{"doi":"10.1001/jamanetworkopen.2025.33186","title":"School Provision of Universal Free Meals and Blood Pressure Outcomes Among Youths","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.","journal":"JAMA Network Open","year":2025,"id":524499,"datarank":0.24141568686511508,"base_score":1.6094379124341003,"endowment":1.6094379124341003,"self_citation_contribution":0.24141568686511508,"citation_network_contribution":0.0,"self_endowment_contribution":0.24141568686511508,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":4,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9535,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2025-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":473024,"name":"Paul L. Hebert","orcid":"0000-0002-5886-7964","position":1,"is_corresponding":false},{"id":890844,"name":"Melissa A. Knox","orcid":"0000-0001-7525-0854","position":2,"is_corresponding":false},{"id":582765,"name":"Wyatt P. Bensken","orcid":"0000-0002-2597-9732","position":3,"is_corresponding":false},{"id":1284609,"name":"Aileen Ochoa","orcid":null,"position":4,"is_corresponding":false},{"id":519403,"name":"Jennifer Sonney","orcid":"0000-0002-0766-2918","position":5,"is_corresponding":false},{"id":342579,"name":"Jones-Smith,","orcid":"0000-0001-8962-1695","position":6,"is_corresponding":false},{"id":1398002,"name":"Anna M. Localio","orcid":"0000-0002-4270-4052","position":0,"is_corresponding":true}],"reference_count":36,"raw_metadata":{"citation_network_status":"fetched"},"created_at":"2026-07-19T02:50:12.083054Z","pmid":"40996762","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}