1. Changes in Diet Quality of American School-Aged Children Before and After the Healthy Hunger-Free Kids Act
Ryan Smith
February 27th, 2018

2. What is the Healthy Hunger-Free Kids Act?

3. Controversy
Reports of food waste and decreased participation in the school lunch program
Inconclusive results from studies as to whether children are reaping the benefits of the new lunches

4. My Research Questions
Do children who participate in the school lunch program have higher diet qualities under the new NSLP standards?
Are the changes in diet quality different based on how frequently a child consumes school lunches?

5. Methods NHANES 2009-10 (pre-) and 2013-2014 (post-)
Unadjusted and adjusted multivariate linear regression models
Outcomes of interest: HEI-2015 score and HHFKA sub- score (continuous)
Predictor variables: Frequency of NSLP participation and survey year (categorical)
Cross products to test for interaction
Covariates considered: age, gender, household income, race/ethnicity, and highest level of education attained by head of household (all categorical)
Methods

6. Findings
Table 2. Change in HEI-2015 scores between and within NSLP participation levels
Model
Unadjusted
Adjusted
Change in HEI-2015 total score
95% CI
NSLP participation
Non-participant (0/week)
-0.045
(-4.240, 4.150)
0.231
(-4.149, 4.612)
Occasional (1-3/week)
-2.074
(-5.341, 1.193)
-2.272
(-5.861, 1.316)
Frequent (4-5/week)
2.162
(0.242, 4.083) *
2.026
(0.278, 3.774) *
Change in HHFKA sub-score
Total population
1.024
(0.250, 1.799)*
1.030
(0.391, 1.670)*
* p-value < 0.05

7. Discussion
Association found in this study provides preliminary evidence that the new NSLP meals are more nutritious than their predecessors.
Children appear to be eating more fruits, vegetables, and whole grains!

8. Limitations & Future Exploration
Single 24-hr dietary recall
Secular trends
Level of detail in NHANES data
Future research needed to continue monitoring trends

9. Questions/Comments Special thanks to: Dr. Barbara Laraia
Dr. Kris Madsen
Dr. Maureen Lahiff
Lilly Nhan
Erika Brown
NPI
PHN cohort
Image Sources:
Slide 1:
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Official White House Photo by Chuck Kennedy
Official White House Photo by Lawrence Jackson
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Slide 8: Paul Rogers.
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