Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Avenue NW, Washington, DC, 20052, USA.
Matthew Gfeller Sport-Related TBI Research Center, Department of Exercise and Sport Science, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Public Health Nutr. 2019 Dec;22(17):3281-3287. doi: 10.1017/S1368980019002246. Epub 2019 Aug 14.
To determine whether school-level participation in the federal Community Eligibility Provision (CEP), which provides free school lunch to all students, is associated with school meal participation rates. Participation in school meals is important for decreasing food insecurity and improving child health and well-being.
Quasi-experimental evaluation using negative binomial regression to predict meal count rates per student-year overall and by reimbursement level adjusted for proportion eligible for free and reduced-price lunch (FR eligibility) and operating days.
Schools (grades kindergarten to 12th) participating in the National School Lunch Program (NSLP) in Maryland and Pennsylvania, USA, from the 2013-2015 (n 1762) and 2016-2017 (n 2379) school years.
Administrative, school-level data on school lunch counts and student enrolment.
CEP was associated with a non-significant 6 % higher total NSLP meal count adjusting for FR eligibility, enrolment and operating days (rate ratio = 1·06, 95 % CI 0·98, 1·14). After controlling for participation rates in the year prior to CEP implementation, the programme was associated with a significant 8 % increase in meal counts (rate ratio = 1·08, 95 % CI 1·03, 1·12). In both analyses, CEP was associated with lower FR meal participation and substantial increases in paid meal participation.
School-level implementation of CEP is associated with increases in total school meal participation. Current funding structures may prevent broader adoption of the programme by schools with fewer students eligible for FR meals.
确定学校层面参与联邦社区资格条款（Community Eligibility Provision，CEP）是否与学校用餐参与率相关。参与学校用餐对于减少粮食不安全状况以及改善儿童健康和福祉非常重要。
使用负二项回归进行准实验评估，以预测学生每年每餐的计数率，同时调整免费和降价午餐（FR 资格）的比例和运营天数。
美国马里兰州和宾夕法尼亚州参加国家学校午餐计划（National School Lunch Program，NSLP）的幼儿园至 12 年级的学校（2013-2015 学年 n=1762，2016-2017 学年 n=2379）。
学校层面关于学校用餐计数和学生注册的行政数据。
调整 FR 资格、注册人数和运营天数后，CEP 与总 NSLP 用餐计数增加了 6%呈非显著相关（比率=1·06，95%置信区间 0·98，1·14）。在控制 CEP 实施前一年的参与率后，该计划与用餐计数增加了 8%呈显著相关（比率=1·08，95%置信区间 1·03，1·12）。在这两种分析中，CEP 与 FR 餐参与率降低和付费餐参与率大幅增加相关。
学校层面实施 CEP 与学校总用餐参与率增加相关。当前的资金结构可能会阻止更多 FR 餐资格较少的学校广泛采用该计划。
