Universal Free School Meals and Child Body Mass Index: Impact of the Community Eligibility Provision

• In Event: Universal Free School Meals Policies: Impact on Child Health and Well-being

Abstract

Background: High poverty schools nationwide are eligible to provide universal free school meals through a policy called the Community Eligibility Provision (CEP). The goal of universal free meals through CEP is to improve food security and child health. School lunch has been shown to be of higher diet quality compared to alternatives. Therefore, providing universal free lunch has potential to decrease childhood obesity, but studies so far are limited and findings are mixed.

Methods: We used electronic health record data from a large network of community-based healthcare organizations and linked school-level data. Based on residential address, date of visit, from the EHR and school catchment boundaries and enrollment status from the National Center for Education Statistics, we assigned each child to the age-appropriate neighborhood school. We created a balanced panel of schools that were observed every year between school year (SY) 2013-14 and SY 2018-19 that had at least one child who had their height and weight measured at an OCHIN clinic during a given school year. We used extended two-way fixed effects for staggered policy adoption, which produce difference-in-difference estimates, to compare average child-level BMI z-scores from schools that adopted CEP to schools that were eligible to adopt but did not do so.

Results: The sample consisted of 164,108 observations from 149,052 children who attended 1,085 unique schools distributed across 12 U.S. States. The sample was 49% male with mean age of 10.9 years, with 45.9% Hispanic, 25.3% White, 12.6% Black, 4.3% Asian, <1% each Native American or Alaska Native, Native Hawaiian or Other Pacific Islander, Multiple racial identities, and 9.3% with unknown racial identity. After policy adoption, children attending schools that adopted CEP gained less in BMI z-score compared to children who attended schools that did not adopt the policy (difference-in-difference: -0.02 (95% CI: -0.04, -0.004)). The estimates for each year following policy adoption suggest the impact of the policy on BMI z-score becomes larger over the first five years of the policy. However, we also find heterogeneity in effects by the year of adoption and state, whereby some adoption cohorts experience greater gains in BMI z-score.

Conclusions: Using modern causal methods for observational data and data from a large balanced panel of schools within 12 U.S. states, we find that a universal free school meals policy targeting high poverty schools in the US is associated with slower gains in BMI z-score for children attending adopting schools compared to children in schools that were eligible to adopt but do not. The impacts became larger in the years following policy adoption; however, there was also evidence of heterogeneity in effects by policy adoption year and state, which deserves further exploration.

 

Author

• Jessica C Jones-Smith, University of California, Irvine
  Presenting Author