Search Results (43)

Background/Objectives: The purpose of this article (a comparative analysis of state laws) is to thoroughly examine enacted state-level healthy universal school meals bills to summarize bill content and determine current practices for program implementation and long-term viability, with special attention to the Community Eligibility Provision (CEP). Methods: Bills enacted at the state level, as of 31 December 2025, were located electronically on state legislature websites and subsequently reviewed with rules, regulations, and implementation guidelines. Content analyses were conducted to identify patterns, themes, and key concepts pertaining to healthy universal school meals laws and program implementation guidelines to inform comparison policy analyses. Results: Nine states (California, Colorado, Maine, Massachusetts, Michigan, Minnesota, New Mexico, New York, and Vermont) have healthy universal school meals laws that include mandatory funding provisions for programming. Michigan is the only state that has a non-permanent law. Such laws eliminate requirements to certify individual students for free, reduced-price, or full-price meals based on their household income, and instead allow entire schools and/or school districts to offer all enrolled students no-cost meals. All states are funding healthy universal school meals programming by leveraging existing or new tax revenue to bridge the gap between the cost of school meals and federal meal reimbursements. Conclusions: State laws that leverage the Community Eligibility Provision (CEP) have become a key way to sustain universal school meal programs when federal funding falls short. States that direct resources to high-poverty schools, help districts determine the most accurate Identified Student Percentage, and reduce undercounting through strong direct-certification practices are better positioned to maintain universal meals over time. These strategies strengthen both child health and academic outcomes by ensuring stable access to no-cost, nutritious meals. Full article

Background/Objective: Nutrition security, defined as consistent access to and consumption of nutritious foods that support health, remains a persistent challenge in rural populations. The HEALTHY (Helping Early Adolescents Live Their Healthiest Youth) program aimed to improve rural adolescents’ nutrition security through school-based strategies. This study evaluated its effectiveness by examining changes in fruit consumption, fruit waste, and skin carotenoid levels. Methods: A quasi-experimental, pre–post program was assessed in five rural middle schools (two experimental sites, three comparison sites). The programming paired four biweekly smoothie taste tests with nutrition education grounded in Social Cognitive Theory and Choice Architecture. Students in grades 3–8 (N = 149) participated. Digital tray photographs quantified selection and waste. The Veggie Meter^® assessed skin carotenoids on a scale from 0 to 800. Surveys captured perceptions and self-reported intakes. Analyses included χ², McNemar’s, GLMM, paired t-tests, and ANCOVA. Significance was set at p < 0.005. Results: At post-program, 98.3% of experimental trays contained the standard fruit option and/or a smoothie, compared with 41.0% of comparison trays (χ² = 41.66, p < 0.001). Fruit selection odds were 16.22 times higher in experimental schools (95% CI: 6.30–41.77, p < 0.001). Among trays with both (n = 39), smoothie waste was lower than the standard fruit option waste (t(38) = −7.10, p < 0.001, d = 1.14), resulting in greater estimated consumption (~0.43 vs. ~0.15 cups). Skin carotenoids increased in both groups, with greater improvement among experimental students in the lowest baseline quartile, F (1,19) = 9.20, p = 0.007, partial η² = 0.326. Conclusions: The HEALTHY program, which paired frozen-fruit smoothies with nutrition education, may offer a feasible and scalable approach to improving nutrition security among rural adolescents. Full article

Background/Objectives: In 2023, the United States Congress amended Section 13 of the National School Lunch Act to allow non-congregate meal service as an option within the Summer Food Service Program in rural areas, creating “SUN Meals To-Go.” The purpose of this qualitative study was to explore caregivers’ perceptions of USDA rural non-congregate summer meal programs in California during the summer of 2024. Methods: This was a cross-sectional, qualitative study using an electronic 20-item survey instrument that was available in English and Spanish. Five school foodservice directors in California shared and/or posted at meal pick-up sites a flyer with a QR code leading caregivers to the survey instrument. A conventional content analysis was conducted with the open-ended responses and descriptive statistics were calculated for close-ended items. Results: Caregivers (n = 827) were primarily married (70.5%) and Hispanic/Latino (54.3%) women (85.5%). They (55%) reported using the 2024 summer meal program “most times” or “every time” it was available. Three themes were constructed through qualitative content analysis: (1) Family support and resource relief, (2) Navigating program accessibility and logistics, and (3) Nourishment and practicality: Reflections on food quality, nutrition, and sustainability. Conclusions: Caregivers highlighted that the program supported their families and provided resource relief. They indicated that accessibility and logistics were effective, provided ideas for fine-tuning the delivery of the program, described this program as supporting their children’s nutrition. Full article

School meals are a cornerstone of the United States’ nutrition safety net for children from low-income families, providing nearly 30 million lunches daily. However, recent U.S. policy actions may limit access to school meals for children who need them most. The One Big Beautiful Bill Act changed eligibility requirements to limit participation in the Supplemental Nutrition Assistance Program (SNAP) and Medicaid. School-age children enrolled in SNAP and Medicaid are automatically enrolled in school meal programs. Limiting participation in SNAP and Medicaid has the potential to significantly impact children’s ability to receive nutritious school meals at low or no cost, will make it harder for schools to participate in community eligibility provision, and will increase the administrative burden on school staff and parents. Full article

Background/Objectives: Children spend the most time in school, which can be a friendly environment that encourages students to eat healthy foods, so school is a good place to learn and practice these behaviors. In Palau, public schools offer free lunches to students. Based on the constructs of Social Cognitive Theory, we conducted a pilot study to evaluate the effects of a school nutrition education program (NE) and the provision of more fruits and vegetables (FV) in school lunches on elementary school students’ nutrition knowledge, as well as their attitudes and behaviors regarding fruit and vegetable consumption. Methods: A public elementary school participated in our trial from February to May 2017. While all students (ages 5–12) at the school were provided with free meals through the National School Meal program, only students in grades 4–8 were invited to participate in a four-month nutrition education program and taste-testing activities, during which more fresh fruits and vegetables were incorporated into the school lunches. Participants filled out questionnaires before and after the trial. Results: Our results showed that students in grades 4–8 (n = 92) had improved scores in all nutrition knowledge items after completing the nutrition education course compared to before the course. Among these, the food category, food servings, and total scores showed statistically significant differences. The scores for attitudes and behaviors regarding FVs intake showed an increasing trend after the completion of the course. Further, the age-based analysis revealed that fifth-grade students showed the greatest improvement in their nutrition knowledge scores, with an increase of 38.5%. However, after adjusting for gender, the significance was no longer observed. Regarding attitude and behavior scores toward fruit and vegetable consumption, fourth-grade students showed the greatest improvement, with increases of 10.9% and 6.3%, respectively. Additionally, we tracked the total amount of FVs consumed by the school annually, noting a consistent rise from 1853 pounds in 2017 to 6580 pounds in 2021, a 3.5-fold increase. Conclusions: This pilot study showed that school nutrition education and providing more fresh fruits and vegetables (FVs) can significantly improve children’s nutrition knowledge, while there was only a slight upward trend in attitudes and behaviors toward FV consumption. However, regularly offering nutrition education courses combined with providing more fruits and vegetables in school lunches could effectively increase children’s consumption of these healthy foods. Full article

Neglected and Underutilized Species (NUS)—locally available, climate-resilient species—possess significant nutritional, social, and environmental benefits, yet their use, research focus, and market presence have diminished over time. Incorporating NUS into school meal programs can potentially boost childhood nutrition, promote healthy eating, encourage sustainable food production, preserve food culture and heritage, and support biodiversity conservation. School meals offered in Kenya are often monotonous and nutritionally inadequate. We conducted a case study on a school in an informal urban settlement in Nairobi, targeting students between ages 6–12, to demonstrate how incorporating locally grown, nutrient-dense foods into school meals can result in better nutrition for school-age children, while making significant savings for schools. Using the World Food Programme’s School Meal Planner (SMP) PLUS software, the school meals offered were analyzed for nutrient adequacy and optimized including five NUS: African nightshade (Solanum spp.), spider plant (Cleome gynandra), Bambara groundnut (Vigna subterranea), bonavist or hyacinth bean (Lablab purpureus), and slender leaf (Crotalaria spp.). The optimization process was based on the commodity price fluctuations and nutrient composition of the local agrobiodiversity used. The study results show how NUS are a viable and healthy alternative to meet the recommended daily nutrient needs for school-aged children at affordable prices. The tool results showcased the effectiveness of linear programming in enabling national decision making for efficient school feeding program planning, by designing comprehensive, affordable food baskets using local agrobiodiversity. Future research should explore implementing optimized school menus while examining broader aspects, such as school lunch environmental impacts and direct procurement approach opportunities that source local ingredients from smallholder farmers. Full article

Objectives: Although the school lunch program is expected to reduce obesity and underweight among children in Japan, there had been no individual-level study examining the impact of school lunch on body size (overweight or underweight). The present study examined the association between school lunch and body size in Japanese junior high school students. Methods: This cross-sectional study was conducted based on data from the Japanese National Health and Nutrition Survey in 2014 and 2018. The present analysis included 323 individuals (12–15 years old). The exposure factor was school lunch usage. The primary outcome measure was body size (normal weight, overweight/obesity (including both overweight and obesity), and underweight). Results: Of 323 individuals, the proportion of school lunch users was 65.6%. School lunch was not statistically significantly associated with normal weight; the multivariate-adjusted odds ratio (95% confidence interval) of normal weight in school lunch users was 1.07 (0.66–1.75) in comparison with non-users. No significant associations were found for overweight/obesity or underweight outcomes. Conclusions: The present findings did not support the expectation for the Japanese school lunch program. Full article

Background: The Healthy, Hunger-Free Kids Act was passed in 2010 to update nutrition standards in the National School Lunch and Breakfast Programs to be in accordance with evidence-based guidelines. In 2017 and 2020, the United States Department of Agriculture proposed flexibilities to the nutrition standards for milk, whole grains, and sodium. Objective: This study examines the positions used by stakeholders in support for or opposition to the proposed rules. Methods: We conducted a longitudinal qualitative content analysis of public comments posted to the U.S. Federal Register in response to the USDA’s proposed rules in 2017 and 2020. All public comments submitted by individuals and organizations were analyzed (n = 7323, 2017 and n = 2513, 2020). Results: Results indicated three categories of arguments: (1) comments favoring the original law, (2) comments favoring flexibilities, and (3) other. In both comment periods, constituents opposed the implementation of flexibilities, while schools and manufacturers/industry predominately supported them. Academic and advocacy organizations opposed the original proposed change (2017) but relaxed their position in 2020. Conclusions: Any flexibility to the required nutritional standards of school meals has the potential to affect the health trajectory of youth. It is imperative to understand how stakeholders view this issue and inform policy change. Full article

Background: Childhood obesity is a pressing global public health challenge, marked by significant disparities in prevalence and management across countries. Japan and the United States offer contrasting approaches to addressing this issue, presenting a valuable opportunity for comparative analysis. Objective: This review examines the effectiveness of public health policies, cultural dietary habits, and lifestyle factors in combating childhood obesity in Japan and the United States. It aims to identify actionable insights to inform global strategies for obesity prevention. Results: Japan exhibits one of the lowest childhood obesity rates globally, attributed to prevention-focused policies such as the food education program, stringent school lunch standards, and culturally ingrained healthy eating practices. These efforts are complemented by active lifestyle promotion through urban planning and school-based physical education programs. In contrast, the United States faces higher obesity rates due to systemic challenges, including socioeconomic disparities, reliance on processed foods, sedentary lifestyles, and inconsistent implementation of federal programs like the National School Lunch Program (NSLP) and Supplemental Nutrition Assistance Program Education (SNAP-Ed). Conclusions: This review highlights Japan’s success in aligning public health initiatives with cultural norms to achieve sustainable outcomes. In the United States, systemic barriers and cultural disconnects hinder obesity prevention efforts. Recommendations include adopting integrated, prevention-focused policies, addressing socioeconomic inequities, redesigning urban environments to promote active living, and fostering global collaboration. This comparative analysis underscores the importance of culturally tailored, multidimensional strategies for addressing childhood obesity and improving public health outcomes worldwide. Full article

Background: Children’s dietary quality is suboptimal, increasing the risk of numerous chronic illnesses. Salad bars (SBs) have potential to enhance children’s nutritional intake within the National School Lunch Program (NSLP); yet, empirical support is lacking. To address this gap, we evaluated the impact of school salad bars on dietary quality and energy intake at lunch. Methods: Seven matched elementary school pairs were randomly selected. All schools served pre-portioned fruit and vegetables (F&V) at baseline. Within each pair, one school received an SB. Digital imagery plate waste methods were applied at baseline and 4–6 weeks post salad bar installation to determine intake (20% increments for food, ounces for beverages). Dietary quality (Healthy Eating Index (HEI-2015)) and energy intake (kcal) were evaluated in NDSR. Multilevel modeling evaluated group (SB vs. control) and time (baseline vs. post) differences and group-by-time interactions for: (1) HEI-2015 (total and component scores) and (2) kcal intake (overall, F&V, non-F&V, and beverage kcals). Results: Data from 5674 trays are reported. Significant group-by-time interactions were observed for HEI-2015 total scores and Greens and Beans, Total Fruit, Whole Fruit, Refined Grains, and Added Sugar component scores (p < 0.0001), supporting improved dietary quality in SB schools. SB HEI-2015 scores were 60.1 ± 9.8 at post (+5.3 from baseline; p < 0.0001) compared with 57.2 ± 9.5 in controls (+1.0 from baseline; p = 0.065). Total energy intake significantly increased in SB schools (376 ± 151 kcal (baseline) → 434 ± 176 kcal (post)), driven by F&V energy (+59 kcal), with no change for controls. Discussion: Within the NSLP, SBs improved dietary quality and increased energy intake due to increased F&V intake without replacing other foods. Results can inform school nutrition policies designed to reduce chronic illness risk. Full article

Understanding the association between food security status (FSS) and diet quality in children is crucial. This study investigated regional variability in FSS, participation in the federal nutrition assistance program (FNAP), and diet quality among US children. National Health and Nutrition Examination Survey (NHANES) data from 2013 to 2016 were analyzed. The association between FSS, FNAP participation, and diet quality (Healthy Eating Index—HEI-2015) was assessed using multiple linear/logistic regression models. The sample included 6403 children (mean age: 7.5 years; 51% male; 33% Hispanic). Within the sample, 13% reported child food insecurity, and 30% reported household food insecurity. Additionally, 90% participated in the FNAP, and 88% were enrolled in school lunch programs. Children in urban areas were significantly more likely to report household food insecurity than those in rural areas (29.15% vs. 19.10%). The overall HEI-2015 score was 48.2. The associations between child/household FSS and FNAP participation as well as between child/household FSS and diet quality did not differ by urban/rural residence status, irrespective of the children’s age groups. There is a need for improvement in children’s diet quality, regardless of age or urban/rural residence. The findings suggest that improving children’s diets requires broader action as well as the prioritizing of children in urban areas experiencing food insecurity in future dietary interventions. Full article

Background and Objectives: School-focused public food procurement and service policies (SPFPs) are increasingly being recognised as interventions that can improve the nutritional quality of food served in schools amidst growing overweight/obesity and persistent micronutrient deficiencies, stunting and wasting in sub-Saharan Africa (SSA). The review aims to investigate the impact of such policies on school food environments and nutritional outcomes of children/adolescents (5–18 y) in SSA and explore challenges and facilitators to implementing effective procurement. Methods: A mixed methods systematic review of studies in SSA published between 2012 and February 2023 was conducted. Studies were included if they reported on a publicly funded school meal (e.g., breakfast, lunch, snack, take home ration) and a nutritional (anthropometric, micronutrient deficiencies, food consumed) or food environment outcome. Quantitative findings were synthesised descriptively. Qualitative evidence was synthesized using an adapted eight-step school food system framework to guide coding (food production, wholesale & trading, transportation & storage, processing & distribution, food preparation, distribution to students, student-stakeholders and community involvement). This framework, along with infrastructure support domains, namely leadership, governance and monitoring/evaluation, guided categorisation of authors’ policy-related recommendations. Results: A total of 33 studies (26 qualitative, 7 quantitative) were included from nine SSA countries. Evidence from the quantitative studies was mixed and did not demonstrate any measurable impact of SPFPs on nutritional outcomes. In total, 53 implementation challenges, particularly in food distribution, food preparation and wholesale & trading, and 37 implementation facilitators, notably student stakeholders, community involvement and processing & distribution, were identified across the school food system. Infrastructure support and policy recommendations from authors span across the school food system, particularly for improving food preparation and engaging students in programming. Discussion: While little evidence on the impact of publicly funded school meal programmes and nutrition outcomes was found (partly explained by inadequate research design to evaluate impact), qualitative evidence suggests that developing or revising SPFPs to include healthy (nutritious and safe) food at all levels of the school food system has much potential. The array of policy action needed to improve implementation of school meal programmes across the school food system calls for action at multiple scales of governance (national/local government), as well as engaging schools and local communities to strengthen stakeholder involvement. Full article

The 2010 Healthy, Hunger-Free Kids Act (HHFKA) improved the nutritional quality of food served in schools. This longitudinal study examined school food offerings over time from school year 2010-11 to 2017-18 in public schools (n = 148) in four New Jersey cities. Six food indices were used to assess the number of healthy and unhealthy items offered as part of the National School Lunch Program (NSLP), in vending machines, and à la carte (i.e., competitive foods). Multilevel, multivariable linear regression with quadratic terms was used to model the trends over time. Interaction terms were added to examine whether the time trends varied by school-level factors, such as proportion of students eligible for free or reduced-price meals (FRPMs), race/ethnicity of enrolled students, and school level. Over the study period, healthy items offered in the NSLP increased (p < 0.001), while unhealthy items in the NSLP decreased (p < 0.001). Significantly different rates of declines in NSLP unhealthy offering were observed among schools at the two extremes of FRPM eligibility (p < 0.05). The trends for healthy and unhealthy foods offered in competitive foods showed significant non-linear trends, and differences were observed for school-level race/ethnicity, with worse outcomes for schools with majority Black student enrollment. Full article

Packed school lunch consumption remains a sparsely studied aspect of childhood nutrition. Most American research focuses on in-school meals provided through the National School Lunch Program (NSLP). The wide variety of available in-home packed lunches are usually nutritionally inferior compared to the highly regulated in-school meals. The purpose of this study was to examine the consumption of home-packed lunches in a sample of elementary-grade children. Through weighing packed school lunches in a 3rd grade class, mean caloric intake was recorded at 67.3% (32.7% plate waste) of solid foods, while sugar-sweetened beverage intake reported a 94.6% intake. This study reported no significant consumption change in the macronutrient ratio. Intake showed significantly reduced levels of calories, sodium, cholesterol, and fiber from the home-packed lunches (p < 0.05). The packed school lunch consumption rates for this class were similar to those reported for the regulated in-school (hot) lunches. Calories, sodium, and cholesterol intake are within childhood meal recommendations. What is encouraging is that the children were not “filling up” on more processed foods at the expense of nutrient dense foods. Of concern is that these meals still fall short on several parameters, especially low fruit/vegetable intake and high simple sugar consumption. Overall, intake moved in a healthier direction compared to the meals packed from home. Full article

Background: In 2018, the United States Department of Agriculture (USDA) issued flexibilities to the National School Lunch and Breakfast Programs, relaxing the nutrition standards for milk, whole grains, and sodium. This study examines the implementation decision-making among Missouri school food services and the impact of implementing these flexibilities on the meals served. Methods: We developed a survey using the Consolidated Framework of Implementation to determine schools’ implementation of the flexibilities and factors related to implementation. To determine how the implementation of flexibilities affected participation, we merged the survey results with school-level meal county data from the Missouri Department of Elementary and Secondary Education. We used ordinary least squares regression to examine how flexibility adoption related to the number of meals served. Results: Most schools implemented the wheat, milk, and sodium flexibilities. Common reasons for implementation were increasing participation, meeting students’ preferences, expanding menu variety, and saving money. The implementation of flexibilities was associated with more lunches and breakfasts being served per month, particularly among free and reduced-price meals. Conclusions: Continued research is needed to determine how the increased uptake of school meals that do not fully meet dietary guidelines by low-income students results in inequities in health outcomes. The findings can inform the design and implementation of future policies, especially as new rules related to flexibility design are determined. Full article