Document Type
Article
Publication Title
Current Developments in Nutrition
Publication Date
5-2025
Abstract/ Summary
Objectives: School meals are the healthiest food source for US children, yet stigma around free or reduced-price meals often hinders participation. School Meals for All (SMFA), also known as universal school meals, may improve children’s nutritional status and school social dynamics, but whether these policies effectively alleviate stigma remains unclear. This study examines whether embarrassment about school lunch predicts participation and how SMFA policies relate to stigma across household income levels. Methods: A cross-sectional, natural experiment was conducted in eight states (four with SMFA, four without) during the 2022–2023 school year. Surveys from 1,066 middle and high school students assessed frequency of school meal participation and embarrassment about school lunch. Generalized estimating equations accounted for state-level clustering, examining associations between embarrassment and participation, and testing SMFA’s influence on stigma. Results: Embarrassment was linked to lower meal participation, particularly among those eligible for free or reduced-price meals (FRPM). Embarrassed FRPM-eligible students participated 20% less often (Rate Ratio = 0.80, 95% CI: 0.71–0.93). SMFA policies were associated with a 27% reduction in embarrassment in FRPM-eligible students (Adjusted Odds Ratio = 0.73, 95% CI: 0.59–0.89), whereas higher-income students in SMFA states were more likely to report embarrassment (aOR = 2.22, 95% CI: 1.85). Overall, 11.5% of students reported embarrassment about eating school lunch. Conclusions: Stigma, measured as embarrassment, is a significant barrier to school meal participation for low-income students. While SMFA policies may reduce embarrassment among these students, they could inadvertently increase stigma among higher-income peers. Addressing perceptions of school meals is crucial for maximizing the potential of universal school meal programs to promote equitable nutrition and health outcomes. Funding Sources: This study was funded by California General Fund SB 170.
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