Food Service Program Research Articles

Ecological study of the reach of congregate vs. grab-and-go summer meals in New York City

Participation in school meals is associated with many benefits. However, participation in school meals served in the summer through the Summer Food Service Program (SFSP) is low due to many barriers, including program requirements such as congregate feeding. During COVID-19, these requirements were waived, allowing grab-and-go meals. The purpose of this study is to compare the number of SFSP breakfast and lunch meals served during the summers of grab-and-go meals (2020 and 2021) to prior summers of congregate feeding (2014–2019) in New York City (NYC). This study is an ecological study of NYC public school geographic districts (n = 32). The primary outcome is the total number of SFSP meals served per student. Using the repeated-measures ANOVA, the results show a significant increase in the number of SFSP meals served per student during the first summer (2020) of grab-and-go meals compared to summers 2016–2019 (p ≤ 0.01) but no significant differences during the second summer (2021) of grab-and-go meals compared to summers 2014–2019. However, there was a significant increase in the number of breakfast meals served in August per student during both the first and second summer of grab-and-go meals compared to summers 2014–2019 (p < 0.05). Among NYC public schools, the waivers may increase the reach of breakfast meals served in August, when there are fewer summer school activities. While there is a need for more research, policymakers may consider making waivers that allow grab-and-go meals permanent flexibilities for the SFSP to increase access to summer meals.

Who takes up a free lunch? Summer Food Service Program availability and household grocery food spending

The Summer Food Service Program (SFSP) provides free meals to children in low-income neighborhoods as a summertime replacement for the National School Lunch Program (NSLP). Unlike the NSLP, the SFSP does not directly means test its recipients, and there are no large-scale administrative data describing the children it serves. I provide the first descriptive evidence of how SFSP site availability and meal provision varies across states and correlates with area demographics. I find that there is a positive relationship between an area’s likely need and SFSP availability, but availability plateaus before reaching full coverage in the highest poverty areas. As a second-best measure of household take up of the SFSP, I link these data to transaction-level records on household grocery expenditures and study the effect of SFSP availability on households’ grocery food spending. I use variation in the timing and intensity of SFSP meal provision to show that, under some assumptions, households with children reduce weekly grocery food spending by 1.8 percent for each additional meal received. These spending reductions are driven by households who are ineligible for subsidized meals during the academic year, providing suggestive evidence of targeting inefficiencies in the SFSP.

Implementing Heart Plus: Design and Early Results of a Novel Comanagement Clinic for Patients With Stimulant-associated Cardiomyopathy

We describe the methodology, design, and early results of a novel multidisciplinary co management clinic model with Addiction Medicine and Cardiology providers using contingency management to engage patients with stimulant-associated cardiomyopathy (SA-CMP). Stimulant use, including methamphetamine and cocaine, is increasing in prevalence nationally and is associated with cardiovascular complications. People with SA-CMP have higher rates of mortality and acute care use (eg, emergency department visits, hospital admissions) and lower rates of outpatient care engagement than individuals with non–SA-CMP. This population also has disproportionately elevated rates of mental health and other medical comorbidities, challenges with social determinants of health, including housing and food insecurity, and representation from communities of color. This multidisciplinary comanagement care delivery model, called Heart Plus, was developed and funded as a quality improvement project. It led to a 5-fold increase in outpatient care engagement with a concomitant 53% decrease in acute care use. All participants reported a decrease in stimulant use. With increased clinical stability, patients were able to better engage with outpatient resources for social determinants of health, such as case management, social work, and housing and food service programs. Patients were also empowered to take control over their health while knowing that health care providers cared about their well-being.

Emergency Free School Meal Distribution During the COVID-19 Pandemic in High-Poverty Urban Settings

BackgroundThe coronavirus disease 2019 pandemic triggered nationwide school closures in March 2020, putting millions of children in the United States who were reliant on subsidized school meals at risk of experiencing hunger. In response, the US Department of Agriculture mobilized the Summer Food Service Program and Seamless Summer Option program to provide emergency free school meals. There is a need to investigate the effectiveness of these programs in covering underresourced communities during the pandemic. ObjectiveThis study assessed associations between meal distribution and census tract demographics (ie, poverty level, race/ethnicity, and deprivation level based on social deprivation index score). DesignAn observational study using longitudinal meal distribution data collected over an 18-month period following school closures (March 2020 to August 2021). Participants and settingMonthly meal distribution data were collected for community sites serving 142 census tracts within 4 urban New Jersey cities predominantly populated by people with low incomes and from racial and ethnic minority groups. Main outcome measuresMain outcome measures were the number of meals served monthly by Summer Food Service Program and Seamless Summer Option meal sites. Statistical analyses performedA 2-part multivariable regression approach was used to analyze the data. ResultsIn the first step, logistic regression models showed that high-deprivation tracts were more likely to serve meals during the observed period (odds ratio 3.43, 95% CI 1.001 to 11.77; P = 0.0499). In the second step, among tracts that served any meals during the observed period, mixed effects negative binomial regression models showed that high-poverty and high-deprivation tracts served comparatively more meals (incidence rate ratio [IRR] 2.83, 95% CI 2.29 to 3.51; P < 0.001 and IRR 1.94, 95% CI 1.65 to 2.28; P < 0.001, respectively). ConclusionsFindings show that meal distribution during the pandemic was higher within census tracts with higher poverty and deprivation levels, indicating that underresourced communities with higher need had more free meals available during this unprecedented public health emergency.

Illuminating Child and Adult Care Food Program Partnerships That Improved Food Access and Waiver Utilization for Feeding Young Children in Early Care and Education Programs During COVID-19: A Qualitative Study

BackgroundLittle is known about the partnerships formed between early care and education (ECE) programs and the Child and Adult Care Food Program (CACFP) and other organizations to continue to feed young children during the COVID-19 pandemic. Such information can provide important lessons to build ECE capacity for feeding children during future emergencies and has the potential strengthen the ECE food systems. ObjectiveThis study aimed to identify the unique partnerships that CACFP state agencies established to provide nutrition to young children during the COVID-19 pandemic DesignQualitative semi-structured interviews with 24 participants representing 21 states across the United States. Participants/SettingVirtual interviews with CACFP directors from December 2020 through May 2021. AnalysisFollowing the realist method, transcripts were analyzed using thematic analysis. Codes were developed inductively and grouped to identify themes and subthemes. ResultsFour themes were identified: (1) CACFP partnerships that supported children and families directly; (2) CACFP partnerships that built the capacity of ECE providers to provide food to children in their own settings; (3) CACFP systems-level partnerships that improved coordination of efforts to continue to feed children in ECE; and (4) CACFP directors encouraged other CACFP state agencies to build nontraditional, diverse partnerships that can be leveraged during pandemics and other natural disasters. Within these themes (subthemes), the purpose of the partnerships focused on improving waiver utilization (eg, Department of Transportation, state health departments), improving food access (eg, Summer Food Service Program [SFSP], food banks, grocery stores, dairy councils), supporting ECE programs to participate in food reimbursement programs (eg, SFSP, CACFP sponsors), and resource sharing (eg, coalitions, CACFP sponsors). ConclusionsThe CACFP state directors reported that existing and new partnerships between CACFP state agencies and external entities successfully facilitated feeding young children in ECE during the COVID-19 pandemic. States may consider developing a road map to proactively explore potential partners in their state to meet specific needs such as accessibility, availability, and affordability for feeding young children in ECE.

USDA Summer Meals Programs: Meeting the Nutritional Needs of Children

BackgroundAlthough research shows that children from households with low incomes have diet quality that is better during the school year vs the summer, very little research exists around the nutritional quality of summer meals available to children through the US Department of Agriculture’s (USDA) summer meals programs. ObjectiveThe objective was to examine the extent to which summer meals contributed to meeting the daily nutritional goals from the 2015–2020 Dietary Guidelines for Americans (DGAs) for 9- to 13-year-olds. The current study also analyzed the types of food offered and the top food sources of energy and nutrients in summer lunches. DesignThis cross-sectional study analyzed a nationally representative sample of summer meal sites participating in the Summer Food Service Program (SFSP) or the Seamless Summer Option (SSO). SettingWeekly lunch menus were obtained from 731 summer meal sites operating in the summer of 2018 (SFSP sites: n = 578; SSO sites: n = 153). Main outcome measuresOutcome measures included the most frequently offered foods in the major food groups. The energy and nutrient content of lunches offered were estimated and compared with the daily nutritional goals provided by the 2015–2020 DGAs for 9- to 13-year-olds. Statistical analyses performedMenu data were entered into USDA’s SurveyNet and linked to the USDA’s Food and Nutrient Database for Dietary Studies 2015–2016. Foods were classified into major and minor food groups from the USDA’s School Nutrition and Meal Cost Study. The energy and nutrient values were compared with the daily nutritional goals provided by the DGAs for children ages 9 to 13 years. ResultsSummer lunches provided substantial contributions toward the daily goals for energy and nutrients for 9- to 13-year-olds. SSO programs provided significantly more vegetables than SFSP programs (P < 0.05) and contained significantly higher amounts of vitamins A (P < 0.05), C (P < 0.05), and iron (P < 0.05). Sodium amounts were below the daily limit for 9- to 13-year-olds across both program types. ConclusionsAlthough SSO lunches offered more vegetables than SFSP lunches, lunches served in both SSO and SFSP contributed substantially toward the daily goals for energy and nutrients.

Locally supported, values-based framework for a university foodservice program: Results of a Delphi study

Institutional foodservice programs provide food in kindergarten through twelfth-grade (K–12) school cafeterias, hospitals, prisons, and institutions of higher education. Values-based procurement pri­oritizes certain values or criteria in addition to price. Institutions where values-based procurement policies have been adopted have increased the proportion of procurement dollars that go to local farms and are spent on products receiving third-party certifications for sustainability, farmworker justice, and animal welfare. Several programs exist to support institutions seeking to adopt and implement values-based procurement practices. However, there have been difficulties with imple­menting programs that have metrics that were not designed based on the local context where the institution is located, particularly for institutions of higher education. This study used the Delphi technique to identify expert consensus on values and metrics based on the local context that could be used as the foundation for a values-based framework for a university dining program. Our study identified eight core values and six categories of metrics that were supported by local and region­al food systems stakeholders at the University of Florida and in the surrounding community. Other higher education institutions can apply and adapt these values and metrics to their local contexts or can use our consensus-building process as a model to develop a set of values and metrics for their institutional procurement program, tailored to their local context.

Plate Waste in USDA Summer Food Service Program Open Sites: Results from the Project SWEAT Sub-Study

ABSTRACT The study objectives were to pilot approaches to examine plate waste and explore plate waste patterns by delivery style (pre-assembled trays versus multi-offering tray line with Offer Versus Serve (OVS)) at United States Department of Agriculture (USDA) Summer Food Service Program (SFSP) sites. Mean plate waste in the USDA SFSP was highest for vegetables (70.9% wasted), followed by meat/meat alternate (56.0%), fruit (47.9%), grains (48.9%), and milk (41.0%). The amount of food wasted was consistently higher when meals were delivered on pre-assembled trays versus multi-offering tray line with OVS. Findings from this study provide initial insights into overall plate waste patterns at USDA SFSP sites and potential implications for waste by delivery style.

Predictors of Participation in the U.S. Department of Agriculture Summer Meal Programs: An Examination of Outreach Strategies and Meal Distribution Methods During COVID-19

Significantly fewer children participate in the U.S. Department of Agriculture-sponsored summer meal programs than in the federal school meal programs during the academic year. During the summer of 2021, several pandemic-related waivers supported more flexible operations for summer meal programs, such as allowing grab-and-go meals and the distribution of meals for multiple days at once. This study assessed how summer meal site characteristics and geographically targeted outreach methods were associated with summer meals served in 2021 in Connecticut. Weekly meal count data were requested from all sponsors of the Summer Food Service Program and the National School Lunch Program Seamless Summer Option. Data were received from 78 sponsors with 763 sites. Geographically targeted outreach (e.g., billboards, bus ads, and flyers) was tracked by location each week. Mixed methods ANOVA was used to examine the predictive value of outreach efforts, program characteristics, and meal distribution methods on meals served each week. The program characteristics examined included the hours open per week, the number of weeks serving meals, the maximum number of meals distributed at one time, and the number of open and closed sites in a school district. Between June 21 and August 20, 2021, a total of 1,188,669 breakfasts and 1,389,347 lunches were served. Sites that were open more hours per week (mean=7.60 hours per week; range=0.17-35) and gave multiple meals to parents at each visit (mean=4.68 meals; range=1-15) reported greater rates of meal distribution. The outreach efforts assessed were not significantly associated with changes in meal distribution at nearby sites. The U.S. Department of Agriculture's waivers in response to COVID-19 permitted extended operating hours and multiple-meal distribution. These operational flexibilities should be considered for permanent regulation changes owing to their positive association with summer meal participation.

The Impact of the COVID-19 Pandemic on the Experiences and Operations of Sponsors of the Summer Food Service Program in Maryland, USA: A Multiphase Mixed Methods Study.

During the COVID-19 pandemic, the Summer Food Service Program (SFSP) was allowed to operate in untraditional non-summer months to ensure children did not lose access to free and reduced-priced nutritious meals when schools were mandated to close in the United States. This study assessed the impact of the pandemic on the operations and experiences of Summer Food Service Program (SFSP) sponsors in the state of Maryland during the COVID-19 pandemic in 2020 (Phase I) and 2021 (Phase II). This study used a multiphase explanatory sequential mixed methods design with qualitative prioritization. Maryland SFSP sponsors completed an online survey (Phase I: n = 27, Phase II: n = 30), and semi-structured in-depth interviews were conducted with a subset of sponsors who completed the survey (Phase I: n = 12, Phase II: n = 7). Inductive and deductive analyses were used for qualitative data, and descriptive statistics were used for quantitative data. The COVID-19 pandemic caused SFSP sponsors to change their operations. Sponsors were primarily concerned about staff safety/burnout and decreased participation. Sponsors perceived waivers implemented by the United States Department of Agriculture to be crucial in enabling them to serve meals to children during the pandemic. The findings from our study support advocacy efforts to permanently implement waivers and provide free school meals for all children.

Impacts of Covid-19 School Closures on School Food Service Revenue: Analysis of Public Local Education Agencies in Maryland.

The public health policies and school closures in response to the Covid-19 pandemic have created disruptions in school meal programs. Research is needed to understand the changes in school food service revenue before and during the initial Covid-19-related school shutdowns. A longitudinal cohort study examining federal and state reimbursements as well as sales revenues for all public local education agencies (LEAs) in Maryland from school years (SY) 2018-2019 and 2019-2020 was conducted. Monthly changes in federal and state reimbursements for Child Nutrition Programs, including the National School Lunch Program (NSLP), School Breakfast Program (SBP), Summer Food Service Program (SFSP), and Child and Adult Care Food Program (CACFP) were examined. In the SY 2018-2019, the total revenues from federal and state reimbursements for SBP, NSLP, SFSP, and at-risk CACFP were $272.9million; in comparison, for the SY 2019-2020, the total revenues were $241.8million (11.4% reduction from SY 2018-2019). On average, the school shutdown (during March to June 2020) was associated with a $450,385 (p-value < .01) reduction in federal and state reimbursements per LEA-month (41% reduction). The school shutdown during the Covid-19 pandemic was associated with a statistically significant reduction in school food service revenues across Maryland's public LEAs.

Health Care as a Partner in Federal Nutrition Programs: Call for Advocacy.

Health Care as a Partner in Federal Nutrition Programs: Call for Advocacy.

Summer Food Service Program Meal Participation in Maryland Increased during the COVID-19 Pandemic

ABSTRACT The Summer Food Service Program (SFSP) provides meals to children during out-of-school time, such as emergency school closures. This study assessed the trends in participation and operations of Summer Food Service Program (SFSP) sponsors in Maryland from 2016 to 2020 and evaluated the effects of the COVID-19 pandemic from 2019 to 2020. The total number of summer meals served significantly increased from approximately 3 million meals in 2019 to over 9.5 million meals in 2020. The number of breakfasts, lunches, and operating days also significantly increased from 2019 to 2020, but there was no significant change in the number of sites.

The impact of the Meals‐to‐You program on food insecurity

AbstractFood insecurity among children in the United States remains a serious problem, especially during summer months. While there are summer meal programs such as the Summer Food Service Program (SFSP), participation rates are low. In response, in 2019, Meals‐to‐You (MTY) was piloted by the U.S. Department of Agriculture through the Baylor Collaborative on Hunger and Poverty where food boxes were delivered to households with a focus on rural areas. This was expanded during COVID to an Emergency Meals‐to‐You component. We find that among participating households, those receiving more boxes had larger declines in food insecurity, especially in more remote rural areas.

Barriers to Summer Food Service Program (SFSP) Implementation Before and After COVID-19: A Qualitative, Collective Case Study

ObjectivesSFSP, as a federal food assistance program, could ensure that children have sufficient nutritious food during summer. According to a 2016 USDA report, only 0.4–0.6% of eligible children participated in this program in Nebraska, which makes for one of the lowest SFSP participation rates in the U.S. This study aims to better understand how the COVID-19 pandemic has impacted SFSP implementation in urban and rural settings across the state. MethodsIn this qualitative, collective case study, we conducted eight structured zoom interviews with three SFSP state agencies (two rural and one urban) and five SFSP sponsors (three rural and two urban) in the state of Nebraska who worked in SFSP in summers of 2019 and 2020. Two project team researchers independently coded interview transcripts following an inductive qualitative thematic analysis and used NVivo software to sort and organize the themes. ResultsInterviews revealed that the following themes of barriers in implementing SFSP before the COVID-19 pandemic were: 1) lack of enough transportation to get kids to the meal sites, 2) SFSP staff shortage, 3) federal restrictions on getting schools qualified to run the SFSP, 4) time limitation and issues around starting a new program, 5) not having superintendents on board, and 6) reconstructing and remodeling the meal sites. Specific themes related to issues amplified by COVID were: 1) lack of transportation for food delivery in rural areas, 2) keeping up with COVID adjustments, and 3) meal preparation and food storage problems. Interestingly, most interviewees mentioned that COVID adjustments of SFSP made it easier to run the program by removing the requirements of physical meal sites for children and decreasing the 50% threshold, which allowed more schools to run the summer meals. ConclusionsInsights from this study may inform the development of policies that expand food access to vulnerable families. On the organizational level, this includes providing participating kids and their parents with both meal distribution options - meal sites and delivery options - during summer. On the policy level, this calls for revising the eligibility of SFSP by decreasing the threshold level from 50% to 30% to allow more schools in low-income neighborhoods to participate. Funding SourcesInternal faculty funding.

Which schools receive state-level support for local food purchases? Evidence from reimbursement incentive programs in Michigan and Oregon

AbstractState-level reimbursement programs are increasingly being used to incentivize procurement of local foods by US K-12 school food authorities (SFAs), which are schools or school districts that administer a food service program. However, few studies have explored the characteristics of SFAs that are associated with applying for and receiving reimbursement incentives. We consider reimbursement incentive programs in two states, Oregon and Michigan. In 2018–2019, the school year we study, Oregon used an opt-in model in which all SFAs were eligible to receive reimbursement incentives. In contrast, Michigan used a competitive funding model in which only some SFAs were eligible to apply and only some SFAs that applied received support. Using data from the Farm to School Census, as well as data from the two states' Departments of Education, we estimate discrete choice regressions to explore the factors that are associated with SFAs' application for and receipt of these reimbursement incentives. We find that SFAs that opted into Oregon's procurement program are larger, in metropolitan areas, and more likely to purchase fruits and vegetables locally. Thus, the reimbursement incentives are directed toward SFAs with characteristics that complement F2S program development, instead of SFAs with greater structural impediments. In Michigan, we find that SFAs with past F2S experience and community support for F2S were the most likely to apply for reimbursement incentives. However, conditional on applying, the SFAs most likely to receive funding in Michigan were those located in rural areas, more likely to source meat and seafood locally, and more likely to source directly from producers. Thus, Michigan's support, which was more budget constrained, appeared to target SFAs with distance-based challenges and non-traditional procurement strategies.

Serving Summer Meals During the COVID-19 Pandemic: A Case Study of 2 Summer Food Service Program Sponsors in Maryland.

ABSTRACTBACKGROUNDThe Summer Food Service Program (SFSP) provides free and nutritious meals to children under age 18 during out‐of‐school times. During the COVID‐19 pandemic, Maryland sponsors served over 9.5 million meals to children through an expanded version of the SFSP. This study aimed to explore and compare the factors that enabled 2 SFSP sponsors in Maryland to dramatically increase meals distribution during the pandemic.METHODSSponsors were selected based on their responses in the larger study and demographic characteristics of the area in which they served. Semi‐structured in‐depth interviews were conducted over Zoom—4 interviews with Sponsor A (3 interviews with the sponsor, 1 interview with their vendor) and 1 interview with Sponsor B. Qualitative data were analyzed inductively and deductively. Participation data from 2019 and 2020 were obtained from the Maryland State Department of Education and analyzed.RESULTSDespite their differences in organization type and geographic region, they identified similar facilitators to their success—communication with the community and utilization of the United States Department of Agriculture‐issued waivers.CONCLUSIONSStrengthening community communication networks and permanently integrating more flexibility into regulation of the SFSP may increase meals participation during future out‐of‐school times.

Farm to Institution to Farm: Circular Food Systems With Native Entomoculture

Edible insects recycle food waste, which can help feed a hungrier planet by making food systems more circular and diversifying protein production. The potential for entomophagy (i.e., insect cuisine) to contribute to waste recycling and lower input food production is only beginning to be explored in the U.S., although insects have been consumed by people for millennia in a wide range of cultures. In this perspective piece, we consider as a case study the potential for university foodservice programs in New England to serve as incubators for circular entomophagous food systems. Students are likely early adopters of entomophagy because they increasingly demand sustainable non-meat protein options. University foodservices meanwhile purchase large amounts of food wholesale from local producers, utilize standardized pre-processing, and generate consistent waste streams which may be valuable feed for local insect farmers. Current Farm to Institution approaches strengthen regional food systems by connecting small farmers with university foodservices; we argue that a similar model (Farm to Institution to Farm) could support establishment of local insect farms, introduce edible insects to a relatively receptive base of university student customers, and provide a more sustainable mechanism for repurposing university food waste as insect feed. But to enable this type of food system, additional requirements include: (1) research on domestication of native insect species; (2) investment in processing capacity, ensuring new insect farmers have reliable markets for raw insect products; (3) infrastructure to recirculate waste streams within existing food systems; and (4) creation of recipes that entice new insect consumers.

The Impact of Waivers on Summer Meal Participation in Maryland.

The Summer Food Service Program (SFSP) is a federally funded program that serves free, nutritious meals during the summer months. In 2019, 6 federal waivers that previously helped sponsors serve meals were rescinded. The purpose of this mixed methods study was to assess the impact of the waiver rescission on the experiences of SFSP sponsors in Maryland. This study analyzed responses from Maryland SFSP sponsors in a quantitative online survey and linked meal participation data for 2018 and 2019 (n=29) and in-depth interviews (n=11) about their experiences serving summer meals. Most respondents reported that the waiver rescission significantly impacted their experience serving meals, including increases in workload, spending and staffing; reductions in meal types (eg, breakfast); fewer meals served; and changing closed sites to open. Sponsors expressed desire for the state to apply for waivers on behalf of all SFSP sponsors in future years. The federal rescission of USDA summer meals waivers created substantial barriers for sponsors. To address the issues created by policy decisions, school food authorities and other SFSP should continue to work with researchers and antihunger advocates to share their experiences in order to shape state programs and policies.

That Pop-Up Restaurant: Innovation in a Summer Feeding Program

Objective: That Pop-Up Restaurant Summer Food Service Program (SFSP) was a federally reimbursed program that first served healthy meals to families in a rural Kansas community during the summer of 2017. The program aimed to empower communities to address child hunger by reducing stigma concerning food assistance and providing high-quality, nutritious meals to families. This pilot was developed to increase low utilization rates of summer feeding programs. Methods: An ecological approach was implemented to engage students and families. Program innovations included an open menu ordering format with paid adult meals and proper food storage while maintaining USDA’s nutritional requirements. Additionally, the menu options exceeded fruit and vegetable requirements. Results: On average, 9.6% of youth who participated in the free and reduced-price lunch programs participated daily in summer nutrition during the 2016-2017 school year (FRAC, 2019). Comparatively, That Pop-Up Restaurant’s pilot had over 25% of eligible youth participate in the program one or more times. Conclusions: That Pop-Up Restaurant summer food service program showed promising results for the target population and program developers aim to replicate the program in various communities.