DO SCHOOL LUNCH SUBSIDIES CHANGE THE DIETARY PATTERNS OF CHILDREN FROM LOW-INCOME HOUSEHOLDS?

I. INTRODUCTION Limited access to nutritious foods threatens the development and growth of children throughout the world. Despite the eradication of widespread hunger and malnutrition in the established market economies of Europe and North America, a healthful diet remains the most expensive alternative for families (Maillot et al. 2007). Imbalances in the nutrient composition of children's diets can have long-run consequences because regularly consuming foods high in essential vitamins and minerals is imperative for avoiding deteriorations in the body's ability to resist infections; and a concurrent combination of infection and undernourishment often results in unfavorable development and growth outcomes for children (Scrimshaw and SanGiovanni 1997). The National School Lunch Program (NSLP) is the widest reaching policy response to this threat in the United States, with more than 30 million students taking advantage of its benefits every school day. (1) A central objective of the program is to relax household resource constraints by providing access to free or low-cost domestic agricultural products for children during school. The means-tested component of the NSLP targets students from households with low income relative to national standards, and it now accounts for over half of the total number of program participants and subsidized school lunches. Eligible students pay 40 cents or less, or nothing for school lunches if they come from a household with income below 185% or 135% of the Federal poverty guidelines, respectively (U.S. Congress 2004a). (2) There has been considerable debate over the program's effectiveness in providing balanced nourishment to children in light of the increasing national trend in obesity prevalence. (3) However, little work has been carried out to investigate the intermediary mechanisms through which program participation impacts children's body sizes. In the most recent study, Gordon et al. (2007b) find that program participants have higher average intakes for micronutrients, such as calcium and vitamins A and B, relative to nonparticipants in the previous 24 hours; and differences in average macronutrient intakes were mixed with increases in protein and decreases in carbohydrates. Similarly, Gleason and Suitor (2003) find that program participants have higher average intakes for several vitamins and minerals and dietary fat and lower average intakes for added sugars. An important limitation of earlier studies was the omission of any precise, comprehensive measure of children's body sizes in the empirical models. To the extent that differences in body sizes partly explain individual dietary patterns, conclusions based on earlier findings may be incomplete. Furthermore, no analytical distinction has been made for those participants receiving means-tested subsidies, and this is arguably the most vulnerable population targeted by the program. Given the vast reach of the NSLP and its strong potential to improve individual development and growth outcomes, we examine how the dietary patterns of children from low-income households are impacted by the school lunch subsidies. A healthful diet according to the most recent U.S. Department of Agriculture (USDA) guidelines comprises five main food groups: grain, vegetable, fruit, milk, and meat and beans. (4) In this study, we investigate how the NSLP means-tested subsidies affect children's consumption of items included in the vegetable, fruit, and milk food groups. Although we are unable to fully explore the effects of the subsidies on items in every recommended food group, the items we do analyze are important dietary sources of calcium, iron, and vitamins A and C that support favorable development and growth outcomes (Scrimshaw 1991; Scrimshaw and SanGiovanni 1997). For instance, not having enough iron in the body, even a moderate deficiency, is linked with decreased cognitive performance among school-age children (Halterman et al. …