Eating breakfast has been associated with improved weight status, nutrient intake, and academic achievement among children. The National School Breakfast Program (SBP) was created by the US Congress to ensure that school-aged children have access to a meal to start the school day. However, SBP participation rates have been consistently low nationwide even among students eligible for free or reduced-price (FRP) meals. Policy makers and practitioners have implemented a variety of initiatives to improve breakfast participation, including alternative breakfast service models, such as universal free school breakfast, breakfast in the classroom, second chance breakfast, and grab and go breakfast. To determine whether alternative breakfast service models are associated with improvements in SBP participation, academic, and health outcomes, we first completed a literature review to examine the associations between these models and SBP participation, student attendance, academic achievement, dietary intake, and weight status. Results indicate that some models may result in an increase in participation, but additional studies are needed. Using district- and school-level longitudinal data on breakfast participation rates and student demographics for schools across North Carolina, we examined whether changes in statewide policies and practices promoting alternative breakfast are associated with improved SBP participation. Findings indicate that most of the initiatives implemented in North Carolina were associated with an increase in either school- or district-level SBP participation. Longitudinal data on students and SBP participation for a large urban school district in the Southeast United States (LUSD) were used to determine whether a district-wide universal free breakfast (UFB) policy implemented in 2013-2014 was associated with changes in school-level SBP participation, attendance, academic achievement, and student weight status. On average across schools there was an increase in participation of 4.1% (SE=0.7, p