Did the Healthy Hunger-Free Kids Act Help Improve Dietary Quality among School-Age Children?
Summary
Using de-identified data from the National Health and Nutrition Examination Survey, this study will assess the causal impacts of the HHFKA school meal nutrition standards on dietary quality of students participating in school meal programs with three specific aims: Aim 1: Estimate the average total/direct/spillover effects of HHFKA on the diet quality of children, overall and by school level (e.g., elementary vs middle/high school), while accounting for endogenous program participation using a simultaneous equation model. Hypotheses: Children consume 30-50% of their daily calories in school; thus, we hypothesize that the improvement in school meal quality will have a direct positive impact on children's dietary quality from school foods. However, nutritional standard changes could also indirectly affect eating habits of students away from school. Therefore, we also examine HHFKA's total and potential (positive/negative) spillover effects. Further, there is evidence that middle and high schools offer a broader range of foods in terms of healthfulness (than elementary schools which have a more healthful school food environment6), allowing students to have more autonomy in selecting foods. Additionally, since eating behaviors and food preferences develop during the early years of life, younger children are more likely to be receptive to changes to their diets. Thus, we hypothesize HHFKA to have larger positive impacts, if any, on younger children and accordingly, test for heterogeneities by school level.Aim 2: Estimate the average effects of HHFKA on sub-categories of diet quality in a multiple programs-multiple outcomes framework. Hypothesis: The updated nutrition standards required several changes to the components of food groups as well as nutrients in school meals. Thus, we examine the impacts on sub-categories of overall diet quality. Aim 3: Estimate the (total/direct/spillover) effects of HHFKA on the distribution of children's overall diet quality via a reduced-from analysis. That is, we consider the heterogeneous effects of HHFKA as we move across the distribution from low-quality diets toward high-quality diets. Hypothesis: We hypothesize HHFKA to have larger positive effects on children prone to lower-quality diets than those prone to higher-quality diets.