ArticleNutrients2023
Implementation of Flexibilities to the National School Lunch and Breakfast Programs and Their Impact on Schools in Missouri.
Article in Nutrients, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.
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Who cites it
4 citing papers in PubMed.
- Integrating macro- and meso-level perspectives on school nutrition programs in Dubai: a joint display mixed methods integration study.Frontiers in public health · 2026Article
- Understanding multi-level policy implementation in the national school lunch and breakfast programs: a mixed-methods and agent-based modeling protocol.Implementation science communications · 2025Article
- "Salt and Eat It or No Salt and Trash It?" Shifts in Support for School Meal Program Flexibilities in Public Comments.Nutrients · 2025Article
- Rethinking our future: Describing and enhancing the impacts of dissemination and implementation science for cancer prevention and control.Journal of clinical and translational science · 2024Article
Corrections and comments
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Authors and funding
7 authors.
Funding
Abstract
backgroundIn 2018, the United States Department of Agriculture (USDA) issued flexibilities to the National School Lunch and Breakfast Programs, relaxing the nutrition standards for milk, whole grains, and sodium. This study examines the implementation decision-making among Missouri school food services and the impact of implementing these flexibilities on the meals served.
methodsWe developed a survey using the Consolidated Framework of Implementation to determine schools' implementation of the flexibilities and factors related to implementation. To determine how the implementation of flexibilities affected participation, we merged the survey results with school-level meal county data from the Missouri Department of Elementary and Secondary Education. We used ordinary least squares regression to examine how flexibility adoption related to the number of meals served.
resultsMost schools implemented the wheat, milk, and sodium flexibilities. Common reasons for implementation were increasing participation, meeting students' preferences, expanding menu variety, and saving money. The implementation of flexibilities was associated with more lunches and breakfasts being served per month, particularly among free and reduced-price meals.
conclusionsContinued research is needed to determine how the increased uptake of school meals that do not fully meet dietary guidelines by low-income students results in inequities in health outcomes. The findings can inform the design and implementation of future policies, especially as new rules related to flexibility design are determined.
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