Impact of the 2010 US Healthy, Hunger-Free Kids Act - Get Instant Homework

Impact of the 2010 US Healthy, Hunger-Free Kids Act on School Breakfast and Lunch Participation Rates Between 2008 and 2015

Nicole Vaudrin, MS, RD, Kristen Lloyd, MPH, Michael J. Yedidia, PhD, MPH, Michael Todd, PhD, and Punam Ohri-Vachaspati, PhD, RD

Objectives. To evaluate National School Lunch Program (NSLP) and School Breakfast

Program (SBP) participation over a 7-year period before and after the implementation of

the 2010 Healthy, Hunger-Free Kids Act (HHFKA), which required healthier school lunch

options beginning in school year (SY) 2012–2013 and healthier school breakfast options

beginning in SY2013–2014.

Methods.Data were gathered from low-income, high-minority public schools in 4 New

Jersey cities. We conducted longitudinal analyses of annual average daily participation

(ADP) in schoolmeals among enrolled students overall and among those eligible for free

or reduced-price meals. We used linear mixed models to compare NSLP and SBP par-

ticipation rates from SY2008–2009 to SY2014–2015.

Results. NSLP participation rates among students overall differed little across years

(from 70% to 72%). SBP rates among enrolled students were stable from the beginning

of the study period to SY2013–2014 and then increased from 52% to 59%. Among

students eligible for free or reduced-price meals, the ADP was lowest in SY2012–2013

(when the HHFKA was implemented) before rebounding.

Conclusions. The HHFKA did not have a negative impact on school meal participation

over time.

Public Health Implications. The HHFKA-strengthened nutrition standards have

not affected school meal participation rates. With time, students are likely to

accept healthier options. (Am J Public Health. 2018;108:84–86. doi:10.2105/

AJPH.2017.304102)

The 2010 Healthy, Hunger-Free Kids Act(Public Law 111-296; HHFKA) aligned National School Lunch Program (NSLP) and School Breakfast Program (SBP) re- quirements with the Dietary Guidelines for Americans. New NSLP meal patterns, im- plemented in school year (SY) 2012–2013, included more fruits, vegetables, and whole grains and a gradual reduction in sodium content. Similar SBP standards were imple- mented during the following year (SY2013– 2014).1 Additional requirements came into effect in SY2014–2015, as well as smart snacks standards for food and beverages sold outside of school meal programs.2 Further changes in the requirements are ongoing.1

The acceptability of new meal offerings has been evaluated in short-term longitudinal

and cross-sectional analyses.2–6 According to qualitative results, school administrators and food service workers perceive that, although students initially complained, consumption patterns have not changed significantly.3 In only 2 studies were participation data used to examine the HHFKA’s impact on school lunch par- ticipation, and neither of these inves- tigations assessed effects on the SBP,4,5

a program that has been historically underused.7

In a study conducted in middle and high schools in 11 Massachusetts school dis- tricts, Cohen et al. found no significant differences in NSLP participation rates 1 year before and 1 and 2 years after the imple- mentation of the HHFKA among students overall and among those receiving free meals.4 Using a small sample (n = 6) of Washington State schools from a single district, Johnson et al. evaluated NSLP participation via meal production records 16 months before and 15 months after implementation of the HHFKA and saw a 1% decrease in participation among mid- dle and high school students.5 The relatively narrow time frames of these studies may be inadequate to capture changes in re- sponse to the new regulations.6 It is likely that schools began making changes when the HHFKA passed (2010) or when the US Department of Agriculture’s pro- posed ruling was issued (2011), before the actual implementation of the standards.8

In this study, we used school meal par- ticipation data over a 7-year period from SY2008–2009 to SY2014–2015 (4 years before and 3 years after HHFKA imple- mentation) to analyze NSLP and SBP par- ticipation rates in low-income, high-minority kindergarten through grade 12 schools. Our aim was to assess the impact of the legislation on changes in these rates.

ABOUT THE AUTHORS Nicole Vaudrin and PunamOhri-Vachaspati are with the School ofNutrition andHealth Promotion,Arizona StateUniversity, Phoenix. Kristen Lloyd and Michael J. Yedidia are with the Rutgers Center for State Health Policy, New Brunswick, NJ. Michael Todd is with the College of Nursing and Health Innovation, Arizona State University.

Correspondence should be sent to PunamOhri-Vachaspati, PhD, RD, School of Nutrition and Health Promotion, Arizona State University, 500 N 3rd St, Phoenix, AZ 85001 (e-mail: pohrivac@asu.edu). Reprints can be ordered at http://www.ajph.org by clicking the “Reprints” link.

This article was accepted August 16, 2017. doi: 10.2105/AJPH.2017.304102

84 Research Peer Reviewed Vaudrin et al. AJPH January 2018, Vol 108, No. 1

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mailto:pohrivac@asu.edu
http://www.ajph.org

METHODS A longitudinal analysis of annual average

daily participation (ADP) in school meals was conducted as part of the New Jersey Child Health Study. Public schools located in 4 urban, low-income, high-minority New Jersey cities (Camden, New Brunswick, Newark, and Trenton) were evaluated. Each of the cities has one public school district. Data were gathered from theNational Center for Education Statistics and the New Jersey Department of Agriculture. Schools were excluded if they were missing either de- mographic or school meal participation data (exclusions made up less than 5% of the original sample during each year). Numbers of schools included varied across years as a result of closings, openings, and reconfi- gurations; 139 were included in SY2008– 2009, 137 in SY2009–2010, 134 in SY2010–2011, 131 in SY2011–2012, 127 in SY2012–2013 (one of these schools did not report SBP participation rates), 127 in SY2013–2014, and 119 in SY2014–2015.

We divided ADP counts according to payment type (full price, reduced price, free,

and total), obtained from the New Jersey Department of Agriculture, by total school enrollments to calculate NSLP and SBP participation rates. We calculated participa- tion rates among students eligible for free or reduced-price meals, students paying full price, and all enrolled students.

Annual school demographic data obtained from the National Center for Education Sta- tistics included percentages of students of different races, percentages eligible for free or reduced-price meals, and school grade levels. ADP rates were square transformed to reduce skewness. We used linear mixed models in SPSS version 23 (SPSS Inc, Chicago, IL) to compare repeated observations of meal par- ticipation rates clustered within schools (that were in turn clustered within cities) and ex- amine pairwise between-year differences in schoolmeal participation rates after adjustment for school level (elementary, middle, or high). Models were run for all payment categories. We back transformed estimated mean partic- ipation rates (calculated from models in- corporating square-transformed ADP rates) by taking the square roots of the estimates.

RESULTS Most of the schools were elementary

schools (75%), and students were primarily of minority (52% Black and 43% Hispanic) and low-income (81% eligible for free or reduced-pricemeals) backgrounds. Across the study period, ADP rates for theNSLP and the SBP were 71% and 54%, respectively.

Comparisons of each study year with SY2008–2009 (the base year) showed that there were no significant differences in model-adjusted NSLP participation rates among all enrolled students overall (Figure 1). Although there were statistically significant differences when the various study years were compared with one another, mean partici- pation rates differed only slightly, ranging from 70% to 72%.

The lowest NSLP participation rate (69%) among students eligible for free or reduced- price meals was in SY2012–2013, the school year the HHFKA lunch standards were implemented; after model adjustment, this ratewas significantly (P< .001) lower than the rates in both SY2011–2012 and SY2013– 2014. Participation rates in all of the other

2008–2009 2009–2010 2010–2011 2011–2012 2012–2013 2013–2014 2014–2015

A nn

ua l A

ve ra

ge D

ai ly

Pa rt

ic ip

at io

n Ra

te , %

School Year

……………………………………………………… …………

Implementation of the HHFKA

NSLP

SBP

64%*

73%*

69%

71%

72%

77%*

70%

82%*

71%

73%*

71%

60%* 59%*

47%

52%55%*

52%

56%*

50%49%

52%

49%

52%

73%*

71% 70%

59%*

71%

NSLP all students NSLP free & reduced SBP all students SBP free & reduced

*P < .05 for differences between base year (2008–2009) and subsequent years. Note. HHFKA = Healthy, Hunger-Free Kids Act. Mean participation rates presented are adjusted for clustering within schools and schools clustered within cities. Models included school level (elementary, middle, and high) as a fixed effect.

FIGURE 1—Annual Average Adjusted National School Lunch Program (NSLP) and School Breakfast Program (SBP) Daily Participation Rates: 4 New Jersey Cities, School Years 2008–2009 to 2014–2015

AJPH RESEARCH

January 2018, Vol 108, No. 1 AJPH Vaudrin et al. Peer Reviewed Research 85

study years (73% in SY2009–2010, 82% in SY2010–2011, 77% in SY2011–2012, and 73% in both SY2013–2014 and SY2014– 2015) were significantly higher (P< .05) than the rate in SY2008–2009 (71%) according to linear mixed-model comparisons.

Model-adjusted SBP participation rates among students overall were not significantly different (P < .05) from those of the base year (52%) until SY2013–2014. Rates climbed to 59% in SY2013–2014 and 60% in SY2014– 2015 (P< .01; Figure 1). Differences were most pronounced among students eligible for free or reduced-price meals, who exhibited an increase in participation from 49% in SY2008–2009 to 59% in…