Purpose: School meals can play an integral role in improving children’s diets and addressing health disparities, and initiatives/policies to increase consumption have the potential to ensure students benefit from the healthy school foods available. This systematic review evaluated studies examining initiatives, interventions, and policies to increase school meal consumption.

Methods: Following PRISMA guidelines, this review was conducted using four databases, and eligible studies were quantitative research articles (peer-reviewed publications or official government reports) evaluating interventions, initiatives, and policies to influence school meal consumption conducted within U.S. elementary, middle, and/or high schools during the academic year. A total of 96 studies were included in the review.

Results/findings: The research evidence supports the following strategies to increase school meal consumption: (1) offering students more menu choices; (2) adapting recipes to improve the palatability and/or cultural appropriateness of foods; (3) providing pre-sliced fruits; (4) rewarding students who try fruits and vegetables; (5) enabling students to have sufficient time to eat with longer (~30 minute) lunch periods; (6) having recess before lunch; and (7) limiting students’ access to competitive foods during the school day. Research findings were mixed when examining the impact of nutrition education and/or offering taste tests to students, although multiple benefits for nutrition education outside the cafeteria were documented. There is some evidence that choice architecture (i.e., “Smarter Lunchroom”) techniques increase the proportion of students who select targeted meal components; however, there is not evidence that these techniques alone increase consumption. There were limited studies of the impact of increasing portion sizes; serving vegetables before other meal components; and strengthening local district and/or school wellness policies, suggesting that further research is necessary. Additionally, longer-term studies are needed to understand the impact of policies that limit students’ access to flavored milk. Several studies found increases in students’ meal consumption following the Healthy Hunger-Free Kids Act (HHFKA) and concerns regarding an increase in food waste following the HHFKA were not supported.

Conclusions: Overall, there are a range of effective strategies to increase school meal consumption that can be implemented by schools, districts, and policymakers at the local, state, and federal levels.

Objective: School closures due to the COVID-19 pandemic caused food insecurity among school-age children to increase, especially among students who relied on free or reduced-price meals (FRPM) on a daily basis. In response, the US congress approved the provision of Pandemic Electronic Benefits Transfer (P-EBT) for families of students receiving FRPM, which allowed state agencies to provide nutritional aid to households who had lost access to FRPM in schools due to school closures. The goal of this paper was to examine the association between schools’ participation in the Community Eligibility Provision (CEP) and reach of P-EBT benefits for eligible students.

Methods: The sample included 105 K-12 public schools located in four low-income New Jersey (NJ) cities. Data were collected on schools’ CEP status, school demographics, and on P-EBT card distribution using publicly available data sources. We used a generalized linear model with logit link, binomial family, and robust standard errors to predict the percentage of students receiving PEBT for each school. The main predictors were CEP status (yes/no) and the percentage of students eligible for FRPM.

Results: Across all levels of free- and reduced-price meal (FRPM) eligibility (range 50-100%), a significantly lower proportion of students from non-CEP schools received P-EBT benefits. The magnitude of the gap between the receipt of P-EBT benefits among CEP and non-CEP schools narrowed as the proportion of FRPM increased but remained significant at all levels of eligibility. For instance, when FRPM eligibility was 60%, the percentage of students receiving PEBT was 96% in CEP schools but only 54% in non-CEP schools. And when FRPM eligibility was 90%, the percentage of students receiving PEBT was 98% in CEP schools versus 87% in non-CEP schools.

Conclusions. CEP schools reached more children eligible for P-EBT benefits than did non-CEP schools at similar levels of FRPM eligibility. The success of relying upon CEP designation in achieving the goals of the P-EBT program suggests the potential value of cost-benefit analyses of policies expanding CEP eligibility criteria to increase the effectiveness of federal meals programs, including emergency interventions, and to strengthen the food safety net for the nation’s children.

Purpose: Children who engage in active commuting to school (ACS) typically engage in higher daily levels of physical activity compared to those who do not walk or bike to school. However, in spite of the established benefits of increased levels of physical activity, research examining the association between ACS and child body mass index has produced mixed findings. A possible explanation is that ACS potentially exposes children to obesogenic food environments along their route. We examined whether the food environment surrounding children’s homes moderated the association between ACS and child body mass index z-scores (zBMI).

Methods: We utilized cross-sectional data from a household survey distributed in 2016 within four low-income cities in New Jersey (n = 584). We used geocoded addresses for the child’s home and for four types of food outlets (i.e., limited-service (fast food) restaurants, convenience stores, small grocery stores, and supermarkets) to characterize the food environment within 0.25 miles of the child’s home. Multivariate regression analyses with interactions between elements of the food environment and ACS status (yes/no) were used to model child zBMI and examine whether the association between ACS and zBMI is moderated by the healthfulness of the food environment.

Results/findings: The association between ACS and child zBMI was moderated by the number of limited-service restaurants (βfor non-active commuters = -0.10, βfor active commuters = 0.16, P-value for difference = .003) and the presence of a small grocery store (βfor non-active commuters = -0.36, βfor active commuters = 0.54, P-value for difference = .03) within 0.25 miles of the child’s home. Accordingly, among children who actively commuted to school, each additional limited-service restaurant within 0.25 miles of their home was associated with a predicted 0.16 increase in zBMI (P=.008). Exposure to convenience stores and supermarkets did not moderate the association between ACS and child zBMI.

Conclusions: These findings suggest that unhealthy food environments may detrimentally impact children who actively commute to school. Policy and intervention efforts to support ACS should also encourage healthy food environments around schools as well as healthy shopping behaviors and healthy eating habits among school children.

Purpose: School-based meal programs may promote healthy dietary intake among youth; however, limited data exist regarding the impact of income-targeted programs across countries, particularly among food insecure youth. The purpose of this study was to examine self-reported awareness of and participation in free school meal programs, and associations with dietary intake among youth from six countries with differing national school meal policies. This study had three primary hypotheses: 1) awareness of and participation in meal programs will be highest in countries with the most comprehensive policies (the United States (US) and Chile); 2) students with greater food insecurity experiences will be more likely to report meal program awareness; and 3) lunch program participation will be associated with higher fruit and vegetable, and lower ‘less healthy’ food intake during school lunch.

Methods: Data were collected through the 2019 International Food Policy Study Youth Survey, a cross-sectional survey of 10,565 youth aged 10-17 from Australia, Canada, Chile, Mexico, the United Kingdom (UK), and the US. Regression models examined: 1) country differences in breakfast and lunch program awareness and participation; and 2) associations between lunch program participation and intake of fruit and vegetables, and ‘less healthy’ foods during the previous school lunch day.

Results/findings: Free breakfast and lunch program awareness and participation varied widely across countries. Approximately half of US and Chilean students participated in lunch programs compared to one fifth of students in the UK, and approximately 5% in Australia, Canada, and Mexico (p<0.001 for all contrasts). More than two thirds of US and Chilean youth with the highest food insecurity level participated in lunch programs, compared to 45% in the UK, 27% in Canada, and 20% or less in Australia and Mexico. Across countries, youth reporting lunch program participation were more likely to report fruit and vegetable intake during their previous school lunch (p<0.001), and higher intake of ‘less healthy’ food in all countries except the US and Chile.

Conclusions: More comprehensive national policies were associated with greater participation in school meal programs, particularly among youth at greatest risk of food insecurity, as well as healthier dietary intake from school lunch.

Background: Adolescence is a time when individuals experience increased independence from household influences and begin to make more of their own food decisions outside the home. Adolescence is also a period when individuals develop an increasing reliance on peer influences. Social influences and physical food environment determinants of adolescents’ food choices have been described previously, but little is known about the way these factors interrelate. With some governments taking action to improve the healthfulness of food environments, such as banning takeaways near schools, it is timely to understand what interplay there is between social and physical food environmental factors in influencing adolescents’ independent food purchasing decisions.

Methods: This qualitative study conducted online focus groups made up of friends aged between 11-18 years attending secondary school or college in England.  Forty-two participants took part in 13 online focus groups. Data were transcribed verbatim and analysed using reflexive thematic analysis.

Results: Adolescents described how substantial interaction between factors from their social and physical food environments played an important role in their independent food choices. Data were analysed under six thematic headings. Adolescents often described the social circumstances which accompanied eating as being more important than the food itself, but food outlets provide space for this social interaction. They also wanted cheap, filling food and often sought out multi-buy deals and reduced-price promotions that are most common on unhealthy foods. Having limited opportunities to make their own food choices, adolescents didn’t want to waste these buying unappealing ‘healthy’ foods. When with their friends, making their own food choices was a chance to treat themselves, mostly to unhealthy foods. Easy-to-access, chain food outlets were preferred as they offered recognisable, accepted brands, and minimised the effort needed to choose their food, which was important when with their friends.

Conclusions: Purchasing unhealthy food is one way adolescents assert their autonomy and socialise with friends. Healthy manipulations to food environments may reduce the social desirability of unhealthy foods among adolescents. Greater understanding of how such changes align or conflict with adolescents’ values is required to develop interventions and policies effective for young people.