Free Meals Research Articles

Stop the shame and the hunger: The need for school meal program reform

The current School Meal Program (SMP) system has existed in the U.S. for more than seventy years, with the intent to offer free and reduced-price meals to students in need. However, after decades of state and local-level implementation of SMPs, the programs today are ineffective at fully addressing students’ physical, social, and emotional needs. State and local education agencies have struggled to carry out successful eligibility, enrollment, and debt-collection processes, ultimately resulting in harmful practices, including lunch-shaming. Such practices impede the success of the program to fulfill its goals and may negatively impact students’ social and emotional development. In the wake of the COVID-19 pandemic and with increased levels of food insecurity, state and local education agencies should consider adjusting their practices to fully meet student nutrition needs. In this unique time, education agencies are presented with an opportunity to move beyond the current SMP model to better fulfill the program’s ultimate goal of providing students with the nutritional support needed to thrive both in and outside the classroom. Here we suggest modern reforms for the SMP landscape through greater levels of federal regulation, guidance, and review processes to support effective SMP implementation at the state and district level; reevaluation of state and local education agencies’ use of available federal options to increase access to school meals; and further research on SMP implementation, debt-collection practices, and costs of a universal free meals program to better understand their effects on student outcomes.

School feeding program and urban–rural inequality of child health: Evidence from China

AbstractSchool feeding programs have served as go‐to policies for addressing child malnutrition in both developed and developing countries. While an increasing number of studies have investigated the health consequences of school feeding programs, empirical evidence regarding their effects on children's health inequality remains limited. This study examines the impact of China's Nutrition Improvement Program (NIP)—A program that provides free meals for rural students at the compulsory education stage—on rural children's health status and urban–rural health status differentials. The analysis uses data from the 2004–2015 China Health and Nutrition Survey. Leveraging county‐by‐county rollouts of the program, we employ difference‐in‐differences approaches as our identification strategy. The results show that the NIP significantly improves children's height‐for‐age z‐scores by 0.136 standard deviations. Moreover, we find that the NIP alleviates the inequality of opportunity in health between urban and rural children by 21.6% in pilot counties. These findings are robust to a series of validity checks. The effect is more pronounced among students who have a younger age, and live in low social status families. Our findings suggest that school feeding programs are effective in decreasing child malnutrition levels and reducing urban‐rural inequality in the long run. [EconLit citations: I10, I18, D63].

Türk Eğitim Sisteminde Matta Etkisi

Over the past 20 years, Türkiye has transitioned its education system to the massification phase, and schooling rates have reached over 99% at all levels of education, from primary to secondary levels. In addition to increasing the accessibility of education to those from disadvantaged socioeconomic status and facilitating the access of girls to education, this important transformation has also increased the effectiveness of the education system. Furthermore, the period was also characterized by free distribution of textbooks and teaching materials to all students in an effort to increase the equality of education opportunities. The provision of free meals, transportation to school, scholarships, accommodation assistance for students in need, as well as conditional financial support based upon the continuation of education was provided to students. The implementation of many social policies has continued over the past two decades in a consistent manner. With such a large system with approximately 19 million students, it is evident that this approach focuses on increasing equality of opportunity in education as opposed to simply increasing educational access. The achievement gap between schools persists despite all these supportive mechanisms, some of which are rooted in the past, some of which have arisen from massification of education. This study discusses the areas or instruments that prevent all students accessing education from receiving the same quality of education, regardless of their socioeconomic status, and areas of higher "Matthew effect" severity. The Matthew effect is particularly strong in four areas, in particular, in the Turkish educational system: access to early childhood education, socioeconomic status, school tracking, and access to senior teachers. The study also provides suggestions for reducing the severity of the Matthew effect in these four areas.

Paying for Free Lunch: The Impact of CEP Universal Free Meals on Revenues, Spending, and Student Health

Abstract The Community Eligibility Provision (CEP) of the Healthy, Hunger-Free Kids Act of 2010 allows school districts to provide free meals to all students if over 40 percent of them are directly certified as free-meal eligible. While emerging evidence documents positive effects on student behavior and academics, critics worry that CEP has unintended consequences for student weight, district finances, and instructional spending. We investigate these using school and district data from New York State and a difference-in-differences design. We exploit staggered CEP adoption, and explore differences between metro, town, and rural districts. We investigate potential mechanisms, including lunch and breakfast participation, and use event studies to assess pre-adoption trends and effects over time. We find that CEP increases total food expenditures, but spending per meal declines. Local food service revenues decline, but increased federal reimbursements more than compensate for local food revenues and expenditures changes. Indeed, while some worry that CEP crowds out education spending, we find no effect on instructional expenditures. Furthermore, CEP increases participation in school lunch and breakfast, but has no deleterious effect on weight outcomes and, instead, is associated with obesity declines in secondary grades. Rural districts experience larger impacts than metro and town districts, alongside some negative fiscal effects.

Nighttime working as perceived by Italian anesthesiologists: a secondary analysis of an international survey

BackgroundNo data are available on the working conditions and workload of anesthesiologists during perioperative nighttime work in Italy and on the perceived risks.ResultsWe analyzed 1085 responses out of the 5292 from the whole dataset. Most of the responders (76%) declared working a median of 12 consecutive hours during night shifts, with an irregular nightshift schedule (70%). More than half of the responders stated to receive a call 2–4 (40%) or 5 times or more (25%) to perform emergency procedures and/or ICU activities during night shifts. More than 70% of the responders declared having relaxation rooms for nighttime work (74%) but none to be used after a nightshift before going back home (82%) and no free meals, snacks, or beverages (89%). Furthermore, almost all (95%) of the surveyed anesthesiologists declared not having received specifical training or education on how to work at night, and that no institutional program has been held by the hospital to monitor fatigue or stress for night workers (99%). More than half of the responders stated having the possibility, sometimes (38%) or always (45%), to involve another colleague in difficult medical decisions and to feel comfortable, sometimes (31%) or always (35%), to call the on-call colleague. Participants declared that nighttime work affects their quality of life extremely (14%) or significantly (63%), and that sleep deprivation, fatigue, and current working conditions may reduce performance (67%) and increase risk for the patients (74%).ConclusionsItalian anesthesiologists declare current nighttime practice to negatively affect their quality of life, and their performance, and are thus concerned for their patients’ safety. Proper education on night work, starting from traineeship, and implementing institutional programs to monitor stress and fatigue of operators and to support them during nighttime work could be a mean to improve nighttime work conditions and safety for both patients and healthcare workers.

Achieving the Unachievable: Work–Life Balance in Radiation Oncology

As radiation oncologists, we often participate in discussions on work–life balance, are offered lectures and free meals, and complete hospital-mandated modules, all under the guise of physician wellness. But how often are these measures efficacious? How do we define being well in our demanding and fast-paced careers? What does it actually look like on a day-to-day basis to achieve work–life balance? Furthermore, is it even possible?

Challenges and Opportunities for Equity in US School Meal Programs: A Scoping Review of Qualitative Literature Regarding the COVID-19 Emergency.

The emergency school meals program provided free meals to children in the United States (US) during COVID-19-related school closures. This scoping review aims to synthesize the existing qualitative empirical evidence published between March 2020 and January 2023 on the operations and utilization of emergency school meal programs during the pandemic. Qualitative, US-based peer-reviewed literature was collected from three sources: (1) parent review of all federal nutrition assistance programs; (2) systematic search of four databases; and (3) manual search of grey literature. Identified scientific articles and grey literature reports (n = 183) were uploaded into Covidence and screened for duplicates and inclusion/exclusion criteria. Our final sample included 21 articles/reports, including 14 mixed methods and seven qualitative-only projects. Articles spanned all U.S. states. Articles had similar research questions to understand school meals and/or general food access during COVID-19, with an emphasis on long-term policy implications. Hybrid deductive/inductive analytic coding was used to analyze data, utilizing domains from the Getting to Equity Framework (GTE). GTE considers multi-level factors that influence nutrition behavior while centering more equitable pathways to improve nutrition security and reduce adverse health. Findings were sorted into two categories: operational challenges during the pandemic and solutions to address inequities in school meal distribution during and after the pandemic, particularly during school closures such as summers or future emergencies. Key challenges related to supply chain issues, safety, and balancing families' needs with limited staff capacity. Programs addressed equity by (a) reducing deterrents through federally issued waivers and increased communications which allowed the serving of meals by programs to families who previously did not have access, (b) building community capacity through collaborations and partnerships which allowed for increased distribution, and (c) preparing and distributing healthy options unless barriers in supply chain superseded the effort. This review highlights the importance of emergency school meal programs and provides insights into addressing challenges and promoting equity in future out-of-school times. These insights could be applied to policy and practice change to optimize program budgets, increase reach equitably, and improve access to nutritious meals among populations at highest risk for nutrition insecurity.

Strategies to Increase Student Participation in School Meals in the United States: A Systematic Review.

School meals play a critical role in promoting child nutrition and advancing equity. An understanding of which evidence-based strategies can increase meal participation is needed to improve student school meal consumption and foodservice finances. Our aim was to systematically review the evidence on interventions, initiatives, and policies to increase school meal participation in the United States. Four electronic databases were searched (PubMed, Academic Search Ultimate, Education Resources Information Center, and Thomson Reuters' Web of Science) to identify peer-reviewed and government studies conducted in the United States and published in English through January 2022. Qualitative studies; studies focused on snacks, afterschool meals, or universal free meals as the sole exposure; and studies conducted in schools not participating in the federal school meal programs or outside of the school year were excluded. Risk of bias was assessed using an adapted version of the Newcastle-Ottawa Scale. Articles were grouped according to type of intervention or policy and were narratively synthesized. Thirty-four articles met inclusion criteria. All studies examining alternative breakfast models (eg, breakfast in the classroom or grab-and-go breakfast) and restrictions on competitive foods found increases in meal participation. There is also some evidence that stronger nutrition standards do not negatively impact meal participation and, in some cases, may promote meal participation. There is limited evidence on other strategies, including taste tests, modified menu options, changes to the meal period length, changes to the cafeteria environment, and wellness policies. There is evidence that alternative breakfast models and restrictions on competitive foods promote meal participation. There is a need for additional rigorous evaluation of other strategies to promote meal participation.

Alternative School Breakfast Service Models and Associations with Breakfast Participation, Diet Quality, Body Mass Index, Attendance, Behavior, and Academic Performance: A Systematic Review.

The United States (US) School Breakfast Program provides Breakfast After The Bell (BATB) to alleviate hunger, provide nutrition, and ensure students have a healthy start to the day. This study aims to review the evidence regarding the impact of BATB on students' diet and academic outcomes, including participation, diet quality and consumption, body mass index (BMI) and weight status, attendance, classroom behavior, and academic performance. The articles were extracted from three electronic databases and published since the start of the literature through December 2022. Studies were peer-reviewed; quantitative research articles or government reports; and conducted in public or private elementary, middle, and high schools. Quality was assessed using the Newcastle-Ottawa Scale. Thirty-seven studies were included in this review. This review found BATB increased school breakfast participation, improved diet quality, and improved classroom behavior particularly among students from racial and ethnic minority backgrounds and students eligible for free or reduced-price meals. The impact of BATB on BMI and weight status, academic achievement and attendance was mixed. This review is particularly timely given free school meals and updated school nutrition standards are being prioritized over the next decade in the US. Thus, it is important to evaluate the nutritional and educational outcomes of BATB. (PROSPERO registration: CRD42021289719).

USDA Summer Meals Program: Lack of Program Awareness Contributes to Unmet Need Among Nonparticipants.

Participation in the US Department of Agriculture's summer meals program is consistently lower compared to National School Lunch Program (NSLP) participation, even though the programs target the same population of children. The purpose of this study was to elucidate reasons for participation and nonparticipation in the summer meals program. A nationally representative sample of 4688 households with children ages 5 through 18 years living near a summer meals site in 2018 completed a survey about their reasons for participation or nonparticipation in the summer meals program, features that would help nonparticipants to attend, and household food security status. Almost half of all households living near a summer meal site were food insecure (45%) and most (77%) had incomes at or below 130% of the federal poverty level. Most participant caregivers (74%) sent their children to summer meal sites for the free meals, while 46% of nonparticipant caregivers said they did not attend because they were unaware of the program. Despite a high level of food insecurity among all households, the most reported reason for not attending the summer meals program was unawareness of the program. These findings highlight a need for better program visibility and outreach.

Prevalence and characterization of food insecurity in a Canadian paediatric emergency department.

Food insecurity (FI) is associated with a number of adverse child health outcomes and increased emergency department (ED) use. The COVID-19 pandemic exacerbated the financial hardship faced by many families. We sought to determine the prevalence of FI among children with ED visits, compare this to pre-pandemic rates, and describe associated risk factors. From September to December 2021, families presenting to a Canadian paediatric ED were asked to complete a survey screening for FI along with health and demographic information. Results were compared to data collected in 2012. Multivariable logistic regression was used to measure associations with FI. In 2021, 26% (n = 173/665) of families identified as food insecure compared to 22.7% in 2012 (n = 146/644) a difference of 3.3% (95% CI [-1.4%, 8.1%]). In multivariable analysis, greater number of children in the home (OR 1.19, 95% CI [1.01, 1.41]), financial strain from medical expenses (OR 5.31, 95% CI [3.45, 8.18]), and a lack of primary care access (OR 1.27, 95% CI [1.08, 1.51]) were independent predictors of FI. Less than half of families with FI reported use of food charity, most commonly food banks, while one-quarter received help from family or friends. Families experiencing FI expressed a preference for support through free or low-cost meals and financial assistance with medical expenses. More than one in four families attending a paediatric ED screened positive for FI. Future research is needed to examine the effect of support interventions for families assessed in medical care facilities including financial support for those with chronic medical conditions.

A Qualitative Analysis of Eating Behaviors Among Food Insecure College Students

ObjectiveTo explore (1) how the cycle of food availability impacts food insecure college students’ food-coping behaviors and (2) how access to a campus food pantry impacts food availability. MethodsQualitative, semistructured one-on-one interviews via Zoom were transcribed verbatim. Three investigators performed content analysis to identify and compare themes among participants with and without access to a campus food pantry. ResultsForty undergraduate students from Illinois 4-year institutions with (n = 20) and without (n = 20) campus food pantries discussed similar experiences related to their food situation, eating behaviors, and use of resources, resulting in 7 themes: unique challenges of the college environment, childhood experiences, the impact of food insecurity, mental energy, the spectrum of resource management, structural barriers, and hiding hunger. Conclusions and ImplicationsFood insecure students may use coping mechanisms to manage food and resources. The existence of a campus food pantry alone is insufficient to meet the needs of these students. Universities could consider providing additional support (ie, free meals), advertising available resources, or integrating food insecurity screening into other established processes.

QuickStats: Percentage* of Children and Adolescents Aged 5–17 Years Who Received Free or Reduced-Cost Meals at School During the Previous 12 Months,† by Race and Hispanic Ethnicity§ and Family Income¶ — National Health Interview Survey, United States, 2021

QuickStats: Percentage* of Children and Adolescents Aged 5–17 Years Who Received Free or Reduced-Cost Meals at School During the Previous 12 Months,† by Race and Hispanic Ethnicity§ and Family Income¶ — National Health Interview Survey, United States, 2021

Assessing the Respect of Children's Rights in Pediatric Hospitals.

Background and Objectives: In 1989, the United Nations (UN) General Assembly adopted the United Nations Convention on the Rights of the Child (UNCRC), with a considerable number of the Articles of the Convention being related to the health status of children. Therefore, adhering to and assessing the implementation of the rights of children during hospitalization is a very important step towards child protection. Herein, we attempt to highlight the depth of knowledge of employees working in children's hospitals with regard to children's rights as well as the degree of adherence to the UNCRC with respect to hospitalized children. Material and Methods: The target group included all healthcare professionals working in the various general pediatric clinics of the three Children's Hospitals of the Athens metropolitan area in Greece. We conducted a cross-sectional study, with data collection carried out in February and March 2020, using a structured questionnaire consisting of 46 questions which was handed out to all personnel. For the analysis, we used the IBM SPSS 21.0. Results: A total of 251 individuals participated in the study (physicians 20%, nurses 72%, and other employees 8%). A total of 54.5% of health professionals did not know what the UNCRC is, and 59.6% of them were not even aware that their hospital had rules and a bioethical committee related to clinical research involving children. Lack of awareness or trust of health professionals is also observed for other procedures or supervisory measures such as abuse protocols, complaint control, admission control, etc. With regard to the health system, there are shortcomings or weaknesses in (a) procedures followed with regard to respect for gender and privacy, (b) information on basic services provided by pediatric hospitals (such as recreation, education and free meals during hospitalization), (c) the logistical infrastructure (such as recreational facilities and facilities for the disabled), (d) the possibility of recording complaints, and (e) hospitalizations that were not necessary. A difference emerged concerning the nurses' responses between the three hospitals, with nurses participating in relevant seminars held in one of the hospitals being significantly more informed. Conclusions: The majority of healthcare personnel seem unaware of basic principles with respect to children's rights during hospitalization as well as relevant procedures and supervisory measures. Moreover, obvious weaknesses of the health system exist with respect to procedures, services, infrastructure, and complaint recording. There is a need for improved education of health professionals with respect to the implementation of children's rights in pediatric hospitals.

Nature's chefs: Uniting the hidden diversity of food making and preparing species across the tree of life

Abstract There may be no such thing as a free meal, but many species have evolved mechanisms for other species to consume the literal fruits of their labors. In the present article, inspired by a chef's recognition that such species are “nature's chefs,” we consider food-making species from the plant, animal, and fungal kingdoms, which produce food or mimic food to increase their own fitness. We identify three ways that species can produce or prepare meals—as food, drinks, or lures—and further distinguish between those providing an honest meal and those deceiving consumers with food mimics. By considering these species holistically, we highlight new hypotheses about the ecology and evolution of the widespread phenomenon of organisms that produce food for other organisms. We find surprising and useful generalities and exceptions among species as different as apple trees and anglerfish by examining species interactions across taxa, systems, and disciplines.

Improvements in School Food Offerings over Time: Variation by School Characteristics.

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.

Effect of Longer Family Meals on Children’s Fruit and Vegetable Intake

Family meals are a formative learning environment that shapes children's food choices and preferences. As such, they are an ideal setting for efforts to improve children's nutritional health. To examine the effect of extending the duration of family meals on the fruit and vegetable intake in children. This randomized clinical trial used a within-dyad manipulation design and was conducted from November 8, 2016, to May 5, 2017, in a family meal laboratory in Berlin, Germany. Included in the trial were children aged 6 to 11 years who did not follow a special diet or have food allergies and adult parents who served as the nutritional gatekeeper in the household (ie, the family member responsible for at least half of the food planning and preparation). All participants underwent 2 conditions: control, defined as regular family mealtime duration, and intervention, defined as 50% longer mealtime duration (10 minutes longer on average). Participants were randomized to the condition they would complete first. Statistical analyses of the full sample were conducted between June 2 and October 30, 2022. Participants had 2 free evening meals under different conditions. In the control or regular condition, each dyad ate in the same amount of time as their reported regular mealtime duration. In the intervention or longer condition, each dyad had 50% more time to eat than their reported regular mealtime duration. The primary outcome was the number of pieces of fruits and vegetables eaten by the child during a meal. A total of 50 parent-child dyads participated in the trial. Parents had a mean (range) age of 43 (28-55 years) years and were predominantly mothers (36 [72%]). Children had a mean (range) age of 8 (6-11) years and included an equal number of girls and boys (25 [50%]). Children ate significantly more pieces of fruits (t49 = 2.36, P = .01; mean difference [MD], 3.32 [95% CI, 0.96 to ∞]; Cohen d = 0.33) and vegetables (t49 = 3.66, P < .001; MD, 4.05 [95% CI, 2.19 to ∞]; Cohen d = 0.52) in the longer condition than in the regular mealtime duration condition. Consumption of bread and cold cuts did not significantly differ between conditions. The children's eating rate (bites per minute over the regular mealtime duration) was significantly lower in the longer than in the regular condition (t49 = -7.60, P < .001; MD, -0.72 [95% CI, -0.56 to ∞]; Cohen d = 1.08). Children reported significantly higher satiety after the longer condition (V = 36.5, P < .001). Results of this randomized clinical trial suggest that the simple, low-threshold intervention of increasing family mealtime duration by approximately 10 minutes can improve the quality of children's diet and eating behavior. The findings underscore the potential for such an intervention to improve public health. ClinicalTrials.gov Identifier: NCT03127579.

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.

Comparing Foodie Calls in Poland, the United Kingdom, and the United States: A Registered Replication Report

Collisson et al. (2020) found Dark Triad traits and gender role beliefs predicted "foodie calls," a phenomenon where people go on a date with others, to whom they are not attracted, for a free meal. Because gender roles and dating norms differ across cultures, we conducted a registered replication across different cultures by surveying 1838 heterosexual women from Poland, the United Kingdom (UK), and the United States (US). Relying on the structural equation modeling, as conducted in the original study, our findings revealed gender role beliefs best predicted foodie calls and their perceived acceptability, whereas the Dark Triad's general factor was nonsignificant. Analyses at the country level yielded mixed results. The original findings were replicated in the UK and Poland, but not in the US, where only narcissism predicted foodie calls. In the US, gender role beliefs predicted foodie call acceptability, but the Dark Triad general factor did not. Potential reasons for why traditional gender roles, but not the Dark Triad, predicted foodie calls in the US are discussed.

Free and reduced-price meal enrollment does not measure student poverty: Evidence and policy significance

Free and reduced-price meal (FRM) enrollment is commonly used in education research and policy applications as an indicator of student poverty. However, using multiple data sources external to the school system, we show that FRM status is a poor proxy for poverty, with enrollment rates far exceeding what would be expected based on stated income thresholds for program participation. This is true even without accounting for community eligibility for free meals, although community eligibility has exacerbated the problem in recent years. Over the course of showing the limitations of using FRM data to measure poverty, we also provide early evidence on the potential value of two alterative measures of school poverty.