School Provision of Universal Free Meals and Blood Pressure Outcomes Among Youths
Bibliographic record
Abstract
Importance: The Community Eligibility Provision is a federal universal free school meals policy for schools in low-income areas. Expanding access to school meals, which are children's most nutritious food source, may be a health-promoting policy. Objective: To assess whether school-level adoption of the Community Eligibility Provision was associated with childhood blood pressure outcomes. Design, Setting, and Participants: This cohort study used a difference-in-differences design for staggered policy adoption, observing low-income public and charter schools in 12 US states longitudinally from 2013 through 2019. The medical records for patients aged 4 to 18 years receiving care from community health organizations in the OCHIN health care network were matched to schools based on address. Data were analyzed from April 1 to July 5, 2024. Exposure: School participation in the Community Eligibility Provision. Main Outcomes and Measures: The primary outcome was the annual school-level proportion of patients with a high blood pressure measurement (at or above the 90th percentile for age, sex, and height), and the secondary outcomes included a hypertensive measurement (at or above the 95th percentile) and mean systolic and diastolic blood pressure percentiles. Results: The sample included 1052 schools matched to 155 778 distinct patients. The mean (SD) proportions of patients based on race and ethnicity were as follows: 0.04 (0.08) Asian patients, 0.46 (0.33) Hispanic patients, 0.01 (0.03) patients of multiple races, 0.01 (0.02) Native Hawaiian or Other Pacific Islander patients, 0.13 (0.22) non-Hispanic Black patients, 0.25 (0.26) non-Hispanic White patients, and 0.09 (0.09) patients with unknown race and ethnicity. The majority of schools (n = 670 [63.7%]) were located in California or Oregon. School participation in the Community Eligibility Provision was associated with a -2.71 percentage point (95% CI, -5.10 to -0.31 percentage point; P = .03) net reduction in the proportion of patients with a high blood pressure measurement, corresponding to a -10.8% (95% CI, -20.4% to -1.2%) net decrease over 5 years. Participation was also negatively associated with the proportion of patients with a hypertensive measurement and with the mean diastolic blood pressure. Conclusions and Relevance: This cohort study of schools matched to child and adolescent patient medical records from a large network of community health organizations found that school participation in the Community Eligibility Provision was associated with a net reduction in blood pressure outcomes. These findings add to mounting evidence that universal free school meals may be associated with improved child health.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".