BACKGROUND Breakfast consumption is associated with better diet quality and healthier weights, yet many adolescents miss breakfast. Nationally, 17.1% of students participate in the School Breakfast Program (SBP). Only 10% of high school students participate. OBJECTIVE Our aim was to evaluate an environmental intervention to increase SBP participation in high schools. DESIGN A group randomized trial was carried out from 2012 to 2015. PARTICIPANTS/SETTING Ninth- and 10th-grade students enrolled in 16 rural schools in Minnesota (median 387 students) were randomized to intervention or control condition. INTERVENTION A school-based intervention that included two key components was implemented over a 12-month period. One component focused on increasing SBP participation by increasing student access to school breakfast through changes in school breakfast service practices (eg, serving breakfast from a grab-n-go cart in the atrium; expanding breakfast service times). The other component focused on promoting school breakfast through student-directed marketing campaigns. MAIN OUTCOME MEASURE Change in school-level participation in the SBP was assessed between baseline (among ninth and tenth graders) and follow-up (among tenth and eleventh graders). School meal and attendance records were used to assess change in school-level participation rates in the SBP. STATISTICAL ANALYSES The Wilcoxon test was used for analysis of difference in change in mean SBP participation rate by experimental group. RESULTS The median change in SBP participation rate between baseline and follow-up was 3% (interquartile range=13.5%) among the eight schools in the intervention group and 0.5% (interquartile range=0.7%) among the eight schools in the control group. This difference in change between groups was statistically significant (Wilcoxon test, P=0.03). The intervention effect increased throughout the intervention period, with change in mean SBP participation rate by the end of the school year reaching 10.3% (95% CI 3.0 to 17.6). However, among the intervention schools, the change in mean SBP participation rates was highly variable (range=–0.8% to 24.8%). CONCLUSIONS Interventions designed to improve access to the SBP by reducing environmental and social barriers have potential to increase participation among high school students.

OBJECTIVE: To examine healthcare coverage and access disparities for American Indian/Alaska Native (AIAN) veterans compared with non-Hispanic white veterans. METHODS: We examined national survey data for honorably discharged veterans in the United States using National Health Interview Survey (NHIS) data between 1997 and 2006. NHIS data were obtained from the Integrated Health Interview Series, a web-based data resource containing harmonized NHIS data from 1969 to the present. Our sample included AIAN and white veterans aged 18 to 64 years (n = 34,504). We used multivariate logistic regression models to estimate the odds of being uninsured, reasons for delayed care, and types of foregone care. RESULTS: In multivariate analysis, AIAN veterans have 1.9 times higher odds of being uninsured compared with non-Hispanic white veterans (95% CI: 1.6-2.7). Compared with white veterans, AIAN veterans are significantly more likely to delay care due to not getting timely appointments (OR = 2.0, 95% CI: 1.1-2.6), not getting through on the phone (OR = 3.0, 95% CI: 1.6-5.8), and transportation problems (OR = 2.9, 95% CI: 1.1-7.3). In unadjusted models, AIAN veterans have significantly higher odds of having foregone 4 of 5 types of care compared with non-Hispanic white veterans. Adjusting for sociodemographic characteristics and insurance eliminated all significant relations. CONCLUSIONS: AIAN veterans have considerable disparities in healthcare coverage and access compared with non-Hispanic whites. Although barriers to care due to cost are nominal for AIAN veterans, barriers to care due to navigating the healthcare system and due to lack of transportation remain substantial.

Background: Limited access to culturally preferred foods serves as a barrier to healthy diet consumption