Go Breakfast Intervention for Rural High School Students: Changes in School Breakfast Program Participation Among At-Risk Students in Minnesota. J Nutr Educ Behav :
Nanney, Marilyn S; Shanafelt, Amy; Wang, Qi et al. (2016) Project BreakFAST: Rationale, design, and recruitment and enrollment methods of a randomized controlled trial to evaluate an intervention to improve School Breakfast Program participation in rural high schools. Contemp Clin Trials Commun 3:12-22
Shanafelt, Amy; Hearst, Mary O; Wang, Qi et al. (2016) Food Insecurity and Rural Adolescent Personal Health, Home, and Academic Environments. J Sch Health 86:472-80
Larson, Nicole; Wang, Qi; Berge, Jerica M et al. (2016) Eating breakfast together as a family: mealtime experiences and associations with dietary intake among adolescents in rural Minnesota, USA. Public Health Nutr 19:1565-74
Hearst, Mary O; Shanafelt, Amy; Wang, Qi et al. (2016) Barriers, Benefits, and Behaviors Related to Breakfast Consumption Among Rural Adolescents. J Sch Health 86:187-94
Nanney, Marilyn S; Olaleye, Temitope M; Wang, Qi et al. (2011) A pilot study to expand the school breakfast program in one middle school. Transl Behav Med 1:436-442