The Interplay Between Summer Meals, Food Insecurity, and Diet Quality Among Low-Income Children in Maryland, USA: A Multiphase Cross-Sectional Study.

Food insecurity and poor diet quality disproportionately affect U.S. children from low-income households, with summer school closures exacerbating risks. Federally funded programs like the Summer Food Service Program (SFSP) and SUN Bucks (Summer EBT) aim to address these challenges, yet evidence of their post-pandemic dietary impact remains limited. This study examines the relationship between policy innovations, summer meal participation, food insecurity, and diet quality among children from low-income households in Prince George's County, Maryland. A cross-sectional design analyzed data from 158 households in Prince George's County Public Schools across two waves (early fall 2022 and 2023). Validated tools (USDA's Six-Item Short Form and Dietary Screener Questionnaire) assessed food security and diet quality. Sociodemographic factors, program participation, and dietary deviations from the 2020-2025 Dietary Guidelines were analyzed. Multivariate logistic regression identified determinants of poor diet quality (≥2 guideline deviations), adjusting for ethnicity, age, and housing stability. Only 32.28% of eligible households participated in summer meal programs, with non-participation driven by lack of awareness (53.68%) and transportation barriers (11.58%). Significant dietary gaps included inadequate whole grain intake (0.8 vs. 3.0 servings/day) and excessive added sugars (14% of daily calories). Summer meal participation was associated with reduced odds of poor diet quality (OR = 0.23, = 0.030), while older age (OR = 52.97, < 0.001) and very low food security (OR = 8.42, = 0.036) increased risk. Hispanic ethnicity had lower odds (OR = 0.17, = 0.019) despite higher baseline food insecurity. : Summer meal participation was associated with improved dietary outcomes but faced systemic participation barriers. Findings support policy reforms, such as multilingual outreach and mobile meal distribution, to address identified gaps.