What were the operating costs, costs and benefits to families, and proportion of eligible youths who received benefits of 2 programs aimed at replacing school meals missed when US schools were closed owing to COVID-19 from March to June 2020?
In this economic evaluation, among 30 million youths eligible to receive free or reduced-price meals, the Pandemic Electronic Benefit Transfer (P-EBT) program (state agencies sent debit cards loaded with the cash value of missed school meals to families) reached 89% of eligible students and cost $6.46 per meal. Grab-and-go school meals (school food service departments provided prepared meals for off-site consumption) reached 27% and cost $8.07 per meal.
These findings suggest that during times when youths cannot access school meals, state and federal agencies should support cost-efficient programs for schools to distribute prepared meals and activate programs such as P-EBT to efficiently reach eligible youths.
School meals are associated with improved nutrition and health for millions of US children, but school closures due to the COVID-19 pandemic disrupted children’s access to school meals. Two policy approaches, the Pandemic Electronic Benefit Transfer (P-EBT) program, which provided the cash value of missed meals directly to families on debit-like cards to use for making food purchases, and the grab-and-go meals program, which offered prepared meals from school kitchens at community distribution points, were activated to replace missed meals for children from low-income families; however, the extent to which these programs reached those who needed them and the programs’ costs were unknown.
To assess the proportion of eligible youths who were reached by P-EBT and grab-and-go meals, the amount of meals or benefits received, and the cost to implement each program.
Design, Setting, and Participants
This cross-sectional study was conducted from March to June 2020. The study population was all US youths younger than 19 years, including US youths aged 6 to 18 years who were eligible to receive free or reduced-price meals (primary analysis sample).
Receipt of P-EBT or grab-and-go school meals.
Main Outcomes and Measures
The main outcomes were the percentage of youths reached by P-EBT and grab-and-go school meals, mean benefit received per recipient, and mean cost, including implementation costs and time costs to families per meal distributed.
Among 30 million youths eligible for free or reduced-price meals, grab-and-go meals reached an estimated 8.0 million (27%) and P-EBT reached 26.9 million (89%). The grab-and-go school meals program distributed 429 million meals per month in spring 2020, and the P-EBT program distributed $3.2 billion in monthly cash benefits, equivalent to 1.1 billion meals. Among those receiving benefits, the mean monthly benefit was larger for grab-and-go school meals ($148; range across states, $44-$176) compared with P-EBT ($110; range across states, $55-$114). Costs per meal delivered were lower for P-EBT ($6.46; range across states, $6.41-$6.79) compared with grab-and-go school meals ($8.07; range across states, $2.97-$15.27). The P-EBT program had lower public sector implementation costs but higher uncompensated time costs to families (eg, preparation time for meals) compared with grab-and-go school meals.
Conclusions and Relevance
In this economic evaluation, both the P-EBT and grab-and-go school meal programs supported youths’ access to food in complementary ways when US schools were closed during the COVID-19 pandemic from March to June 2020.
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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.
Accepted for Publication: July 6, 2022.
Published: August 31, 2022. doi:10.1001/jamanetworkopen.2022.29514
Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2022 Kenney EL et al. JAMA Network Open.
Corresponding Author: Erica L. Kenney, ScD, MPH, Department of Nutrition, Harvard T.H. Chan School of Public Health, 665 Huntington Ave, Boston, MA 02115 (email@example.com).
Author Contributions: Drs Kenney and Krieger had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
Concept and design: Kenney, Fleischhacker, Jones-Smith, Bleich, Krieger.
Acquisition, analysis, or interpretation of data: Kenney, Walkinshaw, Shen, Fleischhacker, Bleich, Krieger.
Drafting of the manuscript: Kenney, Walkinshaw, Fleischhacker, Krieger.
Critical revision of the manuscript for important intellectual content: All authors.
Statistical analysis: Kenney, Walkinshaw, Shen.
Obtained funding: Fleischhacker, Bleich, Krieger.
Administrative, technical, or material support: Walkinshaw, Shen, Fleischhacker, Jones-Smith, Krieger.
Conflict of Interest Disclosures: Dr Kenney reported receiving grants from Healthy Eating Research, a national program of the Robert Wood Johnson Foundation, and from the National Institute of Diabetes and Digestive and Kidney Diseases during the conduct of the study. Dr Jones-Smith reported receiving grants from the Robert Wood Johnson Foundation during the conduct of the study. Dr Bleich reported receiving grants from Healthy Eating Research, a program of the Robert Wood Johnson Foundation, during the conduct of the study. Dr Krieger reported receiving grants from Healthy Eating Research, a program of the Robert Wood Johnson Foundation. No other disclosures were reported.
Funding/Support: This study was funded by Duke University and Healthy Eating Research (Dr Krieger), a national program of the Robert Wood Johnson Foundation, through a special rapid-response research opportunity focused on COVID-19 and the federal nutrition programs to inform decision-making regarding innovative policies and/or programs during and after the COVID-19 pandemic.
Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
Disclaimer: The views expressed in this article by Drs Fleischhacker and Bleich are solely the personal views of those authors.
Additional Contributions: The Nutrition and Obesity Policy Research and Evaluation Network (NOPREN) Food Security Work Group and the Healthy Eating Research/NOPREN COVID-19 Food and Nutrition Work Group provided insights and feedback on earlier presentations of these analyses. Kyla Tucker, MPH (Harvard T.H. Chan School of Public Health), provided assistance with data collection and received compensation.
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