Statewide Universal School Meals Policies and Food Insecurity: Difference-in-Differences Analysis

BACKGROUND AND OBJECTIVES: The National School Lunch and Breakfast Program, a US program that addresses food insecurity, requires children with higher household incomes to pay for meals. It is unclear whether universal school meals (USM) policies, which make all meals free, further alleviate food insecurity, particularly for students who would otherwise pay. This study estimates the association between statewide USM policies and food insecurity. METHODS: A difference-in-differences study using a nationally representative sample of US households with 6- to 17-year-old children from 2012 to 2021 and 2023 to 2024. The exposure was maintaining statewide USM policy after 2022, determined based on state of residence. The primary outcome was household food insecurity; the secondary outcome was child food insecurity. Analyses were stratified by household income. RESULTS: The sample included 75 122 households. Households with the highest incomes in USM-maintaining states experienced a 1.3-percentage-point (95% CI: -2.1, -0.5) differential decrease in household food insecurity and a 0.9-percentage-point (95% CI: -1.4, -0.5) differential decrease in child food insecurity. Households with low-middle income in USM-maintaining states experienced a 3.2-percentage-point (95% CI: -6.1, -0.3) differential decrease in household food insecurity but no differential change in child food insecurity. Households with lowest income in USM-maintaining states experienced no differential change in household food insecurity and a 3.8-percentage-point (95% CI: -6.2, -1.5) decrease in child food insecurity, although caution is required because the parallel trends assumption was violated. CONCLUSIONS AND POLICY IMPLICATIONS: Implementing statewide USM policies could contribute to decreased food insecurity among households with school-aged children.