Universal Free School Meals Linked to Lower Childhood Blood Pressure: JAMA
Researchers have determined in a new study that the implementation of the Community Eligibility Provision (CEP), a federal policy of universal free school meals for low-income area schools, was associated with better childhood blood pressure. The study concluded that participation of schools in CEP was linked to a net decrease in measurements of high blood pressure among children and adolescents, implying that increasing access to free school meals will enhance cardiovascular health in youth populations. The study was published in JAMA Network Open by Anna M. and colleagues.
This was a cohort study with difference-in-differences design to control for staggered policy adoption. It involved low-income public and charter schools in 12 US states, with data gathered longitudinally from 2013 to 2019. Patients' medical records aged between 4 to 18 years who were treated by community health organizations in the OCHIN health care network were examined. The medical records were matched to schools using residential addresses. Data analysis occurred between April 1 and July 5, 2024.
The exposure of interest was school enrollment in the CEP, during which all enrolled children were served free meals based on family income.
Primary outcome: Proportion per year per school of patients with one high blood pressure reading (≥90th percentile for height, sex, and age).
Secondary outcomes: Proportion with hypertensive readings (≥95th percentile) and mean systolic blood pressure percentiles and diastolic blood pressure percentiles.
Results
The analysis contained 1,052 matched schools and 155,778 unique patients.
The sample was racially and ethnically diverse, with the following mean (SD) proportions of patients:
Asian: 0.04 (0.08)
Hispanic: 0.46 (0.33)
Multiple races: 0.01 (0.03)
Native Hawaiian or Other Pacific Islander: 0.01 (0.02)
Non-Hispanic Black: 0.13 (0.22)
Non-Hispanic White: 0.25 (0.26)
Unknown race/ethnicity: 0.09 (0.09)
The majority of schools (670 schools; 63.7%) were in California or Oregon.
School involvement in the Community Eligibility Provision was linked with:
A −2.71 percentage point decrease (95% CI, −5.10 to −0.31; P = .03) in the percentage of children with high blood pressure.
This decrease represented a −10.8% net reduction (95% CI, −20.4% to −1.2%) during 5 years.
Participation was also associated with reductions in percentage of hypertensive readings and with mean diastolic blood pressure.
This cohort study identified that engagement with the Community Eligibility Provision was linked to a net decrease in children and adolescents' high blood pressure outcomes. These findings highlight that universal free school meal programs can be effective public health interventions to enhance child cardiovascular health and mitigate disparities in hypertension risk.
Reference:
Localio AM, Hebert PL, Knox MA, et al. School Provision of Universal Free Meals and Blood Pressure Outcomes Among Youths. JAMA Netw Open. 2025;8(9):e2533186. doi:10.1001/jamanetworkopen.2025.33186
