A Randomized Controlled Trial of Three School Meals and Weekend Food Backpacks on Food Security in Virginia

Abstract Background Food insecurity is a concern for the health and well-being of low-income children in the United States. School-based nutrition assistance programs aim to reduce food insecurity; however, there is limited evidence of their combined impact on food insecurity among children (FI-C). Objective This study tested the impact of the Virginia 365 demonstration project on the food security status of children attending low-income schools. Design A cluster-randomized trial was conducted from 2016 to 2017 with baseline and follow-up surveys. Participants/setting Households with children who attended a treatment (n = 19) or control (n = 19) school in rural and urban Virginia were included. Intervention Treatment schools became food hubs where children had access to free breakfast, lunch, and supper on school days, and a food backpack on weekends and school breaks. Control schools implemented a similar, but less robust set of benefits. Main outcome measures The primary outcome was the percentage of children classified as FI-C as measured by the US Department of Agriculture Household Food Security Survey Module. Secondary outcomes included very low food security among children and food security among households and adults. Statistical analysis performed Logistic regression models tested the impact of the demonstration on FI-C and secondary outcomes adjusting for baseline household and individual characteristics. Results At follow-up, 1,393 treatment households and 1,243 control households completed a survey sufficiently to be included in the analysis. The rate of FI-C in treatment households was higher at 25.9% compared with 23.9% in control households, a difference of 2 percentage points (95% CI 0.1 to 3.9). The rate of very low food security among children in treatment households was lower at 3.2% compared with 3.9% in control households, a difference of −0.7 percentage points (95% CI −1.3 to −0.10). Conclusions Although the distinction in nutrition assistance benefits between treatment and control schools was less than planned, providing a suite of school-based nutrition assistance programs targeted broadly to low-income households with children has both positive and negative impacts on child and household food insecurity.