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Healthier Standards for School Meals and Snacks

Impact on School Food Revenues and Lunch Participation Rates

      Introduction

      In 2012, the updated U.S. Department of Agriculture school meals standards and a competitive food law similar to the fully implemented version of the national Smart Snack standards went into effect in Massachusetts. This study evaluated the impact of these updated school meal standards and Massachusetts’ comprehensive competitive food standards on school food revenues and school lunch participation.

      Methods

      Revenue and participation data from 11 Massachusetts school districts were collected from 2011 to 2014 and analyzed in 2015 using multilevel modeling. The association between the change in compliance with the competitive food standards and revenues/participation was assessed using linear regression.

      Results

      Schools experienced declines in school food revenues of $15.40/student in Year 1 from baseline (p=0.05), due to competitive food revenue losses. In schools with 3 years of data, overall revenues rebounded by the second year post-implementation. Additionally, by Year 2, school lunch participation increased by 15% (p=0.0006) among children eligible for reduced-price meals. Better competitive food compliance was inversely associated with school food revenues in the first year only; an absolute change in compliance by 10% was associated with a $9.78/student decrease in food revenues over the entire school year (p=0.04). No association was seen between the change in compliance and school meal participation.

      Conclusions

      Schools experienced initial revenue losses after implementation of the standards, yet longer-term school food revenues were not impacted and school meal participation increased among children eligible for reduced-price meals. Weakening the school meal or competitive food guidelines based on revenue concerns appears unwarranted.

      Introduction

      In Fall 2012, the updated U.S. Department of Agriculture (USDA) school meal standards went into effect.
      U.S. Department of Agriculture
      Nutrition standards in the National School Lunch and School Breakfast Programs.
      These standards brought school meals in closer alignment with the 2010 Dietary Guidelines for Americans, including more whole grains, larger portions for fruits and vegetables, a greater vegetable variety, calorie limits, and the elimination of trans fats.

      U.S. Department of Agriculture. Dietary guidelines for Americans, 2010. http://health.gov/dietaryguidelines/2010/.

      Research has documented improvements in healthier school food selection and consumption,
      • Cohen J.F.
      • Richardson S.
      • Parker E.
      • Catalano P.J.
      • Rimm E.B.
      Impact of the new U.S. Department of Agriculture school meal standards on food selection, consumption, and waste.
      • Schwartz M.B.
      • Henderson K.E.
      • Read M.
      • Danna N.
      • Ickovics J.R.
      New school meal regulations increase fruit consumption and do not increase total plate waste.
      yet evidence examining school meal revenues is mixed.

      Food and Nutrition Service, U.S. Department of Agriculture. Fact sheet: Healthy, Hunger-Free Kids Act school meals. www.fns.usda.gov/pressrelease/2014/009814.

      School Nutrition Association. Myth vs. fact on Healthy, Hunger-Free Kids Act school meals implementation. https://schoolnutrition.org/uploadedFiles/About_School_Meals/Myth%20vs%20Fact.pdf.

      Although preliminary research found decreases in participation following the new school meal standards, this may have been a pre-existing trend.

      Food Research and Action Center. National School Lunch Program: Trends and factors affecting student participation. http://frac.org/pdf/national_school_lunch_report_2015.pdf. Published 2015.

      Participation rates and school meal revenues may be impacted by other factors, including competitive foods (i.e., foods sold in vending machines, à la carte, and in school stores) that students often purchase instead of school meals.

      Food Research and Action Center. National School Lunch Program: Trends and factors affecting student participation. http://frac.org/pdf/national_school_lunch_report_2015.pdf. Published 2015.

      Additionally, research suggests schools often use meal revenues to offset the cost of producing à la carte foods.
      • Bartlett S.
      • Glantz F.
      • Logan C.
      School Lunch and Breakfast Cost Study-II final report.
      To improve the school food environment, the USDA created standards for competitive foods, called Smart Snacks in School (“Smart Snacks”), which went into effect in Fall 2014.

      U.S. Department of Agriculture. Smart Snacks in School: USDA’s “All foods sold in schools” standards. www.fns.usda.gov/sites/default/files/allfoods_flyer.pdf.

      These standards emphasize whole grains, fruits, vegetables, and low-fat dairy while limiting calories, sugar, sodium, and saturated fats and eliminating trans fats. However, competitive foods do not need to meet these standards if they contain at least 10% of the Daily Value for “nutrients of concern” (i.e., calcium, potassium, vitamin D, or dietary fiber) until Fall 2016. Therefore, these Smart Snack standards have not been fully implemented nationally. Previous research has documented that when healthier competitive food standards are implemented, schools often experience competitive food revenue losses, but compensate with increases in meal revenues.
      • Woodward-Lopez G.
      • Gosliner W.
      • Samuels S.E.
      • Craypo L.
      • Kao J.
      • Crawford P.B.
      Lessons learned from evaluations of California's statewide school nutrition standards.
      • Peterson C.
      Competitive foods sales are associated with a negative effect on school finances.
      • Long M.W.
      • Luedicke J.
      • Dorsey M.
      • Fiore S.S.
      • Henderson K.E.
      Impact of Connecticut legislation incentivizing elimination of unhealthy competitive foods on National School Lunch Program participation.
      However, no previous studies have examined the impact of comprehensive competitive food standards pre- and post-implementation of the updated USDA meal standards. It is therefore unknown if similar financial substitution effects would occur with both healthier competitive food and school meal standards.
      In 2010, Massachusetts passed a comprehensive competitive food law that was almost identical to the fully implemented Smart Snack standards (105 CMR 225.000; a comparison of these standards has been published previously).
      • Hoffman J.
      • Rosenfeld L.
      • Schmidt N.
      • et al.
      Implementation of statewide competitive food and beverage standards: the Massachusetts NOURISH (Nutrition Opportunities to Understand Reforms Involving Student Health) study.
      These standards went into effect throughout Massachusetts simultaneously with the updated USDA school meal guidelines in Fall 2012. Thus, the combined effect of the updated school meal standards and competitive food standards on revenues and school meal participation rates could be examined. The Nutrition Opportunities to Understand Reforms Involving Student Health (NOURISH) study, a collaboration between the Harvard T.H. Chan School of Public Health, Northeastern University, Brandeis University, and the Massachusetts Department of Public Health, was developed to examine the impact of the Massachusetts competitive food standards. The NOURISH study examined compliance,
      • Hoffman J.
      • Rosenfeld L.
      • Schmidt N.
      • et al.
      Implementation of statewide competitive food and beverage standards: the Massachusetts NOURISH (Nutrition Opportunities to Understand Reforms Involving Student Health) study.
      students’ diets, barriers, and strategies for successful implementation, revenues, and meal participation rates. The present study examined changes in school food revenues and meal participation rates among a sample of NOURISH schools pre- and post-implementation of the Massachusetts competitive food standards and USDA school meal standards. It was hypothesized that schools may lose competitive food revenues but benefit from increases in school meal participation, leading to gains in school meal revenues.

      Methods

      Participants and Setting

      In Spring 2012, Massachusetts school districts were recruited to participate in the NOURISH study if they had a middle and high school (districts with only K–8 schools or combined districts for high schools were excluded). From the 113 eligible districts in Massachusetts, districts were randomly selected to participate and 37 districts (one middle school and one high school per district; 74 schools total) agreed to participate (33% participation).
      • Hoffman J.
      • Rosenfeld L.
      • Schmidt N.
      • et al.
      Implementation of statewide competitive food and beverage standards: the Massachusetts NOURISH (Nutrition Opportunities to Understand Reforms Involving Student Health) study.
      Among the participating districts with multiple middle or high schools, one of each was randomly selected. Schools had site visits to document all pre-packaged competitive foods, baked goods sold à la carte (i.e., cookies), and beverages available before and after the Massachusetts competitive food law went into effect (Spring 2012, 2013, and 2014). Additional NOURISH study details have been previously published.
      • Hoffman J.
      • Rosenfeld L.
      • Schmidt N.
      • et al.
      Implementation of statewide competitive food and beverage standards: the Massachusetts NOURISH (Nutrition Opportunities to Understand Reforms Involving Student Health) study.
      This study was approved by the Harvard T.H. Chan School of Public Health’s IRB.
      Among the participating districts, a subsample was invited to provide financial data. All participating districts that managed their competitive food revenues (e.g., did not have vending machine contracts with outside vendors) and therefore had access to competitive food and school meal financial data were asked to participate. A total of 11 districts (92% of eligible districts) agreed to participate and provided financial data at baseline and Year 1 post-implementation. Among the 11 districts, a subsample (n=7) also provided financial data for Year 2 post-implementation; four did not provide financial data in Year 2 owing to the effort required to compile the information. There were no substantial differences between the districts that provided financial data for only 2 years compared with those supplying 3 years of data. The districts were socioeconomically diverse, with on average 32% (range, 7%–58%) of the students eligible for free or reduced-price meals and located throughout Massachusetts (three urban, five suburban, and three rural districts). Student body size greatly varied, with the participating high schools ranging in size from approximately 350 to 1,400 students. Per inclusion criteria, all participating districts managed their school meal program.

      Data

      Schools provided their overall school food revenue information, including competitive foods sales (vending and à la carte combined) and school meal sales. In some districts, revenue data were only available at the district level, but these districts had only one middle and high school, and the elementary schools in these districts did not sell competitive foods (thus, only the participating schools contributed to the competitive food revenues). In districts with multiple middle or high schools, only the participating schools provided financial data, and these data were combined to calculate one value per district. Additionally, school-specific information was provided on the percentage of students eligible for free, reduced-price, and full-price meals, school meal participation rates, average student enrollment, and attendance rates; these data were combined and weighted by the student body sizes in the participating middle and high schools. The financial and participation data were for the school year from August (or early September) until the data collection date (late spring). Attempts were made each year following data collection to obtain the remaining information for the entire school year. Compliance with the competitive food standards was assessed at each school through direct observation by trained research assistants during site visits
      • Hoffman J.
      • Rosenfeld L.
      • Schmidt N.
      • et al.
      Implementation of statewide competitive food and beverage standards: the Massachusetts NOURISH (Nutrition Opportunities to Understand Reforms Involving Student Health) study.
      ; data were then combined for the participating middle and high schools. Compliance was calculated for each district annually during the study as: number of compliant products ÷ total number of products.

      Statistical Analysis

      Data from the 11 school districts that provided financial information were used for the analyses conducted in 2015. To account for varying school sizes, all financial data (i.e., total revenues, meal revenues, and competitive food revenues per district) were calculated on a per student basis by dividing revenues by the student body size, accounting for average daily attendance. Because the financial data were collected in spring when school was still in session, the number of serving days was accounted for to determine annual revenue information (calculated as revenues ÷ the number of serving days X 180 school days). Differences in total revenues, meal revenues, and competitive food revenues by year were analyzed using multilevel modeling with SAS PROC MIXED (mixed-model ANOVA), accounting for repeated measures within school districts (SAS, version 9.4). Similarly, school lunch participation rates per district were calculated by dividing the number of meals served by the average student body size, accounting for the average daily attendance, number of serving days, and number of students eligible for free, reduced-price, and full-price meals (e.g., free lunch participation rates were calculated relative to the number of students eligible for free meals). Differences in school lunch participation, including by free, reduced-price, and full-price lunch, were analyzed using mixed-model ANOVA accounting for repeated measures. Analyses adjusted for the percentage of students eligible for free or reduced-price meals and the average student enrollment in participating schools. The association between compliance with the competitive food standards and revenues and lunch participation was examined using linear regression (SAS PROC GLM) adjusting for baseline compliance with the standards.

      Results

      The changes in revenues pre- and post-implementation of the updated USDA school meal standards and Massachusetts competitive food standards are presented in Table 1. There were minimal differences between unadjusted and adjusted revenue estimates. At baseline (pre-implementation), school districts had average annual total revenues from food (school meals and competitive foods combined) of $351.45 per student, adjusting for the percentage of students eligible for free or reduced-price meals and the average school size. At the end of the first year post-implementation, food revenues were on average $15.40 less per student compared with baseline ($336.05/student Year 1 vs $351.45/student baseline, p=0.05). Among the subsample of districts that provided data for 3 years (n=7), overall food revenues were on average $21.81 less per student in Year 1 compared with baseline ($308.13/student Year 1 vs $329.94/student baseline, p=0.04). However, by Year 2, revenues returned to baseline values ($325.95/student Year 2 vs $329.94/student baseline, p=0.69). When the analyses were restricted to revenues from meals only, there were no statistically significant changes from baseline ($271.85/student) to Year 1 ($279.66/student, difference of $7.81/student, p=0.26). In the subsample of districts with all 3 years of data, there were also no significant differences in meal revenues. Among competitive foods, school districts experienced revenue losses in Year 1 compared with baseline ($68.41/student vs $93.94/student, p=0.005). In districts with all 3 years of data, similar losses were seen in Year 1 ($63.02/student vs $86.01/student at baseline, p=0.003) and Year 2 ($64.02/student vs $86.01/student at baseline, p=0.004). The school districts’ annual average revenue changes are presented in Figure 1 and Appendix Figure 1 (available online). There was a substantial variation in revenues; among districts with all 3 years of data, annual total revenues per student ranged from $166.41 to $397.65 at baseline, $133.78 to $389.66 in Year 1, and $160.61 to $438.25 in Year 2.
      Table 1Change in Annual Revenues Before and After Implementation of the Updated USDA School Meal Standards and the Massachusetts Competitive Food Standards
      Full sample of school districts (n=11)
      n=11 consists of all of the school districts participating in the financial portion of the NOURISH study that provided data at a baseline and Year 1 post-implementation.
      Subsample of school districts (n=7)
      n=7 consists of the subsample schools that provided financial data at baseline and at Year 1 and Year 2 post-implementation.
      BaselineYear 1BaselineYear 1Year 2
      Annual revenuesM
      Calculated using least squares mean regression.
      (SE)
      M
      Calculated using least squares mean regression.
      (SE)
      Difference
      Difference is calculated as Year 1 – baseline.
      (SE)
      p-value
      Calculated using ANOVA, accounting for repeated measures within a school district, and adjusted for the percent of students eligible for free or reduced-price meals and the average school sizes of the participating schools.
      M
      Calculated using least squares mean regression.
      (SE)
      M
      Calculated using least squares mean regression.
      (SE)
      Difference
      Difference is calculated as Year 1 – baseline.
      (SE)
      p-value
      Calculated using ANOVA, accounting for repeated measures within a school district, and adjusted for the percent of students eligible for free or reduced-price meals and the average school sizes of the participating schools.
      M
      Calculated using least squares mean regression.
      (SE)
      Difference
      Difference is calculated as Year 2 – baseline. NOURISH, Nutrition Opportunities to Understand Reforms Involving Student Health; USDA, U.S. Department of Agriculture.
      (SE)
      p-value
      Calculated using ANOVA, accounting for repeated measures within a school district, and adjusted for the percent of students eligible for free or reduced-price meals and the average school sizes of the participating schools.
      Total revenues ($/student)351.45 (34.50)336.05 (34.50)−15.40 (6.87)0.05329.94 (27.03)308.13 (27.03)−21.81 (9.89)0.04325.95 (27.03)−3.98 (9.89)0.69
      Meal revenues ($/student)271.85 (45.20)279.66 (45.20)7.81 (6.48)0.26257.15 (54.85)255.05 (54.85)−2.10 (8.44)0.81272.01 (54.85)14.86 (8.44)0.11
      Competitive food revenues ($/student)93.94 (21.33)68.41 (21.33)−25.53 (6.65)0.00586.01 (38.28)63.02 (38.28)−22.99 (6.01)0.00364.02 (38.28)−21.99 (6.01)0.004
      Note: Boldface indicates statistical significance (p<0.05).
      a n=11 consists of all of the school districts participating in the financial portion of the NOURISH study that provided data at a baseline and Year 1 post-implementation.
      b n=7 consists of the subsample schools that provided financial data at baseline and at Year 1 and Year 2 post-implementation.
      c Calculated using least squares mean regression.
      d Difference is calculated as Year 1 – baseline.
      e Calculated using ANOVA, accounting for repeated measures within a school district, and adjusted for the percent of students eligible for free or reduced-price meals and the average school sizes of the participating schools.
      f Difference is calculated as Year 2 – baseline.NOURISH, Nutrition Opportunities to Understand Reforms Involving Student Health; USDA, U.S. Department of Agriculture.
      Figure thumbnail gr1
      Figure 1Change in total revenues among school districts before and after implementation of the updated USDA school meal standards and the Massachusetts competitive food standards (n=11 school districts).
      USDA, U.S. Department of Agriculture.
      School lunch participation was examined to determine if changes in the competitive food policy would lead to an increase in the percentage of students participating in the school lunch program (Table 2). There were minimal differences between the unadjusted and adjusted results, and no significant changes in overall lunch participation between baseline and Year 1, adjusting for the percentage of students eligible for free or reduced-price meals and the average school size (43.80% Year 1 vs 43.43% baseline, p=0.78). Similarly, for districts with all 3 years of data, compared with baseline, there were no significant differences for Year 1 (47.81% Year 1 vs 48.75% baseline, p=0.64) or Year 2 compared with baseline (48.55% Year 2 vs 48.75% baseline, p=0.93). When stratifying lunch participation by eligibility for free, reduced-price, or full-price meals, there were also no significant differences in free or full-price lunch participation. However, among students eligible for reduced-price lunches, there was a significant increase in participation in Year 2 compared with baseline (73.61% Year 2 vs 58.46% baseline, p=0.0006).
      Table 2Change in Annual School Lunch Participation Before and After Implementation of the Updated USDA School Meal Standards and the Massachusetts Competitive Food Law
      Full sample of school districts (n=11)
      n=11 consists of all of the school districts participating in the financial portion of the NOURISH study that provided data at a baseline and Year 1 post-implementation.
      Subsample of school districts (n=7)
      n=7 consists of the schools that provided financial data at baseline and at Year 1 and Year 2 post-implementation.
      BaselineYear 1BaselineYear 1Year 2
      Annual school lunch participationM
      Calculated using least squares mean regression.
      (SE)
      M
      Calculated using least squares mean regression.
      (SE)
      Difference
      Difference is calculated as Year 1 – baseline.
      (SE)
      p-value
      Calculated using ANOVA, accounting for repeated measures within a school district, and adjusted for the percent of students eligible for free or reduced-price meals and the average school sizes of the participating schools.
      M
      Calculated using least squares mean regression.
      (SE)
      M
      Calculated using least squares mean regression.
      (SE)
      Difference
      Difference is calculated as Year 1 – baseline.
      (SE)
      p-value
      Calculated using ANOVA, accounting for repeated measures within a school district, and adjusted for the percent of students eligible for free or reduced-price meals and the average school sizes of the participating schools.
      M
      Calculated using least squares mean regression.
      (SE)
      Difference
      Difference is calculated as Year 2 – baseline. USDA, U.S. Department of Agriculture; NOURISH, Nutrition Opportunities to Understand Reforms Involving Student Health.
      (SE)
      p-value
      Calculated using ANOVA, accounting for repeated measures within a school district, and adjusted for the percent of students eligible for free or reduced-price meals and the average school sizes of the participating schools.
      Overall lunch participation (%)43.43 (2.33)43.80 (2.33)0.38 (1.28)0.7848.75 (2.52)47.81 (2.52)−0.95 (1.99)0.6448.55 (2.52)−0.20 (2.10)0.93
      Free lunch (%)64.59 (2.94)62.05 (2.94)−2.54 (1.47)0.1270.00 (5.32)67.28 (5.32)−2.72 (2.75)0.3571.01 (5.40)1.01 (2.91)0.74
      Reduced-price lunch (%)53.66 (3.00)57.17 (3.00)3.52 (2.34)0.1758.46 (2.92)63.48 (2.92)5.02 (2.95)0.1273.61 (3.06)15.14 (3.10)0.0006
      Full-price lunch (%)34.27 (3.14)35.16 (3.14)0.90 (1.77)0.6237.66 (4.41)36.47 (4.41)−1.19 (1.86)0.5435.43 (4.46)−2.23 (1.97)0.28
      Note: Boldface indicates statistical significance (p<0.05).
      a n=11 consists of all of the school districts participating in the financial portion of the NOURISH study that provided data at a baseline and Year 1 post-implementation.
      b n=7 consists of the schools that provided financial data at baseline and at Year 1 and Year 2 post-implementation.
      c Calculated using least squares mean regression.
      d Difference is calculated as Year 1 – baseline.
      e Calculated using ANOVA, accounting for repeated measures within a school district, and adjusted for the percent of students eligible for free or reduced-price meals and the average school sizes of the participating schools.
      f Difference is calculated as Year 2 – baseline. USDA, U.S. Department of Agriculture; NOURISH, Nutrition Opportunities to Understand Reforms Involving Student Health.
      The impact of compliance with the Massachusetts competitive food standards on revenues and school meal participation was examined. At baseline, on average 30% (range, 0%–71%) of the competitive foods available in participating schools were already in alignment with the upcoming state standards. By Year 1 post-implementation, on average 76% (range, 17%–100%) of the competitive foods were compliant with the standards, and in Year 2, on average 74% (range, 26%–100%) of the competitive foods were compliant because of some schools returning to serving a few non-compliant foods. Overall, the change in compliance was inversely associated with total food revenues between baseline and Year 1; an absolute 10% change in compliance was associated with a decrease in revenues of $9.78/student for the school year (p=0.04, Table 3). In districts with 3 years of data, the magnitude of the association between compliance and total revenues was similar, but the relationship was not significant in Year 1 (β= –14.50, p=0.30) or Year 2 (β= –24.20, p=0.20). There was also no association between compliance with the Massachusetts competitive food standards and school meal participation rates.
      Table 3Association Between Compliance With the Massachusetts (MA) Competitive Food Standards and Change in School Revenues and Participation Among School Districts Participating in the NOURISH Study (per 10% Change in Compliance With Competitive Food Standards)
      Year 1 versus baseline (n=11)
      n=11 consists of all of the school districts participating in the financial portion of the NOURISH study that provided data at a baseline and Year 1 post-implementation; n=7 consists of the schools that provided financial data at baseline and at Year 1 and Year 2 post-implementation.
      Year 1 versus baseline (n=7)
      n=11 consists of all of the school districts participating in the financial portion of the NOURISH study that provided data at a baseline and Year 1 post-implementation; n=7 consists of the schools that provided financial data at baseline and at Year 1 and Year 2 post-implementation.
      Year 2 versus baseline (n=7)
      n=11 consists of all of the school districts participating in the financial portion of the NOURISH study that provided data at a baseline and Year 1 post-implementation; n=7 consists of the schools that provided financial data at baseline and at Year 1 and Year 2 post-implementation.
      β (SE)
      Calculated using linear regression, adjusting for baseline compliance.
      p-value
      Calculated using linear regression, adjusting for baseline compliance.
      β (SE)
      Calculated using linear regression, adjusting for baseline compliance.
      p-value
      Calculated using linear regression, adjusting for baseline compliance.
      β (SE)
      Calculated using linear regression, adjusting for baseline compliance.
      p-value
      Calculated using linear regression, adjusting for baseline compliance.
      Revenues
       Total revenues ($/student annually)
      Change in average $/student annually with an absolute change of 10% in compliance with the MA competitive food standards.
      −9.78 (3.74)0.04−14.50 (10.53)0.30−24.20 (14.79)0.20
       Meal revenues ($/student annually)
      Change in average $/student annually with an absolute change of 10% in compliance with the MA competitive food standards.
      −3.34 (5.57)0.57−9.37 (9.36)0.39−13.74 (13.72)0.39
       Competitive food revenues ($/student annually)
      Change in average $/student annually with an absolute change of 10% in compliance with the MA competitive food standards.
      −6.44 (5.70)0.308.75 (12.42)0.55−9.46 (13.09)0.55
      Participation
       Overall participation (%)
      Change in average percent participation with an absolute change of 10% in compliance with the MA competitive food standards. MA, Massachusetts; NOURISH, Nutrition Opportunities to Understand Reforms Involving Student Health.
      −0.25 (1.20)0.840.49 (2.50)0.86−1.29 (3.58)0.74
       Free participation (%)
      Change in average percent participation with an absolute change of 10% in compliance with the MA competitive food standards. MA, Massachusetts; NOURISH, Nutrition Opportunities to Understand Reforms Involving Student Health.
      −0.93 (1.13)0.44−3.37 (2.40)0.26−0.93 (5.43)0.87
       Reduced-price participation (%)
      Change in average percent participation with an absolute change of 10% in compliance with the MA competitive food standards. MA, Massachusetts; NOURISH, Nutrition Opportunities to Understand Reforms Involving Student Health.
      0.84 (1.86)0.673.47 (3.70)0.94−1.03 (3.33)0.78
       Full-price participation (%)
      Change in average percent participation with an absolute change of 10% in compliance with the MA competitive food standards. MA, Massachusetts; NOURISH, Nutrition Opportunities to Understand Reforms Involving Student Health.
      −0.94 (1.54)0.561.31 (3.11)0.70−0.53 (2.47)0.84
      Note: Boldface indicates statistical significance (p<0.05).
      a n=11 consists of all of the school districts participating in the financial portion of the NOURISH study that provided data at a baseline and Year 1 post-implementation; n=7 consists of the schools that provided financial data at baseline and at Year 1 and Year 2 post-implementation.
      b Calculated using linear regression, adjusting for baseline compliance.
      c Change in average $/student annually with an absolute change of 10% in compliance with the MA competitive food standards.
      d Change in average percent participation with an absolute change of 10% in compliance with the MA competitive food standards. MA, Massachusetts; NOURISH, Nutrition Opportunities to Understand Reforms Involving Student Health.

      Discussion

      In this study of the impact of the updated USDA school meal standards and Massachusetts competitive food standards (similar to the national Smart Snacks standards), schools experienced initial overall revenue losses, primarily because of decreased revenues from competitive foods. However, by 2 years post-implementation, total revenues were similar to baseline levels because of the competitive food revenue losses being balanced by modest gains in school meal revenues. During this time, there were statistically significant increases in school meal participation among students eligible for reduced-price meals. The change in compliance with the competitive food standards was inversely associated with revenues during the first year post-implementation, but no statistically significant differences were seen among schools with all 3 years of data, and there was no association between change in compliance and school meal participation rates.
      The revenue neutral impact of the combined school meal and competitive food policies is similar to those seen by Woodward and colleagues
      • Woodward-Lopez G.
      • Gosliner W.
      • Samuels S.E.
      • Craypo L.
      • Kao J.
      • Crawford P.B.
      Lessons learned from evaluations of California's statewide school nutrition standards.
      evaluating a healthier competitive food policy in California (without changes to the school meals). Similarly, the present study found that after implementing healthier competitive foods, gains in school meal revenues offset decreases in competitive food revenues. In another study that implemented healthier school meals in five states prior to implementation of the new USDA school meal standards (but without the presence of strict competitive food standards), there were no overall revenue losses in schools with healthier school meals compared with control schools.
      • Treviño R.P.
      • Pham T.
      • Mobley C.
      • Hartstein J.
      • Ghormli L.E.
      • Songer T.
      HEALTHY study school food service revenue and expense report.
      Overall, these studies suggest that with sufficient time to acclimate to healthier changes, schools may be able to improve the food environment without revenue losses.
      A wide range in school revenues was observed in the current study, which may have been due to the variety and quality of the school meals and the availability of compliant competitive foods. Compliance with the competitive food policy was inversely associated with overall revenues in the first year post-implementation; this may have been influenced by the initially limited number of compliant competitive food choices influencing revenues.
      • Hoffman J.
      • Rosenfeld L.
      • Schmidt N.
      • et al.
      Implementation of statewide competitive food and beverage standards: the Massachusetts NOURISH (Nutrition Opportunities to Understand Reforms Involving Student Health) study.
      It is noteworthy that the school district with the highest school meal revenues in the present study had the lowest competitive food revenues. Similarly, the school district with the highest competitive food revenues had the lowest school meal revenues. This supports the growing evidence that competitive foods “compete” with school meals,
      • Peterson C.
      Competitive foods sales are associated with a negative effect on school finances.
      • Fox M.K.
      • Gordon A.
      • Nogales R.
      • Wilson A.
      Availability and consumption of competitive foods in U.S. public schools.
      further highlighting the importance of implementing nutrition standards for both school meals and competitive foods.
      Overall, school lunch participation rates in this study were similar to those found in the School Nutrition Dietary Assessment Study-IV across income eligibility categories among middle and high school students.

      Fox MK, Condon E. School Nutrition Dietary Assessment Study-IV: summary of findings. No. 7605. Mathematica Policy Research. 2012.

      Notably, schools participating in this study did not experience declines in school meal participation on average, including among students purchasing full-price meals, despite implementation of the healthier school meal standards, as has been experienced by some other districts during this time.

      Food Research and Action Center. National School Lunch Program: Trends and factors affecting student participation. http://frac.org/pdf/national_school_lunch_report_2015.pdf. Published 2015.

      In fact, school lunch participation rates increased among students eligible for reduced-price meals. Increases in school meal participation have previously been documented in districts with stricter competitive food standards.
      • Woodward-Lopez G.
      • Gosliner W.
      • Samuels S.E.
      • Craypo L.
      • Kao J.
      • Crawford P.B.
      Lessons learned from evaluations of California's statewide school nutrition standards.
      • Wojcicki J.M.
      • Heyman M.B.
      Healthier choices and increased participation in a middle school lunch program: effects of nutrition policy changes in San Francisco.
      These results suggest that students who received reduced-price meals were the most influenced by the competitive food law. It is possible that these students may be unable to bring lunch from home and thus prefer to spend the limited amount of money they have on a reduced-price school meal rather than a healthier competitive food (which is often similar in price).

      Limitations

      This study had several limitations. Only 11 school districts in Massachusetts participated in the financial portion of the study, and only seven districts provided financial data for all 3 years; this may have impacted the power to detect smaller differences in revenues and participation. Larger studies examining school financial data are warranted once the Smart Snack standards are fully implemented. It is possible that the schools participating in this study differed from other schools in Massachusetts or nationwide. However, the participating schools had varying levels of compliance with the competitive food standards (both pre- and post-implementation) and were similar to both Massachusetts and the nation in their socioeconomic and geographic diversity. Among the students in the participating schools, 32% were eligible for free/reduced-price meals compared with 34% of students in Massachusetts,

      National Center for Education Statistics (NCES). Number and percentage of public school students eligible for free or reduced-price lunch, by state: selected years, 2000-01 through 2010-11. https://nces.ed.gov/programs/digest/d12/tables/dt12_046.asp.

      and the participating schools represented a geographic distribution similar to national estimates where approximately 26% of schools are urban, 32% are rural, and 41% are in suburbs/towns (among schools in this study, 27% were rural, 27% were urban, and 45% were suburban).

      The National Center for Education Statistics (NCES). The status of rural education. http://nces.ed.gov/programs/coe/indicator_tla.asp.

      Future studies should examine elementary schools and districts in other geographically diverse regions. Additionally, the participating districts managed their competitive food sales and school meal programs. Because districts that outsource competitive foods to vending companies only receive a portion of the revenues from their sales, it is possible that the revenue losses from competitive foods seen in this study would differ from districts with vending contracts. However, the collection of detailed financial and participation information is possible from districts that control their own programs, and less so from districts with management companies. Therefore, results are likely generalizable to other districts that manage their competitive foods and school meal programs. Future studies should examine revenues in schools that outsource their vending machines or school meal programs. Lastly, this study used a pre–post design without control schools; although it is possible that broader changes in the economy may have influenced students’ eligibility for free or reduced-price meals, there were no other changes in the schools during the study period that would have directly impacted school food revenues or school lunch participation rates. This study was further strengthened by competitive food compliance data that were captured using direct observation.
      • Hoffman J.
      • Rosenfeld L.
      • Schmidt N.
      • et al.
      Implementation of statewide competitive food and beverage standards: the Massachusetts NOURISH (Nutrition Opportunities to Understand Reforms Involving Student Health) study.
      Future studies should examine the combined influence of the healthier school meal and competitive food policies on students’ diets.

      Conclusions

      This study suggests that schools may experience short-term revenue losses due to the combined implementation of healthier school meals and competitive food policies, but potentially minimal impacts on longer-term overall revenues. It is possible that schools struggling with school meal revenues or participation rates from the USDA school meal standards may benefit from the stricter Smart Snack standards once fully implemented in 2016. These results suggest that weakening the USDA school meal guidelines or Smart Snack guidelines based on school revenues or participation rates is not warranted.

      Acknowledgments

      The authors are grateful to MaryJo Culter, Thomas Land, Kathleen Millett, Christina Nordstrom, Julianna Valcour, and Laura York for their assistance throughout the study. Funding for the Nutrition Opportunities to Understand Reforms Involving Student Health study was provided by Harvard Catalyst and The Robert Wood Johnson Foundation. Juliana Cohen was supported by the Nutritional Epidemiology of Cancer Education and Career Development Program (grant no. R25 CA 098566). Mary Gorski is supported by the Agency for Healthcare Research and Quality (grant no. T32HS000055).
      No financial disclosures were reported by the authors of this paper.

      Appendix A. Supplementary material

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