Statewide Universal School Meal Policies and Food Insecurity in Households with Children.

Introduction: Food insecurity disproportionately affects US households with children, causing adverse health and developmental outcomes. During COVID-19, federal waivers enabled free meals for all K-12 students, but these waivers expired in 2022. Subsequently, some states adopted their own School Meals for All (SMFA) policies. This study examined whether households in states with SMFA policies experienced lower food insecurity than states reverting to means-tested programs and whether associations varied by family income.

Methods: A cross-sectional survey of 3,377 caregivers from eight states (four with SMFA policies, four without) was conducted in spring/summer 2023 and analyzed in 2024. Household food security was measured with the USDA six-item module. Generalized estimating equation models estimated the association of SMFA with food insecurity, adjusting for sociodemographic factors, pre-policy county-level food insecurity data, and state-level clustering. Interaction terms tested differential effects by free/reduced-price meal (FRPM) eligibility.

Results: Households in SMFA states had a 12% lower prevalence of food insecurity than those without SMFA (adjusted Prevalence Ratio [aPR] = 0.88, 95% CI: 0.82, 0.94). This association was most pronounced among households eligible for free meals (19% lower prevalence, aPR = 0.81, 95% CI: 0.76, 0.86) and those near FRPM eligibility thresholds (aPR = 0.82, 95% CI: 0.67, 0.98).

Conclusions: Statewide SMFA policies were associated with lower household food insecurity, particularly among those with low or near-low income. These findings support SMFA as a strategy to reduce food insecurity and suggest that expanding SMFA could further benefit families with school-aged children. Future research should assess SMFA's long-term impacts.