Impact of the 2010 US Healthy, Hunger-Free Kids Act on School Breakfast and Lunch Participation Rates Between 2008 and 2015 Nicole Vaudrin, MS, RD, Kristen Lloyd, MPH, Michael J. Yedidia, PhD, MPH, Michael Todd, PhD, and Punam Ohri-Vachaspati, PhD, RD Objectives. To evaluate National School Lunch Program (NSLP) and School Breakfast Program (SBP) participation over a 7-year period before and after the implementation of the 2010 Healthy, Hunger-Free Kids Act (HHFKA), which required healthier school lunch options beginning in school year (SY) 2012–2013 and healthier school breakfast options beginning in SY2013–2014. Methods. Data were gathered from low-income, high-minority public schools in 4 New Jersey cities. We conducted longitudinal analyses of annual average daily participation (ADP) in school meals among enrolled students overall and among those eligible for free or reduced-price meals. We used linear mixed models to compare NSLP and SBP par- ticipation rates from SY2008–2009 to SY2014–2015. Results. NSLP participation rates among students overall differed little across years (from 70% to 72%). SBP rates among enrolled students were stable from the beginning of the study period to SY2013–2014 and then increased from 52% to 59%. Among students eligible for free or reduced-price meals, the ADP was lowest in SY2012–2013 (when the HHFKA was implemented) before rebounding. Conclusions. The HHFKA did not have a negative impact on school meal participation over time. Public Health Implications. The HHFKA-strengthened nutrition standards have not affected school meal participation rates. With time, students are likely to accept healthier options. (Am J Public Health. 2018;108:84–86. doi:10.2105/ AJPH.2017.304102) The 2010 Healthy, Hunger-Free Kids Act(Public Law 111-296; HHFKA) aligned National School Lunch Program (NSLP) and School Breakfast Program (SBP) re- quirements with the Dietary Guidelines for Americans. New NSLP meal patterns, im- plemented in school year (SY) 2012–2013, included more fruits, vegetables, and whole grains and a gradual reduction in sodium content. Similar SBP standards were imple- mented during the following year (SY2013– 2014).1 Additional requirements came into effect in SY2014–2015, as well as smart snacks standards for food and beverages sold outside of school meal programs.2 Further changes in the requirements are ongoing.1 The acceptability of new meal offerings has been evaluated in short-term longitudinal and cross-sectional analyses.2–6 According to qualitative results, school administrators and food service workers perceive that, although students initially complained, consumption patterns have not changed significantly.3 In only 2 studies were participation data used to examine the HHFKA’s impact on school lunch par- ticipation, and neither of these inves- tigations assessed effects on the SBP,4,5 a program that has been historically underused.7 In a study conducted in middle and hig ...

1. Impact of the 2010 US Healthy, Hunger-Free Kids
Act on School Breakfast and Lunch Participation
Rates Between 2008 and 2015
Nicole Vaudrin, MS, RD, Kristen Lloyd, MPH, Michael J.
Yedidia, PhD, MPH, Michael Todd, PhD, and Punam Ohri-
Vachaspati, PhD, RD
Objectives. To evaluate National School Lunch Program (NSLP)
and School Breakfast
Program (SBP) participation over a 7-year period before and
after the implementation of
the 2010 Healthy, Hunger-Free Kids Act (HHFKA), which
required healthier school lunch
options beginning in school year (SY) 2012–2013 and healthier
school breakfast options
beginning in SY2013–2014.
Methods. Data were gathered from low-income, high-minority
public schools in 4 New
Jersey cities. We conducted longitudinal analyses of annual
average daily participation
(ADP) in school meals among enrolled students overall and
among those eligible for free
or reduced-price meals. We used linear mixed models to

2. compare NSLP and SBP par-
ticipation rates from SY2008–2009 to SY2014–2015.
Results. NSLP participation rates among students overall
differed little across years
(from 70% to 72%). SBP rates among enrolled students were
stable from the beginning
of the study period to SY2013–2014 and then increased from
52% to 59%. Among
students eligible for free or reduced-price meals, the ADP was
lowest in SY2012–2013
(when the HHFKA was implemented) before rebounding.
Conclusions. The HHFKA did not have a negative impact on
school meal participation
over time.
Public Health Implications. The HHFKA-strengthened nutrition
standards have
not affected school meal participation rates. With time, students
are likely to
accept healthier options. (Am J Public Health. 2018;108:84–86.
doi:10.2105/
AJPH.2017.304102)
The 2010 Healthy, Hunger-Free Kids Act(Public Law 111-296;
HHFKA) aligned

3. National School Lunch Program (NSLP)
and School Breakfast Program (SBP) re-
quirements with the Dietary Guidelines for
Americans. New NSLP meal patterns, im-
plemented in school year (SY) 2012–2013,
included more fruits, vegetables, and whole
grains and a gradual reduction in sodium
content. Similar SBP standards were imple-
mented during the following year (SY2013–
2014).1 Additional requirements came into
effect in SY2014–2015, as well as smart snacks
standards for food and beverages sold outside
of school meal programs.2 Further changes in
the requirements are ongoing.1
The acceptability of new meal offerings
has been evaluated in short-term longitudinal
and cross-sectional analyses.2–6 According
to qualitative results, school administrators
and food service workers perceive that,
although students initially complained,
consumption patterns have not changed
significantly.3 In only 2 studies were
participation data used to examine the
HHFKA’s impact on school lunch par-
ticipation, and neither of these inves-
tigations assessed effects on the SBP,4,5
a program that has been historically
underused.7
In a study conducted in middle and
high schools in 11 Massachusetts school dis-
tricts, Cohen et al. found no significant
differences in NSLP participation rates 1 year

4. before and 1 and 2 years after the imple-
mentation of the HHFKA among students
overall and among those receiving free
meals.4 Using a small sample (n = 6) of
Washington State schools from a single
district, Johnson et al. evaluated NSLP
participation via meal production records
16 months before and 15 months after
implementation of the HHFKA and saw
a 1% decrease in participation among mid-
dle and high school students.5 The relatively
narrow time frames of these studies may
be inadequate to capture changes in re-
sponse to the new regulations.6 It is likely
that schools began making changes when
the HHFKA passed (2010) or when the
US Department of Agriculture’s pro-
posed ruling was issued (2011), before
the actual implementation of the
standards.8
In this study, we used school meal par-
ticipation data over a 7-year period from
SY2008–2009 to SY2014–2015 (4 years
before and 3 years after HHFKA imple-
mentation) to analyze NSLP and SBP par-
ticipation rates in low-income, high-minority
kindergarten through grade 12 schools. Our
aim was to assess the impact of the legislation
on changes in these rates.
ABOUT THE AUTHORS
Nicole Vaudrin and Punam Ohri-Vachaspati are with the School
of Nutrition and Health Promotion, Arizona State University,
Phoenix. Kristen Lloyd and Michael J. Yedidia are with the
Rutgers Center for State Health Policy, New Brunswick, NJ.

5. Michael Todd is with the College of Nursing and Health
Innovation, Arizona State University.
Correspondence should be sent to Punam Ohri-Vachaspati, PhD,
RD, School of Nutrition and Health Promotion, Arizona State
University, 500 N 3rd St, Phoenix, AZ 85001 (e-mail:
[email protected]). Reprints can be ordered at
http://www.ajph.org by
clicking the “Reprints” link.
This article was accepted August 16, 2017.
doi: 10.2105/AJPH.2017.304102
84 Research Peer Reviewed Vaudrin et al. AJPH January 2018,
Vol 108, No. 1
AJPH RESEARCH
mailto:[email protected]
http://www.ajph.org
METHODS
A longitudinal analysis of annual average
daily participation (ADP) in school meals was
conducted as part of the New Jersey Child
Health Study. Public schools located in 4
urban, low-income, high-minority New
Jersey cities (Camden, New Brunswick,
Newark, and Trenton) were evaluated. Each
of the cities has one public school district.
Data were gathered from the National Center
for Education Statistics and the New Jersey
Department of Agriculture. Schools were
excluded if they were missing either de-

6. mographic or school meal participation data
(exclusions made up less than 5% of the
original sample during each year). Numbers
of schools included varied across years as
a result of closings, openings, and reconfi-
gurations; 139 were included in SY2008–
2009, 137 in SY2009–2010, 134 in
SY2010–2011, 131 in SY2011–2012, 127 in
SY2012–2013 (one of these schools did not
report SBP participation rates), 127 in
SY2013–2014, and 119 in SY2014–2015.
We divided ADP counts according to
payment type (full price, reduced price, free,
and total), obtained from the New Jersey
Department of Agriculture, by total school
enrollments to calculate NSLP and SBP
participation rates. We calculated participa-
tion rates among students eligible for free
or reduced-price meals, students paying full
price, and all enrolled students.
Annual school demographic data obtained
from the National Center for Education Sta-
tistics included percentages of students of
different races, percentages eligible for free or
reduced-price meals, and school grade levels.
ADP rates were square transformed to reduce
skewness. We used linear mixed models in
SPSS version 23 (SPSS Inc, Chicago, IL) to
compare repeated observations of meal par-
ticipation rates clustered within schools (that
were in turn clustered within cities) and ex-
amine pairwise between-year differences in
school meal participation rates after adjustment

7. for school level (elementary, middle, or high).
Models were run for all payment categories.
We back transformed estimated mean partic-
ipation rates (calculated from models in-
corporating square-transformed ADP rates) by
taking the square roots of the estimates.
RESULTS
Most of the schools were elementary
schools (75%), and students were primarily
of minority (52% Black and 43% Hispanic)
and low-income (81% eligible for free or
reduced-price meals) backgrounds. Across the
study period, ADP rates for the NSLP and the
SBP were 71% and 54%, respectively.
Comparisons of each study year with
SY2008–2009 (the base year) showed that
there were no significant differences in
model-adjusted NSLP participation rates
among all enrolled students overall (Figure 1).
Although there were statistically significant
differences when the various study years were
compared with one another, mean partici-
pation rates differed only slightly, ranging
from 70% to 72%.
The lowest NSLP participation rate (69%)
among students eligible for free or reduced-
price meals was in SY2012–2013, the school
year the HHFKA lunch standards were
implemented; after model adjustment, this
rate was significantly (P < .001) lower than the
rates in both SY2011–2012 and SY2013–
2014. Participation rates in all of the other

8. 40
50
60
70
80
90
2008–2009 2009–2010 2010–2011 2011–2012 2012–2013 2013–
2014 2014–2015
A
n
n
u
al
A
ve
ra
g
e
D
ai
ly
Pa

9. rt
ic
ip
at
io
n
R
at
e,
%
School Year
...............................................................
............
Implementation of the HHFKA
NSLP
SBP
64%*
73%*
69%
71%
72%

10. 77%*
70%
82%*
71%
73%*
71%
60%*
59%*
47%
52%
55%*
52%
56%*
50%49%
52%
49%
52%
73%*
71%

11. 70%
59%*
71%
NSLP all students NSLP free & reduced SBP all students SBP
free & reduced
*P < .05 for differences between base year (2008–2009) and
subsequent years.
Note. HHFKA = Healthy, Hunger-Free Kids Act. Mean
participation rates presented are adjusted for clustering within
schools and schools clustered within cities. Models
included school level (elementary, middle, and high) as a fixed
effect.
FIGURE 1—Annual Average Adjusted National School Lunch
Program (NSLP) and School Breakfast Program (SBP) Daily
Participation Rates: 4
New Jersey Cities, School Years 2008–2009 to 2014–2015
AJPH RESEARCH
January 2018, Vol 108, No. 1 AJPH Vaudrin et al. Peer
Reviewed Research 85
study years (73% in SY2009–2010, 82% in
SY2010–2011, 77% in SY2011–2012, and
73% in both SY2013–2014 and SY2014–
2015) were significantly higher (P < .05) than
the rate in SY2008–2009 (71%) according to
linear mixed-model comparisons.

12. Model-adjusted SBP participation rates
among students overall were not significantly
different (P < .05) from those of the base year
(52%) until SY2013–2014. Rates climbed to
59% in SY2013–2014 and 60% in SY2014–
2015 (P < .01; Figure 1). Differences were
most pronounced among students eligible
for free or reduced-price meals, who exhibited
an increase in participation from 49% in
SY2008–2009 to 59% in SY2013–2014 and
64% in SY2014–2015. Similar to the NSLP,
there was a dip in SBP participation during
SY2012–2013 (47%), when the rate was
significantly (P < .001) lower than in either
SY2011–2012 or SY2013–2014.
DISCUSSION
In this study, we evaluated changes in
school meal participation in low-income,
primarily minority urban schools in New
Jersey over 7 years spanning the period before
and after the alterations in school meal
standards implemented under the HHFKA.
There were no meaningful changes in NSLP
participation rates among students overall.
Among students eligible for free or reduced-
price meals, NSLP participation rates
were high during the recession (2008–2012)
and then dropped to their lowest levels
when the HHFKA was first implemented in
SY2012–2013 before rebounding in sub-
sequent years. National data also show in-
creased NSLP participation among students
eligible for free or reduced-price meals during
the recession.9

13. As noted, 2 studies examining school meal
participation, one focusing on participation
rates4 and the other on production records as
a proxy for meal participation,5 did not reveal
any significant differences among students
overall4,5 or among students receiving free
meals.4 The SY2012–2013 drop in our data
may suggest an initial lack of acceptance of the
new meal standards, particularly among stu-
dents eligible for free or reduced-price meals.
However, with continued student exposure
to healthy meals, the rates rebounded in
SY2013–2014 and continued to increase in
SY2014–2015. Also, as shown in previous
research, the implementation of smart snacks
standards in SY2014–2015 may have affected
NSLP participation rates.10
The higher NSLP participation rates ob-
served in our study relative to the Cohen
et al.4 and Johnson et al.5 studies may be
attributable to the higher percentage of stu-
dents eligible for free or reduced-price meals
(81%) than in those 2 investigations (32% and
52%, respectively). Nationally, meal partici-
pation rates are higher among students eligible
for free or reduced-price meals than among
noneligible students.11
SBP participation rates among students
overall remained relatively unchanged until
SY2013–2014, when they increased by 7
percentage points. Nationally, SBP partici-
pation among students eligible for free or

14. reduced-price meals increased after the
HHFKA’s school breakfast provisions
were implemented, and the increase in
New Jersey schools was among the highest.7
A key feature of the HHFKA, the com-
munity eligibility provision, allows schools
with high poverty rates to offer free meals to
all students.12 None of the schools in our
sample participated in universal free meals
before SY2014–2015, when 27 schools
reported providing only free meals to all
students. Participation in the community
eligibility provision and alternative breakfast
promotion projects (e.g., breakfast after the
bell programs), which have been used in all 4
of the study cities since at least SY2013–2014,
may have contributed to the increase in SBP
participation rates.
Overall, our results are consistent with
those of previous studies indicating that,
contrary to controversial media reports on
reactions to the new standards, the effects
of the HHFKA on school meal acceptance
and participation are minimal. With time,
students are likely to accept healthier
options.
CONTRIBUTORS
N. Vaudrin conducted the analysis and wrote the first
draft. K. Lloyd contributed to the analysis and to the
development of the article. M. J. Yedidia conceptualized
the study and contributed to the interpretation of the
findings and the development of the article. M. Todd
contributed to the data analysis and to the development of

15. the article. P. Ohri-Vachaspati conceptualized the study,
procured the data, and contributed to the analysis and the
development of the article.
ACKNOWLEDGMENTS
Funding for this project was provided by a grant from
the Robert Wood Johnson Foundation and the Eunice
Kennedy Shriver National Institute of Child Health
and Human Development (1R01HD071583-01A1).
HUMAN PARTICIPANT PROTECTION
This study was approved bythe institutional review boards
of Arizona State University and Rutgers University.
REFERENCES
1. US Department of Agriculture, Food and Nutrition
Service. Healthy, Hunger-Free Kids Act. Available at:
http://www.fns.usda.gov/cnd/Governance/Legislation/
CNR_2010.htm. Accessed September 4, 2017.
2. US Department of Agriculture. Tools for schools:
focusing on smart snacks. Available at: https://www.fns.
usda.gov/healthierschoolday/tools-schools-focusing-
smart-snacks. Accessed September 4, 2017.
3. Turner L, Chaloupka FJ. Perceived reactions of ele-
mentary school students to changes in school lunches after
implementation of the United States Department of
Agriculture’s New Meals Standards: minimal backlash,
but rural and socioeconomic disparities exist. Child Obes.
2014;10(4):349–356.
4. Cohen JF, Gorski MT, Hoffman JA, et al. Healthier
standards for school meals and snacks: impact on school
food revenues and lunch participation rates. Am J Prev
Med. 2016;51(4):485–492.

16. 5. Johnson DB, Podrabsky M, Rocha A, Otten JJ. Effect
of the Healthy Hunger-Free Kids Act on the nutritional
quality of meals selected by students and school lunch
participation rates. JAMA Pediatr. 2016;170(1):e153918.
6. Concanno K. Nutrition standards in the National
School Lunch and School Breakfast Programs: proposed
rule. Available at: http://www.gpo.gov/fdsys/pkg/FR-
2011-01-13/pdf/2011-485.pdf. Accessed September 4,
2017.
7. Food Research and Action Center. School breakfast
scorecard: 2013–2014 school year. Available at: http://
frac.org/wp-content/uploads/School_Breakfast_
Scorecard_SY_2013_2014.pdf. Accessed September 4,
2017.
8. Ohri-Vachaspati P, Turner L,Adams MA, Bruening M,
Chaloupka FJ. School resources and engagement in
technical assistance programs is associated with higher
prevalence of salad bars in elementary school lunches in
the United States. J Acad Nutr Diet. 2016;116(3):417–426.
9. Food Research and Action Center. National School
Lunch Program: trends and factors affecting student
participation. Available at: http://frac.org/wp-content/
uploads/national_school_lunch_report_2015.pdf.
Accessed September 4, 2017.
10. Long MW, Luedicke J, Dorsey M, Fiore SS,
Henderson KE. Impact of Connecticut legislation in-
centivizing elimination of unhealthy competitive foods
on National School Lunch Program participation. Am J
Public Health. 2013;103(7):e59–e66.

17. 11. Fox MK, Condon E. School Nutrition Dietary As-
sessment Study IV: summary of findings. Available at:
https://www.fns.usda.gov/sites/default/files/SNDA-
IV_Findings_0.pdf. Accessed September 4, 2017.
12. Logan CW, Connor P, Harvill EL, et al. Community
eligibility provision evaluation. Available at: https://
www.fns.usda.gov/sites/default/files/CEPEvaluation.
pdf. Accessed September 4, 2017.
AJPH RESEARCH
86 Research Peer Reviewed Vaudrin et al. AJPH January 2018,
Vol 108, No. 1
http://www.fns.usda.gov/cnd/Governance/Legislation/CNR_201
0.htm
http://www.fns.usda.gov/cnd/Governance/Legislation/CNR_201
0.htm
https://www.fns.usda.gov/healthierschoolday/tools-schools-
focusing-smart-snacks
https://www.fns.usda.gov/healthierschoolday/tools-schools-
focusing-smart-snacks
https://www.fns.usda.gov/healthierschoolday/tools-schools-
focusing-smart-snacks
http://www.gpo.gov/fdsys/pkg/FR-2011-01-13/pdf/2011-485.pdf
http://www.gpo.gov/fdsys/pkg/FR-2011-01-13/pdf/2011-485.pdf
http://frac.org/wp-
content/uploads/School_Breakfast_Scorecard_SY_2013_2014.p
df
http://frac.org/wp-
content/uploads/School_Breakfast_Scorecard_SY_2013_2014.p
df
http://frac.org/wp-
content/uploads/School_Breakfast_Scorecard_SY_2013_2014.p
df

18. http://frac.org/wp-
content/uploads/national_school_lunch_report_2015.pdf
http://frac.org/wp-
content/uploads/national_school_lunch_report_2015.pdf
https://www.fns.usda.gov/sites/default/files/SNDA-
IV_Findings_0.pdf
https://www.fns.usda.gov/sites/default/files/SNDA-
IV_Findings_0.pdf
https://www.fns.usda.gov/sites/default/files/CEPEvaluation.pdf
https://www.fns.usda.gov/sites/default/files/CEPEvaluation.pdf
https://www.fns.usda.gov/sites/default/files/CEPEvaluation.pdf
Copyright of American Journal of Public Health is the property
of American Public Health
Association and its content may not be copied or emailed to
multiple sites or posted to a
listserv without the copyright holder's express written
permission. However, users may print,
download, or email articles for individual use.