Departments of Health Systems and Population Health.
Economics.
Pediatrics. 2024 Apr 1;153(4). doi: 10.1542/peds.2023-063749.
The Community Eligibility Provision (CEP), a universal free school meals policy, increases school meal participation by allowing schools in low-income areas to provide free breakfast and lunch to all students; however, its impact on obesity remains uncertain. The objective of this study is to estimate the association of CEP with child obesity.
School obesity prevalence was calculated using BMI measurements collected annually between 2013 and 2019 from students in California public schools in grades 5, 7, and 9. To estimate the association of CEP with obesity, we used a difference-in-differences approach for staggered policy adoption with an outcome regression model conditional on covariates, weighted by student population size.
The analysis included 3531 CEP-eligible schools using school-level obesity prevalence calculated from 3 546 803 BMI measurements. At baseline, on average, 72% of students identified as Hispanic, 11% identified as white, 7% identified as Black, and 80% were eligible for free or reduced-price meals. Baseline obesity prevalence was 25%. Schools that participated in CEP were associated with a 0.60-percentage-point net decrease in obesity prevalence after policy adoption (95% confidence interval: -1.07 to -0.14 percentage points, P = .01) compared with eligible, nonparticipating schools, corresponding with a 2.4% relative reduction, given baseline prevalence. Meals served increased during this period in CEP-participating schools only.
In a balanced sample of California schools, CEP participation was associated with a modest net decrease in obesity prevalence compared with eligible, nonparticipating schools. These findings add to the growing literature revealing potential benefits of universal free school meals for children's well-being.
社区资格条款（CEP）是一项普及的免费校餐政策，通过允许低收入地区的学校为所有学生提供免费早餐和午餐，提高了校餐参与度；然而，其对肥胖的影响仍不确定。本研究旨在估计 CEP 与儿童肥胖的关联。
使用 2013 年至 2019 年期间在加利福尼亚州公立学校 5、7 和 9 年级学生中每年收集的 BMI 测量值计算学校肥胖患病率。为了估计 CEP 与肥胖的关联，我们使用了一种具有差异的差异方法，对交错采用政策的情况进行了分析，并采用了基于协变量的结果回归模型，对学生人数进行了加权。
该分析包括 3531 所符合 CEP 条件的学校，这些学校的肥胖患病率是根据 3546803 次 BMI 测量值计算得出的。在基线时，平均 72%的学生被认定为西班牙裔，11%的学生被认定为白人，7%的学生被认定为黑人，80%的学生有资格获得免费或减价餐。基线肥胖患病率为 25%。与符合条件但未参与的学校相比，参与 CEP 的学校在政策实施后肥胖患病率平均下降了 0.60 个百分点（95%置信区间：-1.07 至-0.14 个百分点，P=.01），这相当于基线患病率的 2.4%相对减少。只有在 CEP 参与学校，在此期间供应的餐食才有所增加。
在加利福尼亚州学校的均衡样本中，与符合条件但未参与的学校相比，参与 CEP 与肥胖患病率的适度净下降相关。这些发现增加了越来越多的关于普及免费校餐对儿童福祉的潜在益处的文献。
