School Meal Programs Research Articles

Long-term impacts of school nutrition: Evidence from China’s school meal reform

• This paper adopts a difference-in-differences strategy to examine the long-term effects of a school meal program in rural China. • Early exposure to the school meal program significantly improved children’s cognitive and health outcomes in the long run. • Short-term improvements in children’s nutrient intakes and mothers’ labor market performance were potential mechanisms. • The effects of early exposure to the SNIP are stronger among children from low-socioeconomic status families. Child malnutrition remains a major public health concern, especially in many developing countries. This paper examines the long-term effects of a school meal program on individuals’ cognitive and health outcomes in rural China. Exploiting the staggered implementation of the Student Nutrition Improvement Program (SNIP), we find that early exposure to the SNIP (ages 6–15) significantly improved children’s cognitive and health outcomes in the long run. These effects are not observed in urban residents who experienced similar socioeconomic changes in the same county. Empirical tests suggest that short-term improvements in children’s nutrient intakes and mothers’ labor market performance were likely to be potential mechanisms. Moreover, the effects of early exposure to the SNIP are stronger among children from low-socioeconomic status families. Our results suggest that the school nutrition program could be an important investment in children’s long-run human capital. This may be relevant for many developing countries today that attempt to provide or have provided subsidized school meals.

Estimating Individual Treatment Effects using Non-Parametric Regression Models: a Review

Abstract Large observational data are increasingly available in disciplines such as health, economic and social sciences, where researchers are interested in causal questions rather than prediction. In this paper, we examine the problem of estimating heterogeneous treatment effects using non-parametric regression-based methods, starting from an empirical study aimed at investigating the effect of participation in school meal programs on health indicators. First, we introduce the setup and the issues related to conducting causal inference with observational or non-fully randomized data, and how these issues can be tackled with the help of statistical learning tools. Then, we review and develop a unifying taxonomy of the existing state-of-the-art frameworks that allow for individual treatment effects estimation via non-parametric regression models. After presenting a brief overview on the problem of model selection, we illustrate the performance of some of the methods on three different simulated studies. We conclude by demonstrating the use of some of the methods on an empirical analysis of the school meal program data.

The Impact of School Meal Programs on Educational Outcomes in African Schoolchildren: A Systematic Review.

Malnutrition and hunger can lower a child’s ability to learn effectively. Many countries in Africa experience high rates of childhood undernutrition, and school feeding programs are a common tool used to address this challenge. A systematic review was conducted to evaluate the effect of school-provided meals on educational outcomes in preschool and primary school children. Specific outcomes of interest in this review included test scores, attendance, and enrollment rates. PubMed and Scopus were used for an electronic search of relevant studies. Studies included in this review were randomized and non-randomized controlled trials, prospective cohort studies, controlled before-after studies, and pre/post-test design studies published in the past 10 years in English in sub-Sahara Africa. Findings from the nine studies included in this review suggest a positive correlation between school feeding programs and educational outcomes. Although mealtime may reduce classroom time, the benefits of providing a meal outweigh the potential loss of learning time because hungry children may not learn as effectively. In conclusion, it is recommended that school meal programs be implemented and expanded. To improve general wellbeing and learning capabilities of children, school meals should be employed starting at a young age. More research on school feeding programs is needed concerning the preschool age group (2–5 years), as there is a limited amount of information in this area.

Patterns of Food Assistance Program Participation, Food Insecurity, and Pantry Use among U.S. Households with Children during the COVID-19 Pandemic.

This study aims to describe differences in participation in the Supplemental Nutrition Assistance Program (SNAP), Special Supplemental Nutrition Program for Women and Children (WIC), and school meal programs by household characteristics prior to and during the pandemic, and to examine the association of program participation with food security status and food pantry use. We analyze secondary data (n = 470) from an online survey collected in July/August 2020 using weighted multiple logistic regression models. Participation in SNAP declined among households with children in the first four months of the pandemic, while participation in WIC increased slightly, and participation in school meals remained unchanged. There were significant differences in SNAP, WIC, and school meal programs use by race/ethnicity, income, and urbanicity before and during the pandemic. Food insecurity prevalence was higher among SNAP participants at both periods but the gap between participants and non-participants was smaller during the pandemic. Pantry use and food insecurity rates were consistently higher among federal nutrition assistance program participants, possibly suggesting unmet food needs. These results highlight the need for increased program benefits and improved access to food, particularly during periods of hardship.

School Health and Nutrition Monitoring: What Practitioners and Policy Makers Can Learn from China

School Health and Nutrition Monitoring: What Practitioners and Policy Makers Can Learn from China

Large-Scale School Meal Programs and Student Health: Evidence from Rural China

Large-Scale School Meal Programs and Student Health: Evidence from Rural China

PRODUZINDO A SUBALTERNIDADE: AS MERENDEIRAS NOS DOCUMENTOS E INICIATIVAS DA GESTÃO FEDERAL DO PNAE

ABSTRACT: This paper deals with the lunch lady (Merendeira), a professional responsible for preparing school meals in Brazilian public schools and who plays a key role in achieving the goals of the National School Meals Program (PNAE), such as contributing to the biopsychosocial growth and development, learning, school performance and the formation of healthy eating habits for students. Despite the lunch lady’s importance for the Program, the educational potential of this professional is often invisible and unrecognized in the school environment. Therefore, this study aimed to investigate what are the documents and initiatives developed by the federal management of PNAE that involve the lunch lady and if they can contribute to the (de)valorization of her profession and her maintenance as a subject that does not participate in the school environment’s decisions, reinforcing her subaltern position. The document analysis allowed us to verify that PNAE has a legal framework to strengthen and enhance the roles of the lunch ladies, especially concerning the role of educator. However, the results of this analysis suggest that the actions are focused on the scope of registration in the official discourse more than on representation/representation, which can contribute to the lunch lady’s social discredit and the consolidation of their role as a subordinate subject.

Large-Scale School Meal Programs and Student Health: Evidence from Rural China

Reducing urban-rural gaps in child health and nutrition is one of the most difficult challenges faced by many countries. This paper evaluates the impact of the Nutrition Improvement Program (NIP), a large-scale school meal program in rural China, on the health and nutritional status of compulsory education students aged 6-16. We use data from multiple rounds of the China Health and Nutrition Survey between 2004-2015 and implement a quasi-experimental approach exploiting cross-county variations in program implementation. We find that NIP participation is, on average, associated with a higher height-for-age z-score in the order of 0.22-0.42 standard deviations. The impacts are larger among students in a better health condition but small or not significant among the most disadvantaged. We do not observe heterogeneous effects across several individual and household characteristics. We also do not find significant effects on Body Mass Index-for-age and weight-for-age z scores. The results suggest that NIP partially improved students’ health over the first years of implementation, but more support is needed to achieve broader impacts that effectively reach all vulnerable students. Several robustness checks support our findings.

Nutritional Content and Health Profile of Single-Serve Non-Dairy Plant-Based Beverages.

A growing number of people are seeking a non-dairy plant-based beverage both for their personal health, and for the health of the planet. The aim of this study was to conduct a cross-sectional survey of single-serve plant-based beverages to assess their nutritional content and health profile. A total of 51 non-dairy plant-based beverages were analyzed from the nutrition label listed on the commercial package. The various beverages contained extracts of soy (n = 14), almonds (n = 13), oats (n = 12), peas (n = 7), banana (n = 2), coconut (n = 2), and rice (n = 1). Almost one-half (45%) of the single-serve beverages had 5 g or more of protein/serving. A total of 75% and 65% of the single-serve beverages had calcium and vitamin B12 levels, respectively, fortified to at least 20% of the Daily Value (DV), while only 28% had vitamin D fortification at the 20% DV level. Two-thirds of the single-serve beverages had high sugar levels, while 39% were low in sodium, 63% were low in fat, and 96% were low in saturated fat. The single-serve plant-based beverages had more protein, calcium, vitamin B12, and sugar but less fat than the non-dairy, multi-serve plant-based beverages/ serving. A limited number of single-serve beverages met the requirements of school meal programs.

A Content Analysis of Implementation Strategies Chosen by Virginia School Nutrition Directors

Objective: School-based interventions are common approaches to address childhood obesity; however, there is little understanding of strategies that can foster their implementation into schools. In this study, we aimed to identify goals and the specific strategies selected by school nutrition directors (SNDs) in Virginia to execute school-based interventions. Methods: Between 2018 and 2019, SNDs in Virginia participated in Team Nutrition workshops through which they created action plans. We carried out a content analysis of 132 action plans collected from 100 school divisions. We developed codes deductively and inductively. The codes captured plan completion, goals, and strategies. Each plan was independently coded by 2 coders. Results: Action plans included 1.2 goals (SD = 0.54) and 3.9 strategies per goal (SD = 2.1). Goals were most commonly related to improving menus or increasing participation in the school meal programs. The strategies varied based on the goals. However, obtaining buy-in from school personnel and students was the most commonly included goal (64.4%) across plans. The level of action plan completion decreased with each subsequent section of the worksheet. Conclusions: Emerging patterns identified in this study suggest SNDs’ strategy selection is based on goals and that trainings should be tailored to promote the development of skills required to execute optimal strategies.

Farm-to-school nutrition programs with special reference to Egypt and Morocco

The United States’ Farm-To-School Program (F2SP) is a competitive grant program that targets participants of the National School Lunch Program and School Breakfast Program with the aim of increasing the quantity and frequency of locally sourced fruits and vegetables offered to children during the school year. This narrative review aims to summarize the outcomes of the F2SP’s interventions on child health and wellness using the research available to date and provide points to consider when implementing the F2SP outside of the United States, particularly in Egypt and Morocco. Analysis of the existing literature showed that both Egypt and Morocco have been beneficiaries of their aid and have seen improvements in the number of children receiving meals at school. With its centralized school meals system, and with support from the World Food Programme (WFP), Egypt has the infrastructure to set up and sustain a long term F2SP that will enrich local communities, grow local economies, and support the health of the next generation. As the WFP continues its work in Morocco, the focus should be maintained on developing a strong school meals system and addressing immediate food insecurity. The viability of such a program being implemented should be reassessed once outcomes from current hunger relief efforts become available. Additional research is needed to continue to study the feasibility, applicability, and impact of this program, especially as it would be applied in areas with no centralized school meals programs across North Africa. Keywords: Farm-to-school nutrition; school meals; Egypt; Morocco

Sustainable School Meal Programs in Sinda District, Zambia: A Qualitative Descriptive Study

Sustainable School Meal Programs in Sinda District, Zambia: A Qualitative Descriptive Study

Nutrition Supports Deconstructed and Disrupted: An Evaluation of a Multilevel School-Based Intervention during the Time of COVID.

The Best Food Forward (BFF) project aims to provide multiple nutrition supports and interventions to improve family food security (FS) and health outcomes associated with FS within two metropolitan school districts. A quasi-experimental time-series design guided a multilevel evaluation for BFF through surveys, biometric screenings, focus groups, and observations among a random sample of caregiver–child dyads. FS, utilization of school meal programs, and nutrition behaviors were observed and analyzed at three time points: preintervention, postintervention pre-COVID-19, and postintervention post-COVID-19. Participants included 122 parents and 162 youth. Families reported (1) an income less than $35,000 annually (48.8%) and (2) a COVID-19-related job loss (36.9%). Parents used Supplemental Nutrition Assistance Programs or Women, Infants, Children benefits prior to (51.1%) and following COVID-19 (50.0%). No significant differences in FS were found. RM-ANOVA indicated an increase in breakfast consumption at home and a decrease in use of the school breakfast program (F(1.78, 74) = 19.64, p < 0.001, partial η2 = 0.21) and school lunch program (F(1.51, 74) = 23.30, p < 0.001, partial η2 = 0.24). Rates of FS and eating behaviors did not change significantly over time. Correlations of program usage and eating behaviors demonstrate the importance of promoting participation in school meal programs. BFF may have prevented significant decreases in FS during COVID-19.

Did School Meal Programs and SNAP Participation Improve Diet Quality of US Children from Low-Income Households: Evidence from NHANES 2013-2014?

Nutrition assistance programs such as school meals and the Supplemental Nutrition Assistance Program (SNAP) are designed to provide a safety net for the dietary intake of children from low-income families. However, compared with eligible non-participants, the relationship of diet quality with school meals only and school meals + SNAP is not well understood. The objectives of the study include: (1) To explore whether and to what extent nutrition assistance program participation (school meals only and school meals + SNAP) is related to diet quality; and (2) to examine the differences of diet quality between participating in school meals only, school meals + SNAP, or non-participation among American children. Children aged 5 to 18 years old from income eligible households who participated in the 2013–2014 National Health and Nutrition Examination Survey (NHANES) were included in this cross-sectional study (n = 1425). Diet quality was measured using the Healthy Eating Index (HEI)–2015 and its 13 subcomponents. A Rao-Scott Chi-square test, propensity scores approach, and Analysis of Covariance were performed. Covariates included age, sex, race/ethnicity, weight status, and family monthly poverty index. SAS survey procedures were used to incorporate the appropriate sample design weights. Participation in school meals + SNAP was not associated with higher diet quality compared to eligible non-participants or school meals-only participants. Participation in school meals + SNAP improved the intake of total dairy, but not added sugars or total vegetables compared to school meals only. Overall, school meal + SNAP participation did not significantly improve the overall diet quality of children in low-income households relative to comparable non-participants.

Improving the Performance of Children School Meal using Meal Report at Kindergarten School in Indonesia: A Quasi-Experimental Study

BACKGROUND: Kindergarten children are prone to be stunted. Currently, most kindergarten school run school meal program. AIM: The aim of the study was to assess the effect of school meal report on the meal performance. METHODS: The study was a Quasi Experiment. Four kindergarten schools were selected; two schools as intervention study and the other two schools as the control group. We enrolled 106 mothers. There were five items of food performance to be scored from 6 to 10. While children in the control group were suggested to bring meals every day without a school meal report. RESULTS: At baseline the range score of five items was not significantly different, the average score was 7.15±0.21 vs 7.09±0.18; p&gt;.05 in the intervention group and control group respectively. However, at end-line the scores meal performance in the study group was significantly improve and made it meaningfully different than in the control group (8.94±0.31 vs 7.52±0.40; p&lt;.05). The meal performance in both groups started at low performance. However, in study group at week four the scores gradually improved to the best performance at week eight till week twelve, while meal performance children in control group had a low performance. CONCLUSION: Meal report is effective in improving meal performance of kindergarten children. Future studies need to find the effect of school meal reports on nutritional status and frequency of sickness.

The Campaign for Universal Free Lunch in New York City: Lessons Learned.

The New York City (NYC) Department of Education is the largest public school system in the United States, with an enrollment of >1.1 million students. Students who participate in school meal programs can have higher dietary quality than nonparticipating students. Historically, family income documentation qualifying students in the NYC Department of Education for free or reduced-price meals reimbursed by the National School Lunch Program perpetuated poverty stigma. Additionally, National School Lunch Program qualification paperwork was a deterrent to many vulnerable families to participate and impeded all eligible children's access to nutritious meals, potentially magnifying food insecurity. The Healthy, Hunger-Free Kids Act of 2010 provided a viable option for schools to serve free meals to all students, regardless of income status, as a universal free lunch (UFL) through a Community Eligibility Provision if ≥40% of students already participated in another means-based program, such as the Supplemental Nutrition Assistance Program. In this case study, we describe the processes of (1) strategic coalition building of the Lunch 4 Learning campaign (a coalition of students, parents, school-based unions, teachers, pediatricians, community leaders, and children's advocacy organizations) to bring UFL to all NYC public schools, (2) building political support, (3) developing a media strategy, and (4) using an evidence-based strategy to overcome political, administrative, and procedural challenges. The Lunch 4 Learning campaign successfully brought UFL to all NYC public schools in 2017. This case study informs further advocacy efforts to expand UFL in other school districts across the country and national UFL advocacy.

Nutritional status of mid-day meal program on government and private school students: a comparative study

Background: Mid-day meal scheme is a school meal programme of the Government of India, designed to improve the nutritional status of school-age children. Malnourished children will not attain optimum potential for growth and development and this affects their physical capacity to work and physiological changes in the later phase of life. The food that we eat affects the nutritional status; hence the study was evaluated to find the nutritional status of the mid-day meal program in school going children.Methods: Total of 100 subjects were selected into 2 groups, 50 students from government schools and another 50 from private schools. Government school groups received mid-day meal scheme and private school students brought their personal lunch. Anthropometric and haemoglobin evaluation was done.Results: The study showed that mid-day meal effects on nutritional status and one meal gives a calorific value of 357.6 and there was a significant difference between the distribution of MUAC (CM) during pre and post nutritious period in government school students. There was no significant difference between the other anthropometric measurements like height, weight and TSFT and hemoglobin values.Conclusions: Study showed that mid-day meal affects nutritional status. A balanced freshly cooked meal in the noon is healthier and nutritious impacting the school children’s academic performance.

The Good Food for Learning Universal Curriculum-Integrated Healthy School Lunch Intervention: Protocol for a Two-Year Matched Control Pre-Post and Case Study.

BackgroundGood nutrition affects children’s health, well-being, and learning, and schools offer an important setting to promote healthy behaviors that can last a lifetime. Once children reach school age, they spend more of their waking hours in school than in any other environment. Children’s eating habits may be easier to influence than those of adults. In Canada, households with children are more likely to experience food insecurity, and school food programs that are universally available to all children can support the development of healthy eating patterns across groups of varying socioeconomic status. There is a significant gap in the rigorous community-engaged academic research on the impact of school meal programs, especially universal ones.ObjectiveThe aim of this population health intervention research is to study the impact of a 2-year universal, curriculum-integrated healthy school lunch program in elementary schools in Saskatoon, Saskatchewan, Canada, on food consumption, dietary quality and food and nutrition-related knowledge, attitudes, and practices.MethodsThis population health intervention study will be conducted in 2 intervention elementary schools matched with 2 control schools. We will collect preintervention data, including objective measurements of food eaten at school and food-related knowledge, attitudes, and behaviors. This will be followed by the intervention itself, along with qualitative case studies of the intervention process in the 2 intervention schools. Then, we will collect postintervention data similar to the preintervention data. Finally, we will finish the data analysis and complete the ongoing sharing of learning from the project.ResultsThis study was funded in April 2020 but because of the COVID-19 pandemic, data collection did not begin until May 2021. The intervention will begin in September 2021 and end in June 2023, with end point data collection occurring in May and June 2023. The case study research will begin in September 2021 and will be ongoing for the duration of the intervention.ConclusionsThe opportunity we have to systematically and comprehensively study a curriculum-integrated school lunch program, as well as the promising practices for school food programs across Canada, is without precedent.International Registered Report Identifier (IRRID)DERR1-10.2196/30899

795Contribution of school meals provision/receipt to “catch up growth” in young children: A counterfactual approach

795Contribution of school meals provision/receipt to “catch up growth” in young children: A counterfactual approach

Impact of Chefs Working in School Nutrition Programs: National Survey

To identify the perceived impact of chefs working in School Nutrition Programs on school food quality and variety, student food consumption, program participation, and program finances. The Chefs Move to Schools program was a comprehensive program to address childhood obesity. The program’s aim was to partner chefs with local school food authorities to form collaboration. As the program concluded, schools have continued to involve chefs in local school nutrition programs (SNP) in different capacities. Because the school chef is a burgeoning position in SNP infrastructure, identifying roles and responsibility of chefs working in SNPs is critical. This research was conducted using a multi-phased research approach that included a holistic, multiple-case study design and a national survey. Descriptive statistics included means, standard deviations, and frequencies. Some of the key study findings in this study are: 1. The benefits to hiring a chef include (a) “chefs enhance the reputation and public perceptions of SNPs” (M = 4.34, SD = 0.95); (b) “chefs enhance the food quality of school meals and recipes” (M = 4.25, SD = 0.90); and (c) “chefs develop creative and innovative school menus” (M = 4.22, SD = 0.93). 2. Upon hire, chefs have little training in school meal program administration (17.4% SN management and 22.7% chefs), SNP policy (21.1% SN management and 28.8% chefs), meal patterns for SNPs (22.8% SN management and 25.8% chefs), and USDA foods (25.6% SN management and 27.3% chefs). The findings of the current study suggest that chefs have both a positive impact on meal quality attributes and program operations in SNPs. Additionally, chefs can be supported at the local level by providing training on the SNP operations.