Document Type
Article
Publication Title
Journal of School Health
Publication Date
12-4-2025
Abstract/ Summary
Background
Universal school meals (USMs) policies, which provide free meals to all students regardless of income, have the potential to improve child nutrition and reduce stigma. Quantitative evidence on the association between USM and stigma is limited.
Methods
Leveraging a natural policy variation in state‐level USM implementation, we surveyed 1066 middle and high school students from eight US states (four with USM, four without) during the 2022–2023 school year. Stigma was measured as self‐reported embarrassment about eating school lunch. We used generalized estimating equations to examine the associations between USM, embarrassment, and lunch participation.
Results
Overall about one in nine students (11.5%) across all surveyed states reported embarrassment, which was associated with 11% less frequent (aRR = 0.89, 95% CI: 0.83–0.97). School lunch participation overall, especially among those from low‐income families. While USM was associated with lower odds of embarrassment among students from low‐income families, higher‐income students in USM states were more likely to feel embarrassed.
Implications
Addressing stigma requires pairing USM with strategies to enhance meal quality, cultural relevance, and inclusive messaging.
Conclusions
USM can alleviate stigma for lower‐income students yet may increase embarrassment among higher‐income peers, highlighting the need for comprehensive approaches benefiting all socioeconomic groups.
Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-No Derivative Works 4.0 International License.