Abstract
Background
The Community Eligibility Provision (CEP) allows high-poverty schools participating
in US Department of Agriculture meal programs to offer universal free school meals.
Emerging evidence suggests benefits of CEP for student meal participation, behavior,
and academic performance. Although CEP became available nationwide in 2014, in school
year 2019–2020, one third of eligible schools were not participating.
Objective
This study evaluates which school, district, and state factors are associated with
CEP participation.
Design
Cross-sectional study comparing CEP-participating with eligible nonparticipating schools
to assess the relationship between CEP participation and school, district, and state
factors.
Participants
US public schools eligible for CEP in school year 2017–2018 (n = 42,813).
Main Outcome Measures
CEP participation.
Statistical Analyses Performed
Penalized regression variable selection methods to determine which factors contribute
information to the model. Generalized logistic regression to predict odds of CEP participation
unadjusted and adjusted for each factor in the full sample and in stratified analyses
by whether a state was part of the CEP phase-in period (early vs late implementing
states).
Results
In the full sample, adjusted odds of CEP participation were greater in states where
CEP had been available longer (odds ratio [OR], 1.50; 95% confidence interval [CI],
1.34, 1.67). In late implementing states, adjusted odds of CEP participation were
higher in schools with more students directly certified for free meals (OR in schools
with 80%–89% vs 30%–39% directly certified: 19.32; 95% CI, 12.98, 28.76), Title I
schools (OR, 1.85; 95% CI, 1.55, 2.21), and urban schools (OR suburban vs urban, 0.46;
95% CI, 0.36, 0.59). Differences by school level, enrollment, district size, student
race/ethnicity, and geographic region also existed.
Conclusions
Findings may help advocates, state agencies, and policymakers understand potential
barriers to adoption and guide research exploring effective strategies to promote
uptake. Future research should use qualitative and longitudinal designs to explore
barriers to adoption, including cost and state and local policies.
Keywords
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Biography
A. A. Hecht is a postdoctoral fellow, Institute for Research on Poverty, University of Wisconsin-Madison, Madison, WI.
Biography
S. A. Stuart is a professor, Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
Biography
K. M. Pollack Porter is a professor, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
Article info
Publication history
Published online: August 02, 2021
Accepted:
June 22,
2021
Received:
September 4,
2020
Footnotes
STATEMENT OF POTENTIAL CONFLICT OF INTEREST No potential conflict of interest was reported by the authors.
FUNDING/SUPPORT Training and research support for AAH was provided by the Johns Hopkins Center for a Livable Future-Lerner Fellowship and the Johns Hopkins Lerner Center for Public Health Promotion.
AUTHOR CONTRIBUTIONS A. A. H. conceptualized and designed the study, conducted analyses, interpreted findings, drafted the initial manuscript, and reviewed and revised the manuscript. E. A. S. and K. M. P. P. helped conceptualize the study and interpret findings. and critically reviewed the manuscript for important intellectual content. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.
Identification
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© 2022 by the Academy of Nutrition and Dietetics.
