Jones-Smith Jessica C, Localio Anna M, Knox Melissa A, Lindman Tom, Boone-Heinonen Janne, Ochoa Aileen M, Basu Anirban
Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA 98195, United States.
Department of Health, Society, and Behavior, University of California, Irvine, CA 92697-3937, United States.
Health Aff Sch. 2025 Jul 18;3(8):qxaf144. doi: 10.1093/haschl/qxaf144. eCollection 2025 Aug.
The Community Eligibility Provision (CEP) is a federal policy that allows high-poverty schools to provide universally free breakfast and lunch to all children. Providing universal free meals has potential to decrease childhood obesity, but so far, studies are limited and findings mixed.
We used electronic health record data from a large network of community-based health care organizations and linked school-level data paired with extended 2-way fixed-effects models for staggered policy adoption to compare child body mass index -scores (BMIz) from schools that adopted CEP to eligible, nonadopting schools.
The sample consisted of 149 052 distinct lower-income children who attended a balanced panel of 1085 schools in 12 states. Mean age was 10.8 years, with 84% being publicly insured, and plurality race/ethnicity being Hispanic (43.1%). Children in CEP schools gained less in BMIz compared with children in eligible, nonadopting schools (difference-in-differences: -0.02; 95% CI: -0.04, -0.004), with estimates becoming more negative over time. However, we also found some evidence of heterogeneity by the year of adoption with increases in BMIz in some specifications.
This study builds on evidence suggesting that, for some low-income populations, universal free school meals are associated with relative decreases in BMI.
社区资格条款（CEP）是一项联邦政策，允许高贫困率学校为所有儿童提供免费早餐和午餐。提供普遍免费餐食有可能降低儿童肥胖率，但到目前为止，研究有限且结果不一。
我们使用了来自一个大型社区医疗保健组织网络的电子健康记录数据，并将学校层面的数据与扩展的双向固定效应模型相结合，用于交错政策采用情况，以比较采用CEP的学校与符合条件但未采用的学校中儿童的体重指数得分（BMIz）。
样本包括149052名不同的低收入儿童，他们就读于12个州的1085所学校组成的平衡样本中。平均年龄为10.8岁，84%为公共保险，多数种族/族裔为西班牙裔（43.1%）。与符合条件但未采用的学校中的儿童相比，采用CEP学校的儿童BMIz增长较少（差异差值：-0.02；95%置信区间：-0.04，-0.004），随着时间推移，估计值变得更负。然而，我们也发现了一些按采用年份的异质性证据，在某些规格中BMIz有所增加。
本研究基于一些证据，表明对于一些低收入人群，普遍免费学校餐食与BMI的相对降低有关。
