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

项目总结 促进参与学校营养计划的政策可以减少 行为障碍，即注意缺陷多动障碍(ADHD)、对立违抗障碍 (ODD)和品行障碍(CD)。粮食不安全使儿童容易患上这些疾病，并使之恶化 他们的症状。它损害儿童的发展，导致注意力不集中，并与外化有关 行为。初步数据显示，两种学校送餐方式可能会有所不同。一个是 社区资格条款(CEP)，使学校能够向所有注册的儿童提供免费膳食， 无论家庭的社会经济地位如何。另一项是在课后提供学校早餐。 开始(钟声后的早餐)。越来越多的证据表明，这些送餐选择减少了纪律 学校发生的事故，但没有研究纳入关于诊断或利用服务的信息 行为障碍。我们的中心假设是，更好地获得学校膳食可以减少 面临食物流行率上升的服务不足社区儿童的行为障碍 不安全感。有证据表明，排他性纪律(即停职或开除)有助于 行为问题的升级，这可能使儿童倾向于进行奇怪的或CD诊断和/或 与少年司法系统的互动。普遍免费餐饮和铃声后的早餐增加 参与学校供餐是许多学校可行的送餐选择，但仍未得到充分利用。 使用一个新的与教育成就和纪律相联系的纵向所有付款人索赔数据库 根据成果，提出了三个具体目标： 1.描述不同种族、民族和不同学校对ADHD、ODD和CD的医学诊断的差异。 性别、年龄、乡村和社区特征。 2.量化学校送餐政策和医疗诊断对纪律结果的影响，以及 按种族/民族、乡村和社会经济地位划分的学业成就。 3.确定钟声后普遍用餐和早餐单独或联合使用对 被诊断为儿童行为障碍的可能性和随后的服务利用总体和 种族、民族和乡村。 这项研究将从阿肯色州公立学校的儿童中抽样调查。阿肯色州在全国排名第二 全国被诊断患有ADHD的儿童比例，第三名患有ADHD的儿童 在儿童粮食不安全的发病率中，儿童死亡率居第二位。了解是否应该制定政策 更容易获得的膳食可以防止对可能升级为纪律的行为障碍的医学诊断 学校发生的事件将对改善与健康相关的生活质量、人力资本产生重大影响 发展，减少与青少年和成人刑事司法系统的接触。

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.