Child Nutrition Programs Research Articles

The role of the expanded food and nutrition education program in improving healthy eating index scores for low-income households in selected counties in Texas.

The Expanded Food and Nutrition Education Program (EFNEP) is a federal initiative aimed at improving the dietary behaviors and nutrition knowledge of low-income households. This study evaluates the impact of Texas EFNEP on the dietary quality of participants using data from across ten counties over four fiscal years (2019-2022). Dietary quality was assessed using the Healthy Eating Index-2015 (HEI), calculated from 24-hour dietary recalls collected before and after participation in the program. The study analyzed changes of HEI scores across fiscal years, counties, socio-demographic characteristics, and public assistance program participation. The Texas EFNEP intervention resulted in a statistically significant improvement in overall HEI scores, 4.23 on average. The greatest dietary improvements were noted in Tarrant and Hidalgo counties. Among racial groups, participants identified as Asian showed the most improvement on average, followed by participants identified as white and as black. On average, Hispanic participants experienced greater dietary improvements than non-Hispanic participants. Based on regression analysis, geographic location and participation in public assistance programs such as the Child Nutrition Program (CNP) significantly impacted total HEI scores, but age, income, and hours taught in EFNEP were not statistically significant determinants. Statistically significant improvements were detected in eight of the nine adequacy components of the HEI, including total fruit, whole grains, and dairy. Concerning the moderation components, statistically significant changes were evident for refined grains, added sugar, and saturated fat. However, the program was less effective in moderating sodium intake, a known dietary challenge in low-income populations. The findings suggest that the Texas EFNEP contributed to improvements in overall dietary quality, including enhancements in both adequacy and moderation components of the Healthy Eating Index. These findings are consistent with prior research concerning the effectiveness of EFNEP studied in other states and regions.

Incremental financial costs of strengthening large-scale child nutrition programs in Bangladesh, Ethiopia, and Vietnam: retrospective expenditure analysis

BackgroundInattention to young child growth and development in a transitioning global environment can undermine the foundation of human capital and future progress. Diets that provide adequate energy and nutrients are critical for children’s physical and cognitive development from 6 to 23.9 months of age and beyond. Still, over 70% of young children do not receive foods with sufficient nutrition particularly in low-and-middle income countries. Program evaluations have documented the effectiveness of large-scale behavior change interventions to improve children’s diets, but the budgetary implications of programs are not known. This paper provides the incremental financial costs of strengthening three large-scale programs based on expenditure records from Bangladesh, Ethiopia, and Vietnam.ResultsThe programs reached between one and 2.5 million mothers and children annually per country at unit costs of between $0.9 to $1.6 per mother and child reached. An additional 0.7 to 1.6 million people who were influential in supporting mothers and achieving scale were also engaged. The largest cost component was counselling of mothers. Rigorous external impact evaluations showed that over 434,500 children benefited annually from consuming a minimum acceptable diet in all countries combined, at an annual cost per country of $6.3 to $34.7 per child benefited.ConclusionsLarge scale programs to improve young children’s nutrition can be affordable for low- and middle-income countries. The study provides the incremental costs of selectively strengthening key program components in diverse settings with lessons for future budgeting. The costs of treating a malnourished child are several-fold higher than prevention through improved improving young children’s dietary practices. Differences across countries in program models, coverage, costs, and outcomes suggest that countries need a minimum investment of resources for strengthening high-reach service delivery and communication channels and engaging relevant behavioral levers and community support for mothers to achieve impact at scale.

Social sector drivers and stunting reduction in Pakistan: A subnational analysis.

Social sector drivers and stunting reduction in Pakistan: A subnational analysis.

Preoperative nutrition intervention program increases cleft surgery eligibility in the low- and middle-income country setting

BackgroundChildren with cleft lip and/or palate (CL/P) are highly susceptible to malnutrition, which may restrict surgery eligibility and delay repair. Preoperative nutrition programs for children with unrepaired CL/P are an effective treatment to overcome malnutrition for safe surgical intervention in high-resource settings; however, the effectiveness of such programs has not been demonstrated in the setting of low- and middle-income countries (LMICs). We studied the impact of a preoperative nutrition program on improving nutritional status and achieving surgical eligibility for children with CL/P.MethodsA retrospective review of patients treated by the Operation Smile (OS) Durgapur Cleft Centre in India from March 2021 to December 2022 was conducted. Patient gender, weight, age, cleft type, parental demographics, and income were recorded. The patients’ malnutrition status was categorized as “mild”, “moderate”, or “severe” based on the Indian Academy of Pediatrics (IAP). Patient IAP classifications were noted at multiple timepoints, where change in nutrition status overtime served as the primary outcome of this study. Whether the child became eligible for surgery was assessed as a secondary outcome. Descriptive statistics used t-tests for continuous variables and chi-squared tests for categorical variables. P-values < 0.05 were considered significant.ResultsThe study included 236 patients who presented for nutritional intervention after being deemed ineligible for surgery. Initial IAP malnutrition classifications were 36.9% (n = 87) mild, 42.8% (n = 101) moderate, and 20.3% (n = 48) severe malnutrition. After intervention, 179 (75.8%) patients improved in IAP nutrition status, 49 (20.7%) maintained baseline status, and only eight (3.4%) declined. Final improvement levels were significantly associated with younger age at intake (p < 0.001) and maternal education background (p = 0.011). At study end, a total of 183 (77.5%) patients were eligible for cleft repair while 53 (22.5%) patients were malnourished and remained enrolled in the program. A total of 162 (68.6%) patients underwent surgery.ConclusionMalnutrition prevents children with CL/P from receiving surgical care in LMICs. This nutrition intervention enabled 228 (96.6%) patients to improve or maintain baseline nutrition and 183 (77.5%) to become surgically eligible who would not have been eligible otherwise. Preoperative nutrition programs offer a promising solution to addressing malnutrition as a barrier to timely, safe cleft repair in resource-constrained settings.

State Laws Leveraging the Community Eligibility Provision to Build Healthy School Meals for All: A Content Analysis.

State Laws Leveraging the Community Eligibility Provision to Build Healthy School Meals for All: A Content Analysis.

Qualitative Study of Healthcare Seeking Behavior and Development of Behavioural Nudges for a Nutrition Program in Gombe State, Nigeria

Objective: This qualitative study aimed to identify and explain healthcare seeking behaviours among caregivers of young children and apply these findings to develop a mobile phone-based messaging intervention to encourage sustained attendance at a community-based management of acute malnutrition (CMAM) program in Gombe state, Nigeria. Design: Researchers conducted focus group discussions (n=6) and key informant interviews (n=3) with 33 subjects. Transcripts were independently coded and thematic analysis was conducted to gain an understanding of the facilitators, barriers, and motivators shaping caregivers’ decisions to attend health services for malnourished children, as well as access to and use of mobile phones. Participants: Focus groups and interviews were conducted with caregivers of children aged 6-59 months living within travelling distance of three CMAM sites in Gombe state, Nigeria. Results: Barriers to seeking health services included high costs; perceptions of poor quality of care, including poor treatment by health workers; and female caregivers’ limited autonomy. Despite barriers, participants recommended seeking hospital care for a malnourished child. Participants described widespread mobile phone use and recommended messages emphasising that CMAM services are free, conveying respect for caregivers, and reminding caregivers to continue making an effort to attend the CMAM program even as their child began to appear healthier. Conclusions: This study provides a framework for developing contextually salient behavioural nudges for child health and nutrition programs which, in combination with other community outreach strategies, could help motivate and sustain care seeking behaviour.

Caste, wealth and geographic equity in program reach and expected outcomes: an exploratory analyses of Suaahara in Nepal.

Monitoring and evaluation of maternal and child nutrition programs typically concentrates on overall population-level results. There is limited understanding, however, of how intervention reach and expected outcomes differ among sub-populations, necessary insight for addressing inequalities. These analyses aim to determine if maternal exposure to social and behavior change (SBC) interventions is associated with scales of maternal practices (antenatal care, iron and folic acid in pregnancy, diet in pregnancy, postnatal care, iron and folic acid postpartum, and maternal dietary diversity) and child practices (institutional birth, health mothers' group participation, growth monitoring and promotion, early initiation of breastfeeding and infant and young child feeding) in Nepal, overall and by wealth, caste, and geography. Cross-sectional data from 2022 from the USAID-funded Suaahara program in Nepal were used for analysis. The study focused on households with children aged 0-2 years (N = 1815). Descriptive analysis was followed by regression models, adjusted for potentially confounding child, mother, and household factors, as well as community-level clustering. Greater intensity of maternal engagement with the SBC interventions was positively associated with both scales for maternal and child nutrition-related practices. The magnitude of the positive associations, however, was less for the socially excluded caste versus others for maternal nutrition; there was almost no caste-based variation in associations for child nutrition. Positive associations were found only among the lower 40% socio-economically when mothers engaged with at least two platforms for maternal nutrition and at least three platforms for child nutrition. In contrast, engagement with one platform for the relatively wealthier was positively associated with both maternal and child outcomes. Similarly, the positive associations were stronger among those residing in the terai (lowland plains) than those in the hills and mountains for both maternal and child outcomes. The scope for improving maternal and child nutrition practices is significant, in part via well-designed, targeted, SBC programs. These analyses highlight the importance of considering different domains of equity both in implementation and related research. Further mixed methods research is needed to more deeply explore why certain types of interventions reach and/or have a greater effect on sub-populations.

NEW Soul for Families: Lessons Learned from Implementing a Plant-based Nutrition Program in the Community

Abstract: Background: Childhood obesity is linked to a higher risk of other chronic diseases. Cultural preferences for soul food dishes may contribute to obesity in African American children and families. Objective: To discuss lessons learned from the development and implementation of NEW Soul for Families, a plant-based nutrition program for African American children. Methods: A partnership with the Boys &amp; Girls Clubs, EdVenture Children’s Museum, and the Food Academy was formed. Children ( n = 15) participated in the program across two cohorts. Each cohort lasted three weeks with three classes per week. Parents of enrolled children were invited to attend one class per week. Children learned nutrition topics and engaged in hands-on cooking. Lessons Learned: Community partners shared power to successfully implement the program; surveying parents increased their attendance from the first cohort to the second cohort; children rated the program positively. Conclusions: NEW Soul for Families was well received by community partners and participants. More studies are needed to determine effectiveness.

Nutrition-Focused Quality Improvement Programs in Pediatric Care.

Nutrition is fundamental to a child's growth and development. However, nutritional health is often compromised by acute and chronic conditions and treatments that can commonly result in malnutrition. Malnutrition encompasses undernutrition and overnutrition and may be exacerbated by food insecurity. Recent health policy efforts in the United States (US) include those focused on quality measurement and social determinants of health (SDOH) to reduce risks for malnutrition and food insecurity. Nutrition-focused quality improvement programs (QIPs) have emerged as a successful model for benchmarking current nutrition care in adult patients and creating pathways for establishing best practices for timely malnutrition screening, intervention, and appropriate follow-up and care coordination. However, less is known about opportunities for nutrition-focused QIPs in hospital pediatric malnutrition care. This Perspective helps fill the gap by discussing the problem of pediatric malnutrition and current US quality frameworks and child nutrition programs related to malnutrition and food insecurity. In addition, this Perspective summarizes how nutrition-focused QIPs can impact malnutrition, including how QIPs can link hospital care with patient discharge planning and outpatient interventions. Finally, the Perspective outlines specific opportunities for the implementation of pediatric nutrition-focused QIPs to reduce office visits and/or inpatient readmissions through appropriate nutrition screening, assessment, and interventions.

The effect of immigration policy regime change on state-level participation rates of the special supplemental nutrition program for women, infants, and children in the United States

The change in immigration policy in state-level participation rates of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in the United States by citizenship and ethnicity was estimated over the period 2013-2018 using the Triple Difference estimate method. The principal finding was that the state-level WIC participation rate for Hispanic non-citizens was lower by 8.6% relative to all other groups (Hispanic citizens, non-Hispanic citizens, and non-Hispanic non-citizens). This study then not only provides quantitative evidence concerning the ongoing debate about the impact of the immigration policy changes under the Trump administration but also extends the extant literature by estimating the causal effects of immigration policy regime change on WIC participation of non-citizens.

Study of Role of Internet Access and Frontline Workers in Community-based Child Nutrition Programs for Budget Allocation of National Health Services

Background: Breastfeeding practices differ greatly across world health organization regions and continued innovative efforts are needed to achieve the right feeding practices. Objectives: This study was aimed to identify the role of internet access to women population and accredited social health activist (ASHA) workers in improving infant and young child feeding practices. Materials & Methods: Data for current study was collected from the national family health survey-5 (NFHS-5), India which is openly available to the public. The sample was sub-grouped as urban and rural women and children. Data was analysed using Pearson correlation coefficient and multiple linear regression model. Compared to national family health survey-4 data (9.6%), our study based on NFHS-5 data (11.3%) has shown marginal improvement in the number of children getting an adequate diet in the age group of 6-23 months. Urban women (51.8%) have higher access to internet as compared to rural (24.6%) women. The correlation coefficient between percentage of women with internet access and children receiving adequate diet was 0.513 (P=0.001), indicating a direct relationship between the two variables. The multiple linear regression model showed that percentage of women with internet access has independent association with children getting an adequate diet (B=0.23, P=0.002) adjusted for ASHA workers. Despite robust government programs like home based newborn care (HBNC) and home-based care for young child (HBYC) where around 1.04 million ASHAs are perceiving one of the objectives of an adequate diet for every child, the prevalence of children with adequate nutrition is not encouraging. This study suggests access to the internet to women especially ASHA workers and lactating mothers can help to promote infant and young child feeding practices.

Integrating early child development into an existing health and nutrition program: evidence from a cluster-randomized controlled trial

IntroductionIn low-resource settings, introducing child health programs into community services may compete for caregiver time. We analyzed the impact of a new early childhood development (ECD) program in rural Madagascar on family attendance at other health services and of adding at-home play materials on program attendance.MethodsWe randomized 75 communities where community health workers (CHWs) implement an existing child health and nutrition program (Projet d’Amélioration des Résultats Nutritionnels or PARN), the status quo. We offered two 6-month cycles of 12 ECD sessions to eligible caregiver-child dyads (6–30 months) in 25 sites [T]; we added take-home play materials in Cycle 2 to 25 sites [T+]. We used differences-in-differences with administrative data to analyze the effect of offering ECD sessions on monthly PARN attendance (T+/T vs. C) among age-eligible children and the impact of toy boxes/libraries on monthly ECD session attendance (T + vs. T). We used random intercept models to analyze characteristics associated with program registration.ResultsWe analyzed data for 9,408 dyads; 30% and 32% registered for the program in Cycle 1 and 2 (respectively). On average, CHWs delivered 11.4 sessions (SD: 1.5). Children from wealthier households who already attended PARN sessions were more likely to register, and we found no effect of T or T + on PARN attendance. Adding play materials did not affect monthly ECD session attendance. Children from more populated sites were less likely to participate in both ECD and PARN sessions.ConclusionsIntegrating new services for ECD into the health system was feasible and did not reduce dyad participation in existing services. Investment in health services in more populated areas is needed to provide coverage to all eligible children. Novel strategies should be explored to engage the most vulnerable children in new and existing health services.Trial registrationAEA Social Science Registry (AEARCTR-0004704) on November 15, 2019 (prospective registration) and ClinicalTrials.gov (NCT05129696) on November 22, 2021 (retrospective registration).

The Influence of Complementary Feeding on Appetite and Growth Development in Children Aged 7-12 Months

Complementary feeding (MP-ASI) is crucial for meeting the nutritional needs of infants aged 7-12 months, influencing their appetite and growth. Objective: This study evaluates the effects of MP-ASI on the appetite and growth of infants aged 7-12 months in 2024. A pre-post test design with 194 respondents assessed the impact of different types of MP-ASI on appetite and growth. All respondents received the same type of MP-ASI. Data were analyzed using univariate and bivariate analyses with SPSS. There was no statistically significant relationship between the type of MP-ASI given and weight gain. However, varieties such as spinach and eggs, and chayote and eggs, showed higher compliance with recommended nutritional standards (KPSP), indicating that MP-ASI type significantly influences adherence to these standards. Diverse MP-ASI positively affects the appetite and growth of infants aged 7-12 months. The study underscores the importance of MP-ASI variety and quality in child nutrition programs. Increasing parental education on the importance of MP-ASI variety is recommended to support optimal developmental potential in children.

Impact of Inpatient Patient-Provider Language Concordance on Exclusive Breastfeeding Rates Postpartum.

Studies outside of obstetrics suggest that patient-provider language concordance may impact the efficacy of educational interventions and overall patient satisfaction. Many pregnant patients who present to the hospital for delivery with initial plans to exclusively breastfeed ultimately leave the hospital supplementing with formula. We aim to examine the impact of language concordance between patients and their primary bedside nurse during the delivery hospitalization period on the relationship between intended and actual feeding practices for term newborns of primiparous patients at a single institution. This is a single-center, prospective cohort of primiparous patients with term, singleton gestations admitted for delivery between February 2022 and January 2023. Participants completed a predelivery survey on arrival and a postpartum survey before hospital discharge. The primary outcome was the association between nurse-patient language concordance and postpartum exclusive breastfeeding. Multiple logistic regression analysis was performed to assess the primary outcome, and p-values < 0.05 were considered significant. Overall, 108 participants were surveyed, of which 84 (77.8%) noted language concordance with their primary nurse and 24 (22.2%) reported language discordance. The race/ethnicity, language spoken at home, reported plans to return to work, WIC (special supplemental nutrition program for women, infants, and children) enrollment, and prenatal feeding plan variables revealed significant differences in reported language concordance. Following adjustment for patient-reported prenatal feeding plan, patients who reported language concordance with their primary nurse were significantly more likely to exclusively breastfeed in the immediate postpartum period (adjusted odds ratio, 5.60; 95% confidence interval, 2.06-16.2). Patients who reported language concordance with their primary nurse were significantly more likely to breastfeed exclusively in the immediate postpartum period. These findings highlight that language concordance between patients and bedside health care providers may contribute to initiating and continuing exclusive breastfeeding during the peripartum period. · Patients who reported language concordance with their primary nurse were more likely to breastfeed.. · Patient-Provider language concordance may impact infant feeding decisions in the postpartum period.. · More research is needed to further explore the impact of language concordance with other providers..

Mixed Methods Study Investigating Adolescent Acceptance and Implementation Outcomes of Serving Spicy Vegetables in School Lunch

BackgroundOnly a few adolescents are meeting their daily vegetable requirement. At the same time, spicy food is increasingly popular and familiar across cultures. ObjectivesTo explore the implementation of spicy vegetables into school meals, the primary objective is to determine adolescents’ preferred degree of hot spice on steamed broccoli. Secondary objectives include estimating the appropriateness and acceptability of spicy vegetables in the National School Lunch Program and identifying strategies to promote spicy vegetables within school meals. MethodsOne hundred participants between the age 11 and 17 y sampled 4 steamed broccoli florets with varying levels of a ground red and cayenne pepper spice blend (0, 0.9, 2.0, and 4.0 g). Participants rated their likeability of each broccoli sample on a 9-point hedonic scale and answered a survey assessing chili liking, chili consumption patterns, appropriateness, and acceptability. An interview assessed perspectives on spicy vegetables within school lunch.Regression analyses assessed relationships between participant attributes and sample ratings and survey outcomes. Agglomerative hierarchical cluster analysis was conducted to cluster together participants with similar sample liking ratings. ResultsSeventy-seven percent of participants reported that chili pepper makes food taste better, and 67% consumed spicy food weekly or daily. Chili likers (n = 41) were the dominant cluster group, compared with moderates (n = 31) and chili dislikers (n = 28). Thematic analysis results suggested that most participants support incorporating spicy vegetables into school lunch but mushy vegetable texture may undermine the impact of changing school vegetable spice levels. ConclusionsSpicy foods are commonly consumed by adolescents, and these findings support the inclusion of spicy vegetables in school lunch. Additional research is needed to identify policies and practices to improve the texture of vegetables in school meals and determine additional strategies to support cultural humility in child nutrition programs.

Traditional Indigenous Foods in Child Nutrition Programs and USDA FoodData Central (FDC)

Traditional Indigenous Foods in Child Nutrition Programs and USDA FoodData Central (FDC)

An evaluation of Congressional Budget Office's baseline projections of USDA mandatory farm and nutrition programs

AbstractThe Congressional Budget Office (CBO) projections of USDA's mandatory farm and nutrition program outlays are important in shaping US agricultural policy. Using CBO projections and observed outcomes from 1985 through 2020, we examine the degree to which projections of farm, supplemental nutrition assistance program (SNAP), and child nutrition program outlays are unbiased, efficient, and informative. We find that projections for farm and child nutrition program outlays are unbiased, SNAP outlays are unbiased at short‐term but are downward biased beyond a 3‐year horizon. All three series of projections are inefficient. SNAP and child nutrition program outlay projections are informative up to a 5‐year horizon, but the farm program outlay projections are informative for only a 1‐year horizon. Disaggregated farm program data since 2008 suggests that the uninformativeness principally stems from conservation and commodity program projections. The findings may be valuable to CBO, as they continue to improve projections, and to projection users, in adjusting their expectations.

The Impact of COVID-19 on Breastfeeding Initiation and Duration in a Low-Income Population, Washington, DC.

Objective: To assess the impact of the coronavirus disease 2019 (COVID-19) pandemic on breastfeeding initiation (BFI) and duration among women enrolled in the Special Supplemental Nutrition Program for women, infants, and children (WIC) in Washington District of Columbia (DC). Materials and Methods: We used WIC program data from Washington DC to assess the pandemic's impact on BFI and duration among WIC recipients. t-Tests and unadjusted odds ratios compared breastfeeding outcomes before and during the pandemic. Multivariable logistic and linear regression models estimated the pandemic's impact on initiation and duration, respectively, while controlling for social determinants of health and other factors. Results: BFI was similar among women who gave birth before (61.4%) or during the pandemic (60.4%) (p = 0.359). However, the proportion of women who breastfed at 1 month decreased significantly from 56.1% (before pandemic) to 47.6% (during pandemic) (p < 0.0001). This pattern for duration continued at 3 and 6 months: 46.9% to 37.1% (p < 0.0001) at 3 months and 34.8% to 25.7% (p < 0.0001) at 6 months. On average, women who delivered during the pandemic breastfed 33.9 fewer days than those who delivered before (p < 0.0001). Conclusions: BFI among DC WIC recipients was similar for infants born before or during the pandemic, and determinants of initiation remained similar to previous reports (e.g., race/ethnicity, education). However, for women who initiated breastfeeding, average duration was significantly lower for infants born during the pandemic than before. Our findings suggest the importance of leveraging WIC and other breastfeeding supports to promote breastfeeding during pandemics and other emergencies.

Women empowerment and childhood stunting: evidence from rural northwest Ethiopia

BackgroundWomen are often the primary caregivers of children, and as such, their empowerment could influence the nutritional status of their children. However, the role of maternal empowerment on the nutritional status of children in Ethiopia is largely unknown.AimTo determine the association of women’s empowerment with childhood stunting in rural northwest Ethiopia.MethodsA community-based cross-sectional study was conducted among 582 mothers with children aged 6–59 months. A multistage sampling technique was used to select the study participants. Binomial logistic regression analyses were used to assess whether women’s empowerment (categorized as low, moderate and high) and its five dimensions (household decision-making, educational status, cash earnings, house/land ownership, and membership in community groups) were associated with stunting in children. Odds ratios with 95% CI were estimated, and statistical significance was declared at a p-value of < 0.05.ResultsA total of 114 (19.6%), 312 (53.6%), and 156 (26.8%) participants had low, moderate, and high empowerment levels, respectively. In addition, 255 (43.8%) mothers had children who were stunted (too short for their age). In the adjusted models, mothers with moderate empowerment (AOR 0.60, 95% CI: 0.35, 0.97) and high empowerment (AOR 0.56, 95% CI: 0.37, 0.86) had lower odds of having stunted children compared to mothers with low empowerment. Mothers who had a secondary education or higher (AOR 0.57, 95% CI: 0.35, 0.93), owned a house or land (AOR 0.64, 95% CI: 0.44, 0.94) and were members of community groups (AOR 0.54, 95% CI: 0.36, 0.80) were less likely to have stunted children.ConclusionHigh women empowerment was significantly associated with a lower likelihood of childhood stunting. The findings suggest a need to look beyond the direct causes of stunting and incorporate targeted strategies for empowering women into child nutrition programs.

Healthy School Meals for All in Utah.

The National School Lunch and School Breakfast programs reduce food insecurity and improve dietary intake. During the COVID-19 pandemic, school meals were provided to all children at no cost, regardless of income. This policy is known as Healthy School Meals For All (HSMFA). The purpose of the study was to examine the feasibility of a HSMFA policy in Utah. A mixed-methods approach was used, including qualitative interviews for policymakers, surveys for school foodservice directors, and financial modeling of Utah Child Nutrition Programs data. Analysis included a phenomenological analytic approach for qualitative data, descriptive statistics for surveys, and development of a cost model with 6 scenarios. Qualitative data revealed themes of (1) awareness; (2) responsibility; (3) perspectives on school meals; and (4) new opportunities. Most (81%) foodservice directors believed HSMFA should continue post-pandemic. HSMFA would cost $51,341,436 to $82,358,375 per year. HSMFA would result in the equitable treatment of all children regarding access to healthy school meals. Given the support of foodservice directors but the lack of political consensus, considering stepwise implementation and providing cost estimates may increase feasibility of a HSMFA policy in Utah.