|5R21CA239061-02 Interpret this number
|Federal School Nutrition Policies, Student Food Insecurity and Bmi
Obesity in childhood increases the risk of the leading forms of chronic diseases in adulthood (e.g.,
cardiometabolic disease and cancer) that cause premature mortality in the U.S. Prevention of childhood life food
insecurity and nutritional deficiencies implicated in this cascade of disease, disability and mortality has been the
primary objective of the USDA free and reduced price meal (FRPM) programs for over six decades.
Unfortunately, there has been increasing (albeit mixed) evidence to suggest that such programs may actually
contribute to child obesity in low-income populations. The 2012 Healthy Hunger Free Kids Act (HHFKA) was
designed to improve the nutritional quality of school foods and beverages and the Community Eligibility
Provision (CEP) of the legislation allows schools serving predominantly low-income populations to offer free
meals to all students. The proposed project will be the first to exploit these two federal policies offer to design
natural experiments to test hypotheses about the impact of FRPM on food insecurity, child body mass index
(BMI) and disparities in child BMI trajectories. The project specific aims are to: 1) use national policy changes
in FRPM (i.e., HHFKA and CEP) to better understand how changes in meal nutritional requirements and FRPM
participation affects children's food security and BMI trajectories; 2) evaluate whether food insecurity mediates
the effect of FRPM on BMI trajectories; and 3) examine the impact of HHFKA and CEP policy changes in FRPM
on disparities in Aims 1 and 2 by race/ethnicity and maternal nativity. We achieve these objectives using large
nationally representative, ethnically diverse longitudinal data that span pre- and post-HHFKA and CEP
implementation from two surveys in the National Center for Education Statistics' Early Childhood Longitudinal
Study (ECLS) program, i.e. the ECLS-K:2011, (n=18,200) and the ECLS-K (n= 22,782). Both surveys followed
children from kindergarten through at least 5th grade collecting rich data on school meal participation, food
insecurity, socioeconomic status and students' measured height and weight. We will use a general panel model
estimated using structural equation models for that allows us to flexibly examine and test the assumptions we
make in structuring our analyses as natural experiments. We also incorporate novel (multi-level and panel)
extensions to propensity score matching to improve balance between `treated' and `untreated' children in these
natural experiments. The results are expected to improve our understanding of how school meal programs
impact children across school contexts, where access is lacking, and will help inform how federal school meal
policies may effectively support health in all children.
Association of the Healthy, Hunger-Free Kids Act of 2010 With Body Mass Trajectories of Children in Low-Income Families.
, Weden M.M.
, Cabreros I.
, Datar A.
JAMA network open, 2022-05-02; 5(5), p. e2210480.