The impact of providing free universal school breakfast programs on breakfast intake among Norwegian upper secondary school students - a quasi-experimental study

The impact of providing free universal school breakfast programs on breakfast intake among Norwegian upper secondary school students - a quasi-experimental study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article The impact of providing free universal school breakfast programs on breakfast intake among Norwegian upper secondary school students - a quasi-experimental study Elling Bere, Annlaug Selstø, Arnfinn Helleve This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6309674/v2 This work is licensed under a CC BY 4.0 License Status: Posted Version 2 posted You are reading this latest preprint version Show more versions Abstract Background: Several adolescents skip breakfast on school days. There is a large social gradient in breakfast skipping with those deprived skipping breakfast the most. Several Norwegian upper secondary schools have recently implemented free universal breakfast programs. The effect of such programs to reduce breakfast skipping is unclear. Therefore, the aims of this study were to examine the effects of recently implemented school breakfast programs on adolescents' breakfast skipping behaviors and to investigate sociodemographic factors that may moderate these effects. Methods: Two repeated cross-sectional surveys were conducted in three Norwegian counties with one or two years between. A total of 78 schools with more than 20 000 participants at both baseline and follow-up were included. The proportions of students’ awareness of any school breakfast program and changes from baseline to follow-up measurements were used to categorized schools into quintiles of implementation. Those reporting that they usually don’t eat breakfast during the school week were considered as breakfast skippers. General demographic characteristics of the study participants included country, grade level, gender, family affluence score, parental education and field of study (vocational or study specialization). Results: The quintiles ranged from no (new) implementation (Q1) to high implementation (Q5). There were overall more breakfast skippers at follow-up (25%) than at baseline (22%). A gradient was seen in the change in breakfast skipping from baseline to follow-up within the quintiles, i.e. implementation was related to less increase in breakfast skipping, or a slight decline (time*implementation interaction p≤0.001). Breakfast skipping in Q5 was 20% at baseline and 19% at follow-up, and respectively 19% and 24% in Q1. Including type of school in the model, the interaction time*implementation*field of study was significant, and stratified analyses indicated that the studyspecialization group showed a decline in breakfast skipping in Q5 compared to Q1-Q4, while the pattern was less clear for vocational students. Conclusions: The implementation of school breakfast programs did not lead to a reduction in breakfast skipping; but it appeared to mitigate an increasing trend of breakfast skipping. Adolescents universal school breakfast program breakfast skipping socioeconomic status upper secondary school Full Text Additional Declarations No competing interests reported. Supplementary Files TableS1.docx Cite Share Download PDF Status: Posted Version 2 posted You are reading this latest preprint version Show more versions Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6309674","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":460714801,"identity":"1704e30a-3788-11f0-91e4-06cc9d20a69f","order_by":0,"name":"Elling Bere","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA/klEQVRIie3QPUoEMRiA4YQPYpMxrVu4e4VPAlsJXiVpttpiwMZCMDIQm7D1eA5B7IwEUs0ZFPECKzYigzgz/oBFZlrBvE1CyEN+CMnl/mI7YPwwGkKgnwhoiB8lQHuChMcvMrPraUJ+EYzr8XsJoOehfGu1W1QeypP7uYzFnac3h0kyq6gJlxvUjjEFdXMsl3FXedqskgRDRwqH+pZxhMIqff3g0FMbkuTomzgmtlC8q7Mry8cJds8P/LUnnEBhlEI2QfaGU4yUjq0w1FEd1LEj2qbfIi6q8MLb+b6D8PhUnqqFsFxun236x4ao/Rz9z4oaB13t5I5cLpf7z30AsO5VEltTjlYAAAAASUVORK5CYII=","orcid":"","institution":"Norwegian Institute of Public Health","correspondingAuthor":true,"prefix":"","firstName":"Elling","middleName":"","lastName":"Bere","suffix":""},{"id":460714805,"identity":"1e88e018-3788-11f0-91e4-06cc9d20a69f","order_by":1,"name":"Annlaug Selstø","email":"","orcid":"","institution":"Norwegian Institute of Public Health","correspondingAuthor":false,"prefix":"","firstName":"Annlaug","middleName":"","lastName":"Selstø","suffix":""},{"id":460714819,"identity":"26da7470-3788-11f0-91e4-06cc9d20a69f","order_by":2,"name":"Arnfinn Helleve","email":"","orcid":"","institution":"Norwegian Institute of Public Health","correspondingAuthor":false,"prefix":"","firstName":"Arnfinn","middleName":"","lastName":"Helleve","suffix":""}],"badges":[],"createdAt":"2025-03-26 07:23:26","currentVersionCode":2,"declarations":"","doi":"10.21203/rs.3.rs-6309674/v2","doiUrl":"https://doi.org/10.21203/rs.3.rs-6309674/v2","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":95613058,"identity":"3307969c-9ab2-4a6a-9125-fcd19730514a","added_by":"auto","created_at":"2025-11-11 08:23:42","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":374057,"visible":true,"origin":"","legend":"","description":"","filename":"Beremain11.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6309674/v2_covered_9e083c30-69bd-41ad-b30f-4ef083db7d93.pdf"},{"id":83320751,"identity":"96a5675e-4d96-4401-af91-c3feca8a9d9c","added_by":"auto","created_at":"2025-05-23 03:46:29","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":22793,"visible":true,"origin":"","legend":"","description":"","filename":"TableS1.docx","url":"https://assets-eu.researchsquare.com/files/rs-6309674/v2/c5e372acef2fb6a9992a01e8.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"The impact of providing free universal school breakfast programs on breakfast intake among Norwegian upper secondary school students - a quasi-experimental study","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Adolescents, universal school breakfast program, breakfast skipping, socioeconomic status, upper secondary school","lastPublishedDoi":"10.21203/rs.3.rs-6309674/v2","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6309674/v2","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eBackground: Several adolescents skip breakfast on school days. There is a large social gradient in breakfast skipping with those deprived skipping breakfast the most. Several Norwegian upper secondary schools have recently implemented free universal breakfast programs. The effect of such programs to reduce breakfast skipping is unclear. Therefore, the aims of this study were to examine the effects of recently implemented school breakfast programs on adolescents' breakfast skipping behaviors and to investigate sociodemographic factors that may moderate these effects.\u003c/p\u003e\n\u003cp\u003eMethods: Two repeated cross-sectional surveys were conducted in three Norwegian counties with one or two years between. A total of 78 schools with more than 20 000 participants at both baseline and follow-up were included. The proportions of students’ awareness of any school breakfast program and changes from baseline to follow-up measurements were used to categorized schools into quintiles of implementation. Those reporting that they usually don’t eat breakfast during the school week were considered as breakfast skippers. General demographic characteristics of the study participants included country, grade level, gender, family affluence score, parental education and field of study (vocational or study specialization).\u003c/p\u003e\n\u003cp\u003eResults: The quintiles ranged from no (new) implementation (Q1) to high implementation (Q5). There were overall more breakfast skippers at follow-up (25%) than at baseline (22%). A gradient was seen in the change in breakfast skipping from baseline to follow-up within the quintiles, i.e. implementation was related to less increase in breakfast skipping, or a slight decline (time*implementation interaction p≤0.001). Breakfast skipping in Q5 was 20% at baseline and 19% at follow-up, and respectively 19% and 24% in Q1. Including type of school in the model, the interaction time*implementation*field of study was significant, and stratified analyses indicated that the studyspecialization group showed a decline in breakfast skipping in Q5 compared to Q1-Q4, while the pattern was less clear for vocational students.\u003c/p\u003e\n\u003cp\u003eConclusions: The implementation of school breakfast programs did not lead to a reduction in breakfast skipping; but it appeared to mitigate an increasing trend of breakfast skipping.\u003c/p\u003e","manuscriptTitle":"The impact of providing free universal school breakfast programs on breakfast intake among Norwegian upper secondary school students - a quasi-experimental study","msid":"","msnumber":"","nonDraftVersions":[{"code":2,"date":"2025-05-23 03:46:25","doi":"10.21203/rs.3.rs-6309674/v2","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}},{"code":1,"date":"2025-05-13 12:27:41","doi":"10.21203/rs.3.rs-6309674/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"0137d046-f810-4938-8cd8-eb9a2d67c1e6","owner":[],"postedDate":"May 23rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-11-11T08:23:15+00:00","versionOfRecord":[],"versionCreatedAt":"2025-05-23 03:46:25","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v2","identity":"rs-6309674","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6309674","identity":"rs-6309674","version":["v2"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}