The federal government established nutrition assistance programs such as the School Breakfast Program and school districts have implemented Breakfast in the Classroom (BIC) to improve participation rates, yet millions of low-income children do not partake in these programs. Thus, many school districts are failing to meet the nutritional needs of the low-income population, which can have negative effects on a child's healthy development. The purpose of this qualitative case study was to observe and explore teachers' perspectives regarding school breakfast implementation in a small school district in the Mid-Atlantic region of the United States. Research questions examined experiences with implementation, benefits and challenges to the program, and how children's needs are impacted based on Maslow's hierarchy of needs, the theoretical framework for this study. Data from the research participants' interviews, journals, and classroom observations were coded, themes were identified, and triangulation occurred to answer the research questions. Findings indicated changes need to be made with food portions, food options, food quality, the logistics of implementation, and outreach efforts. Recommendations included changing equipment, providing equal amounts of food, evaluating food options and quality, providing clean up supplies, and educating parents on BIC. Stakeholders addressing these challenges can increase support and participation rates in the program, leading to positive social change. Implications for positive social change include reduced state costs associated with hunger, decreased food insecurity for low-income families, improved behaviors in the classroom, and improved support of the physiological, safety, and socialization needs of children.

<p>Observational evidence links breakfast skipping, a behavior frequently observed among adolescents, with other poor health related behaviors that perpetuates a lifestyle associated with poor weight management and decreased cognitive performance. Furthermore, evidence suggests that both the consumption of breakfast and the quality of breakfast consumed may influence both weight and cognitive performance related outcomes. In an effort to improve the prevalence of breakfast consumption and the quality of breakfasts consumed among adolescents, recent initiatives have sought to increase participation in the federal School Breakfast Program (SBP). </p><p>The main objectives of this dissertation were to determine: 1) whether the habitual consumption of breakfast influences perceived appetite following the consumption of breakfast and whether habitual breakfast consumption influences post prandial appetitive sensations following the consumption of breakfasts varying in macronutrient distribution; 2) the feasibility of consuming an egg-based, ‘Breakfast in the Classroom’ (BIC) program in 8th grade students and whether the daily consumption of egg-based breakfasts improve School Breakfast Program participation, the quality of breakfasts consumed, and snacking behavior in 8th grade students; and 3) whether differences in cognitive performance exist between 6th-8th grade students who consume school breakfast, students who consume breakfast at home only, and students who skip breakfast following the initiation of a higher-protein Breakfast in the Classroom program. </p><p>This dissertation is organized into chapters that consist of published manuscripts or manuscripts formatted for submission to peer-reviewed journals. Chapter 2 consists of comprehensive review of the evidence linking breakfast consumption and composition to obesity and cognitive performance with an emphasis on the recent advances in school breakfast programs and future directions. Chapter 3 evaluates whether the habitual consumption of breakfast influences perceived appetite following the consumption of breakfast and whether habitual breakfast consumption influences postprandial appetitive sensations following the consumption of breakfasts varying in macronutrient distribution. Chapter 4 examines the feasibility of implementing an egg-based BIC program and subsequent effects on SBP participation, the quality of breakfasts consumed, and evening snacking in 8th grade students. Chapter 5 examines differences in cognitive performance between 6th-8th grade students who consume school breakfast, students who consume breakfast at home only, and students who skip breakfast following a higher-protein BIC. Chapter 6 summarizes the main findings and presents considerations for future research.</p><p>Collectively, the findings from this dissertation demonstrate:1) consuming 30 grams of protein at breakfast improves appetite and satiety compared to a breakfast containing 15 grams of protein, independent of habitual breakfast consumption in overweight adolescent females; 2) implementing a universally-free ‘Breakfast in the Classroom’ program that serves two additional eggs to a traditional school breakfast served via a traditional SBP is feasible and improves SBP participation, the quality of breakfast consumed, and reduces unhealthy evening snacking; and 3) students who consume breakfast at school, as part of a higher-protein BIC program, perform better on tasks assessing cognitive flexibility and executive function in middle school students when compared to students who skip breakfast, regardless of key behavioral and/or socioeconomic factors. Thus, this work suggests increasing protein content of school breakfasts using a universally-free distribution program is feasible and may provide benefits on overall diet quality and cognitive performance for 6th-8th grade students. <br></p>