The Impact of School Meal Delivery on Behavioral Disorders among Children in Health Disparity Populations

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PROJECT SUMMARY Policies to facilitate participation in school nutrition programs could reduce diagnosis rate disparities in behavioral disorders, namely attention-deficit hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), and conduct disorder (CD). Food insecurity predisposes children to these conditions and aggravates their symptoms. It impairs child development, contributes to inattention, and is associated with externalizing behaviors. Preliminary data show that two school meal delivery options could make a difference. One is the Community Eligibility Provision (CEP), which enables schools to provide free meals to all enrolled children, regardless of household socio-economic status. The other is making school breakfast available after classes begin (breakfast after the bell). There is growing evidence that these meal-delivery options reduce disciplinary incidents at school, but no studies have incorporated information on diagnosis or utilization of services for behavioral disorders. Our central hypothesis is that better access to school meals reduces the burden of behavioral disorders among children in underserved communities who face an elevated prevalence of food insecurity. There is evidence that exclusionary discipline (i.e., suspension or expulsion) contributes to an escalation of behavioral issues, which may predispose the child to an ODD or CD diagnoses and/or interactions with the juvenile justice system. Universal free meals and breakfast after the bell increase participation in school meals and are feasible meal delivery options for many schools but remain underutilized. Using a novel longitudinal all-payer claims database linked to educational achievement and disciplinary outcomes, three specific aims are proposed: 1. Describe variation in medical diagnoses for ADHD, ODD, and CD across schools by race, ethnicity, gender, age, rurality, and neighborhood characteristics. 2. Quantify the effect of school meal delivery policies and medical diagnoses on disciplinary outcomes and academic achievement by race/ethnicity, rurality, and socioeconomic status. 3. Determine the effect of universal meals and breakfast after the bell, alone and in combination, on the likelihood of diagnosed childhood behavioral disorders and subsequent service utilization overall and by race, ethnicity, and rurality. The study will draw from the population of Arkansas public schoolchildren. Arkansas ranks second in the nation for the percentage of children diagnosed with ADHD, third in the percentage of children taking ADHD medications, and second in the incidence of childhood food insecurity. Understanding whether policies to make meals more accessible prevent the medical diagnosis of behavioral disorders that can escalate into disciplinary events at school will have significant implications for improving health-related quality of life, human capital development, and fewer encounters with the juvenile and adult criminal justice systems.