Abstract

The National School Lunch Program:

Ideas, proposals, policies, and politics shaping students' experiences with school lunch in the United States, 1946 - present

By

Wendi Anne Gosliner

Doctor of Public Health

University of California, Berkeley

Professor Ann Keller, Chair

On an average school day in 2012, The National School Lunch Program (NSLP) supported the provision of lunch meals to almost 2/3 of school-age youth in the United States. Recent spikes in childhood obesity rates and the emergence of childhood-onset Type 2 diabetes have brought renewed attention to the program's potential to positively impact the health of the nation's youth. The Healthy Hunger Free Kids Act of 2010 began a process of reforming the NSLP, requiring schools to serve foods consistent with updated nutrition standards, representing the most important punctuation to school lunch policy in decades. The three papers comprising this dissertation provide new insights into ways the public health nutrition community can support the success of the new policies, and continue to improve the impact of the school lunch program on children's health and development.

The first paper examines the relationship between fruit and vegetable consumption at school and specific factors in the school setting, such as the amount of time available to eat lunch, the quality and variety of produce options served, and whether students are involved in food service decision-making. This cross sectional study of California 7th and 9th grade students (n=5,439) was conducted in 31 schools in 2010. Multilevel regression models were used to assess relationships between students' responses to survey questions regarding school food behaviors and recorded observations of school food environments. The study found that a longer lunch period was associated with increased odds of a student eating fruits (40%) and vegetables (54%) at school. Fruit quality increased the odds of a student consuming fruit at school (44%). Including a salad bar and involving students in food service decisions increased a student's odds of consuming vegetables at school (48% and 34%, respectively). The findings suggest that institutional factors in schools are positively associated with middle and high school students' consumption of produce items at school.

The second paper explores the original issues and arguments that were presented by advocates, administration officials, and members of Congress in the 1940's, when a National School Lunch program first was being debated in Congress. Political science theory suggests that understanding history can provide insight into current policy debates. The purpose of this paper is to better understand the early framing and arguments that led to the original structure of the NSLP. It was hypothesized that understanding the full complement of issues and arguments debated at the time the program was established would help explain the policies that shape current school lunch environments. This study examined the transcripts of the three Congressional hearings held in 1944-1945, when proposals for establishing ongoing federal support for school lunch programs were first considered in Congress. The study identifies many issues of contention in the early debates, including whether the primary program objective was to serve the Nation's agricultural needs or to support children's health and wellbeing, which federal agency would administer the program, the degree to which federal resources should be used to support school meals, which children would benefit from school lunch programs, whether food and nutrition education should be included, and whether resources would be provided for equipment and training of personnel. The paper shows that the outcome of the early debates continues to shape present policies, and that modern advocates' vision for an optimal school lunch program mirrors the vision of advocates in the 1940's. The paper underscores the importance of understanding the school lunch program's history, in order to more effectively promote and protect children's opportunities to benefit from school meals.

The final paper presents the results of a pilot study of legislative documents from the National School Lunch Program's history (1946 - present), in order to provide a longer-term perspective on the evolution of the program. The purpose of this study is to explore and describe the school lunch policy ideas and proposals that have appeared on the federal decision-making agenda over time, in order to inform future directions for research and advocacy related to school lunch policy. A ProQuest Congressional search utilizing the search terms "school lunch," "school meal," "child nutrition," or "school nutrition" was conducted, and all hearing and bill summaries were reviewed. The findings suggest that Congressional attention to school lunch, in the form of legislative hearings and bills, has shifted over time, with more legislative attention devoted to the program during the period of expansion in the late 1960s through the period of curtailment in the early to mid-1980s. Further, the study shows that the program consistently has suffered from constrained resources, and that periods of investment in the NSLP have been followed by efforts to curtail the program. The study also reveals that after the program's beginning, many issues cycled on and off of the federal decision-making agenda. These issues include: the degree to which the program should be administered at the federal or state level; which students should benefit from school meals; whether nutrition education should be included; what foods and beverages are served; and how the USDA-distributed commodities should be structured. While the school lunch program generally enjoys bi-partisan support, policymakers have not yet exhibited the political will to provide a program consistent with advocates' desires to operate seamlessly within the school system and offer healthy meals to all students. Future efforts to support and improve the program can now be informed with a better understanding of the program's past political successes and failures. Recommendations about ways the public health nutrition community can continue to support and improve the National School Lunch Program, based on the history described, conclude the paper.

Together, these three papers highlight both opportunities and challenges facing the National School Lunch Program. Cast in the light of this historical perspective, advocates for ideas that have failed in the past can see the value of considering whether current approaches are vulnerable to the same politics that trumped them in past political battles. Similarly, program supporters should understand the proposals to dismantle the federal school lunch program, and why they failed, in order to be prepared to defend the program against similar proposals that may be anticipated in the future. Further, these papers show that while the public health nutrition community may perceive the school lunch program to be a stable federal investment, this perceived stability may be more a function of political good fortune than of a strong and secure federal commitment to children's health and nutrition. Yet current projections suggest that investing in the nutritional health of today's youth is especially important, given the costly epidemics of early-onset diet-related chronic diseases now plaguing the nation. We can no longer afford not to provide a robust and effective National School Lunch Program.

Introduction: Sugar-sweetened beverages (SSBs) are a major contributor to children’s added sugar consumption. This study examines whether children’s SSB and water intake are associated with diet quality and total energy intake.

Methods: Using data on children ages 2–18 years from the 2009–2014 National Health and Nutrition Examination Survey, linear regression models were used to analyze SSB and water intake in relation to Healthy Eating Index (HEI-2010) scores and total energy intake. Generalized linear models were used to analyze SSB and water intake in relation to the HEI-2010 scores. Analyses were conducted including and excluding caloric contributions from SSBs, and were conducted in 2016–2017.

Results: SSB intake was inversely associated with the HEI-2010 total scores (9.5-point lower score comparing more than two servings/day with zero servings/day, p-trend<0.0001) and positively associated with total energy intake (394 kcal higher comparing more than two servings/day with zero servings/day, p-trend<0.0001). The associations between SSB and HEI-2010 total scores were similar when SSBs were excluded from HEI-2010 calculations. Water intake was positively associated with HEI-2010 total scores, but not associated with total energy intake. SSB intake was inversely associated with several HEI-2010 component scores, notably vegetables, total fruit, whole fruit, greens and beans, whole grains, dairy, seafood and plant proteins, and empty calories. Water intake was positively associated with most of the same HEI-2010 component scores.

Conclusions: Children who consume SSBs have poorer diet quality and higher total energy intake than children who do not consume SSBs. Interventions for obesity and chronic disease should focus on replacing SSBs with water and improving other aspects of diet quality that correlate with SSB consumption.

Vegetable and fruit consumption plays an important role in lowering the risk of obesity, heart disease, diabetes, stroke and some cancers. Yet, only 20% of the population eats the daily recommended amount of produce, and 10% of children do not consume any vegetables or fruit on a daily basis. To increase vegetable and fruit intake across the population, which can extend lives and reduce health care expenditures while also enhancing demand for California agricultural products, the UC Nutrition Policy Institute has conducted research to guide public policy and institutional and community programs. The institute has studied produce consumption among children and families in child care settings, emergency food systems, schools and federal nutrition assistance programs. Conducting research to support policymakers in deciding on effective nutrition programs and policies involves partnering with community organizations and decision-makers from the outset, collecting qualitative as well as quantitative data, and sharing research findings with those who can act upon them.

Less than 11% of young school-aged children eat the recommended amounts of fruits and vegetables, despite abundant evidence that these foods protect against many types of cancer, heart disease and diabetes, and when combined with other dietary changes can help protect against obesity. In 2005, California became the first state to address the availability of fresh and local produce in the federal School Breakfast Program through state funding. The California Fresh Start Program doubled the number of different fresh fruits offered to students. With the greater variety, the number of fresh fruit servings taken by students in the Fresh Start pilot program more than doubled. Evaluation of the program revealed many lessons, which are especially important now, as schools across the country prepare to increase the number of fruits and vegetables offered in the School Breakfast Program by or before July 2014 as mandated by the Healthy, Hunger-Free Kids Act.

Background: Research on the association between school meal consumption and overall dietary intake post-Healthy Hunger-Free Kids Act implementation is limited.

Objective: This study examines the association between frequency of participating in the National School Lunch and School Breakfast Programs and children’s dietary intakes.

Design: The Healthy Communities Study was a cross-sectional observational study conducted between 2013-2015.

Participants/setting: U.S. children ages 4-15 years (n=5,106).

Main outcome measures: Dietary measures were assessed using the National Health and Nutrition Examination Survey Dietary Screener Questionnaire. Dietary intake included fruit/vegetables, fiber, whole grains, dairy, calcium., total added sugar, sugar-sweetened beverages, and energy-dense foods of minimal nutritional value.

Statistical analysis: Multivariate statistical models assessed associations between frequency of eating school breakfast or lunch (every day vs. not every day) and dietary intake, adjusting for child and community-level covariates. 

Results: Children who ate school breakfast every day compared to children who ate 0-4 days/week, reported consuming more fruits/vegetables (0.1 cup/day, 95% CI: 0.01, 0.1), dietary fiber (0.4 g/day, 95% CI: 0.2, 0.7), whole grains (0.1 oz/day, 95% CI: 0.05, 0.1), dairy (0.1 cup/day, 95% CI: 0.05, 0.1), and calcium (34.5 mg/day, 95% CI: 19.1, 49.9). Children who ate school lunch every day compared to those who ate less frequently, consumed more dairy (0.1 cup/day, 95% CI: 0.1, 0.2) and calcium (32.4 mg/day, 95% CI: 18.1, 46.6).  No significant associations were observed between school meal consumption and energy-dense nutrient poor foods or added sugars.

Conclusions: Eating school breakfast and school lunch every day by U.S. schoolchildren was associated with modestly healthier dietary intakes. These findings suggest potential nutritional benefits of regularly consuming school meals.