The school environment plays an important role in children’s diets and overall health, and policies for universal free school meals have the potential to contribute to positive child health outcomes. This systematic review evaluates studies examining the association between universal free school meals and students’ school meal participation rates, diets, attendance, academic performance, and Body Mass Index (BMI), as well as school finances. The search was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA). A search for studies published in economically developed countries published through December 2020 was performed in PubMed, Education Resources Information Center (ERIC), Thomson Reuters’ Web of Science, and Academic Search Ultimate, followed by examining the references in the resultant literature. A total of 47 studies were identified and the Newcastle-Ottawa Scale (NOS) was applied to assess bias. Nearly all studies examining universal free school meals found positive associations with school meal participation. Most studies examining universal free school meals that included free lunch found positive associations with diet quality, food security, and academic performance; however, the findings of studies examining only universal free breakfast were mixed. Research findings were similarly mixed when examining attendance as an outcome. Concerns about adverse outcomes on student BMI were not supported by the literature; in fact, several studies detected a potentially protective effect of universal free school meals on BMI. Research examining the impact of universal free meals on school finances was limited, but suggest that lower-income school districts in the U.S. may have positive financial outcomes from participation in universal free school meal provisions. Additionally, providing free meals to students may be associated with improved household incomes, particularly among lower-income families with children. Further research is needed to examine the financial implications of universal free meals for both school districts and families. Overall, universal free school meals may have multiple benefits for students and countries should consider universal free school meal provisions with strong nutrition guidelines. (PROSPERO registration: CRD42020221782).

School meals can play an integral role in improving children’s diets and addressing health disparities. Initiatives and policies to increase consumption have the potential to ensure students benefit from the healthy school foods available. This systematic review evaluates studies examining initiatives, interventions, and policies to increase school meal consumption. Following PRISMA guidelines, this review was conducted using four databases and resulted in a total of 96 studies. The research evidence supports the following strategies to increase school meal consumption: (1) offering students more menu choices; (2) adapting recipes to improve the palatability and/or cultural appropriateness of foods; (3) providing pre-sliced fruits; (4) rewarding students who try fruits and vegetables; (5) enabling students to have sufficient time to eat with longer (~30 min) lunch periods; (6) having recess before lunch; and (7) limiting students’ access to competitive foods during the school day. Research findings were mixed when examining the impact of nutrition education and/or offering taste tests to students, although multiple benefits for nutrition education outside the cafeteria were documented. There is some evidence that choice architecture (i.e., “Smarter Lunchroom”) techniques increase the proportion of students who select targeted meal components; however, there is not evidence that these techniques alone increase consumption. There were limited studies of the impact of increasing portion sizes; serving vegetables before other meal components; and strengthening local district and/or school wellness policies, suggesting that further research is necessary. Additionally, longer-term studies are needed to understand the impact of policies that limit students’ access to flavored milk. Several studies found increases in students’ meal consumption following the Healthy Hunger-Free Kids Act (HHFKA) and concerns regarding an increase in food waste following the HHFKA were not supported. Overall, there are a range of effective strategies to increase school meal consumption that can be implemented by schools, districts, and policymakers at the local, state, and federal levels (PROSPERO registration: CRD42021244688).

The integration of physical activity into elementary school classrooms, through brief activity breaks (ABs) and lessons that incorporate movement into instruction as active lessons (ALs), are key parts of school physical activity programming and can improve children’s health and academic outcomes. With nationally representative survey data from 640 public elementary schools in the United States, we examined the use of these practices and the extent of implementation within classrooms. ALs were used in 71.7% of schools, and ABs were used in 75.6% of schools. In multivariate models, ALs were significantly less likely to be used in majority-Latino schools (adjusted odds ratio = 0.48, 95% confidence interval [0.25, 0.93], p < .05) than in predominantly White schools. ABs were significantly less likely to be used in lower socioeconomic schools (adjusted odds ratio = 0.57, 95% confidence interval [0.34, 0.95], p < .05) than in higher socioeconomic schools. At schools where ABs were ever used, they were used by 45.6% of teachers, but fewer teachers used them at larger schools (β = −.08, p < .01) and at lower socioeconomic schools (β = −.09, p < .05). The reach of ALs and ABs is modest and classroom-level implementation is quite low. Additional dissemination and support is warranted to improve the reach and implementation of these strategies in elementary schools. Such efforts could improve the school-day experience in ways that benefit millions of young children.

School meals play a major role in supporting children’s diets and food security, and policies for universal school meals (USM) have the potential to contribute to positive child health outcomes. During the COVID-19 pandemic, schools provided free school meals to all students in the United States, but this national USM policy ended in school year (SY) 2022–2023; however, a few states have adopted policies to continue USM statewide for SY 2022–2023. Research examining the challenges and strategies for successful continuation of USM is essential, along with studying pandemic-related challenges that are likely to persist in schools. Therefore, we conducted a study in Maine (with a USM policy) to evaluate the impact of COVID-19 and the concurrent implementation of USM, as well as examine differences in implementation by school characteristics, throughout the state. A total of n = 43 school food authorities (SFAs) throughout Maine completed surveys. SFAs reported multiple benefits of USM including increased school meal participation; reductions in the perceived stigma for students from lower-income households and their families; and no longer experiencing unpaid meal charges and debt. SFAs also experienced challenges due to the COVID-19 pandemic, particularly regarding costs. When considering future challenges, most respondents were concerned with obtaining income information from families, product and ingredient availability, and the costs/financial sustainability of the school meal programs. Overall, USM may have multiple important benefits for students and schools, and other states should consider implementation of a USM policy.

United States Department of Agriculture (USDA) school meal programs are an important part of the safety net for reducing food insecurity, yet not all students who qualify for free or reduced-price meals participate. In 2014–2015, the Community Eligibility Provision became available nationwide. This provision, along with Provisions 1, 2, and 3 of the USDA school meals programs, allows local school food authorities to offer universal free meals at schools with high student poverty. It is expected that adoption of a provision allowing universal free meals will increase rates of student participation in meal programs at schools where many students are at risk for food insecurity. This study examines school-level adoption of any provision for universal free meals and subsequent changes in student participation rates for the School Breakfast Program and National School Lunch Program in California from 2013–2014 to 2016–2017. A database was assembled for 10,343 public schools, including meals served, demographics, eligibility for provisions, and use of provisions in each year. Multilevel regression models were used to examine school adoption and student participation rates over time. Difference-in-difference calculations from lagged longitudinal models adjusting for school demographics showed that when eligible schools adopted provisions, participation rates increased an average of 3.48 percentage points for breakfast and 5.79 points for lunch the following year. By 2016–2017, over half of all eligible schools were using a provision for universal free meals. Among eligible schools, provision adoption was more common at schools that were larger, had predominantly Latino students, and were in rural areas. When eligible schools adopt provisions for universal free meals, student participation rates significantly increase, improving program reach among children most at risk for food insecurity. However, not all eligible schools adopt a provision for universal free meals and some adopters drop out in subsequent years. Research to better understand factors influencing the decision whether to adopt a provision or to continue it could inform policy and program leaders. Increases in breakfast participation are smaller than those for lunch, suggesting that other barriers to breakfast participation warrant further investigation.