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  • Are free school meals failing families? Exploring the relationship between child food insecurity, child mental health and free school meal status during COVID-19: national cross-sectional surveys

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Epidemiology
Original research
Are free school meals failing families? Exploring the relationship between child food insecurity, child mental health and free school meal status during COVID-19: national cross-sectional surveys
  1. Tiffany C Yang1,
  2. Madeleine Power2,
  3. Rachael H Moss1,
  4. Bridget Lockyer1,
  5. Wendy Burton2,
  6. Bob Doherty3,
  7. Maria Bryant2,4
  1. 1Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
  2. 2Health Sciences, University of York, York, North Yorkshire, UK
  3. 3The York Management School, University of York, York, UK
  4. 4York Hull Medical School, University of York, York, UK
  1. Correspondence to Dr Tiffany C Yang; tiffany.yang{at}bthft.nhs.uk

Abstract

Objective Food insecurity is linked to poor health and well-being in children and rising prevalence rates have been exacerbated by COVID-19. Free school meals (FSM) are considered a critical tool for reducing the adverse effects of poverty but apply a highly restrictive eligibility criteria. This study examined levels of food security and FSM status to support decision-making regarding increasing the current eligibility criteria.

Design Two cross-sectional national surveys administered in August–September 2020 and January–February 2021 were used to examine the impact of COVID-19 on the food experiences of children and young people.

Setting UK.

Participants 2166 children (aged 7–17 years) and parents/guardians.

Main outcome measures Participant characteristics were described by food security and FSM status; estimated marginal means were calculated to obtain the probability of poor mental health, expressed as children reporting feeling stressed or worried in the past month, by food security status and FSM status.

Results We observed food insecurity among both children who did and did not receive of FSM: 23% of children not receiving FSM were food insecure. Children who were food insecure had a higher probability of poor mental health (31%, 95% CI: 23%, 40%) than children who were food secure (10%, 95% CI: 7%, 14%). Food insecure children receiving FSM had a higher probability of poor mental health (51%, 95% CI: 37%, 65%) than those who were food insecure and not receiving FSM (29%, 95% CI: 19%, 42%).

Conclusion Many children experienced food insecurity regardless of whether they received FSM, suggesting the eligibility criteria needs to be widened to prevent overlooking those in need.

  • MENTAL HEALTH
  • COVID-19
  • PUBLIC HEALTH
  • Food insecurity

Data availability statement

Data may be obtained from a third party and are not publicly available. The datasets analysed during the current study are not freely available. Applications to access the data can be made to The Food Foundation.

https://creativecommons.org/licenses/by/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

https://doi.org/10.1136/bmjopen-2021-059047

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    Data availability statement

    Data may be obtained from a third party and are not publicly available. The datasets analysed during the current study are not freely available. Applications to access the data can be made to The Food Foundation.

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    Footnotes

    • Contributors TCY, MP, RHM, BL, WB, BD, and MB designed and planned the study. MB acquired the data. TCY performed the statistical analysis and was responsible for the initial draft of the manuscript. All authors were involved in interpreting the study results, revising the manuscript and approving the final version for submission. MB is the guarantor. The corresponding author attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted.

    • Funding This work is supported in part by the FixOurFood programme (BB/V004581/1) funded by the UK Research and Innovation Transforming Food Systems Programme; ActEarly UK Prevention Research Partnership Consortium (MR/S037527/1); The National Institute for Health Research under its Applied Research Collaboration Yorkshire and Humber (NIHR200166); and The Health Foundation COVID-19 Award (2301201).

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.