Statewide Universal School Meal Policies and Food Insecurity in Households With Children.

INTRODUCTION

Food insecurity disproportionately affects U.S. households with children, causing adverse health and developmental outcomes. During COVID-19, federal waivers enabled free meals for all K-12 students, but these waivers expired in 2022. Subsequently, some states adopted their own School Meals for All policies. This study examined whether households in states with School Meals for All policies experienced lower food insecurity than those in states reverting to means-tested programs and whether associations varied by family income.

METHODS

A cross-sectional survey of 3,377 caregivers from 8 states (4 with School Meals for All policies, 4 without) was conducted in spring/summer 2023 and analyzed in 2024. Household food security was measured with the U.S. Department of Agriculture 5-item module. Generalized estimating equation models estimated the association of School Meals for All with food insecurity, adjusting for sociodemographic factors, prepolicy county-level food insecurity data, and state-level clustering. Interaction terms tested differential effects by free and reduced-price meal eligibility.

RESULTS

Households in School Meals for All states had a 12% lower prevalence of food insecurity than those without School Meals for All (adjusted prevalence ratio=0.88; 95% CI=0.82, 0.94). This association was most pronounced among households eligible for free meals (19% lower prevalence; adjusted prevalence ratio=0.81; 95% CI=0.76, 0.86) and those near free and reduced-price meal eligibility thresholds (adjusted prevalence ratio=0.82; 95% CI=0.67, 0.98).

CONCLUSIONS

Statewide School Meals for All policies were associated with lower household food insecurity, particularly among those with low or near-low income. These findings support School Meals for All as a strategy to reduce food insecurity and suggest that expanding School Meals for All could further benefit families with school-aged children. Future research should assess School Meals for All's long-term impacts.