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

Abstract

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 school meals among enrolled students overall and among those eligible for free or reduced-price meals. We used linear mixed models to compare NSLP and SBP participation 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. Published online ahead of print November 21, 2017: e1-e3. doi:10.2105/AJPH.2017.304102).

Full text

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 school meals 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. Published online ahead of print No-
vember 21, 2017: e1–e3. 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
andfoodserviceworkersperceivethat,
although students initially complained,
consumption patterns have not changed
significantly.
3
In only 2 studies were
participationdatausedtoexaminethe
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’spro-
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 Punam Ohri-Vachaspati are with the School of Nutrition and Health Promotion, Arizona State University,
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 Punam Ohri-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
Published online ahead of print November 21, 2017 AJPH Vaudrin et al. Peer Reviewed Research and Practice e1
AJPH RESEARCH AND PRACTICE

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 the National 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
school meal 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-price meals) backgrounds. Across the
study period, ADP rates for the NSLP 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
rate was significantly (P<.001) lower than the
rates in both SY2011–2012 and SY2013–
2014. Participation rates in all of the other
40
50
60
70
80
90
2008–2009 2009–2010 2010–2011 2011–2012 2012–2013 2013–2014 2014–2015
Annual Average Daily
Participation Rate, %
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
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e2 Research and Practice Peer Reviewed Vaudrin et al. AJPH Published online ahead of print November 21, 2017

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 SY2013–2014 and
64% in SY2014–2015. Similar to the NSLP,
there was a dip in SBP participation during
SY2012–2013 (47%), when the rate was
significantly (P<.001) lower than in either
SY2011–2012 or SY2013–2014.
DISCUSSION
In this study, we evaluated changes in
school meal participation in low-income,
primarily minority urban schools in New
Jersey over 7 years spanning the period before
and after the alterations in school meal
standards implemented under the HHFKA.
There were no meaningful changes in NSLP
participation rates among students overall.
Among students eligible for free or reduced-
price meals, NSLP participation rates
were high during the recession (2008–2012)
and then dropped to their lowest levels
when the HHFKA was first implemented in
SY2012–2013 before rebounding in sub-
sequent years. National data also show in-
creased NSLP participation among students
eligible for free or reduced-price meals during
the recession.
9
As noted, 2 studies examining school meal
participation, one focusing on participation
rates
4
and the other on production records as
a proxy for meal participation,
5
did not reveal
any significant differences among students
overall
4,5
or among students receiving free
meals.
4
The SY2012–2013 drop in our data
may suggest an initial lack of acceptance of the
new meal standards, particularly among stu-
dents eligible for free or reduced-price meals.
However, with continued student exposure
to healthy meals, the rates rebounded in
SY2013–2014 and continued to increase in
SY2014–2015. Also, as shown in previous
research, the implementation of smart snacks
standards in SY2014–2015 may have affected
NSLP participation rates.
10
The higher NSLP participation rates ob-
served in our study relative to the Cohen
et al.
4
and Johnson et al.
5
studies may be
attributable to the higher percentage of stu-
dents eligible for free or reduced-price meals
(81%) than in those 2 investigations (32% and
52%, respectively). Nationally, meal partici-
pation rates are higher among students eligible
for free or reduced-price meals than among
noneligible students.
11
SBP participation rates among students
overall remained relatively unchanged until
SY2013–2014, when they increased by 7
percentage points. Nationally, SBP partici-
pation among students eligible for free or
reduced-price meals increased after the
HHFKA’s school breakfast provisions
were implemented, and the increase in
New Jersey schools was among the highest.
7
A key feature of the HHFKA, the com-
munity eligibility provision, allows schools
with high poverty rates to offer free meals to
all students.
12
None of the schools in our
sample participated in universal free meals
before SY2014–2015, when 27 schools
reported providing only free meals to all
students. Participation in the community
eligibility provision and alternative breakfast
promotion projects (e.g., breakfast after the
bell programs), which have been used in all 4
of the study cities since at least SY2013–2014,
may have contributed to the increase in SBP
participation rates.
Overall, our results are consistent with
those of previous studies indicating that,
contrary to controversial media reports on
reactions to the new standards, the effects
of the HHFKA on school meal acceptance
and participation are minimal. With time,
students are likely to accept healthier
options.
CONTRIBUTORS
N. Vaudrin conducted the analysis and wrote the first
draft. K. Lloyd contributed to the analysis and to the
development of the article. M. J. Yedidia conceptualized
the study and contributed to the interpretation of the
findings and the development of the article. M. Todd
contributed to the data analysis and to the development of
the article. P. Ohri-Vachaspati conceptualized the study,
procured the data, and contributed to the analysis and the
development of the article.
ACKNOWLEDGMENTS
Funding for this project was provided by a grant from
the Robert Wood Johnson Foundation and the Eunice
Kennedy Shriver National Institute of Child Health
and Human Development (1R01HD071583-01A1).
HUMAN PARTICIPANT PROTECTION
This study was approved by the institutional review boards
of Arizona State University and Rutgers University.
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