{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T06:36:28Z","timestamp":1787726188754,"version":"build-2784847793"},"reference-count":47,"publisher":"American Medical Association (AMA)","issue":"9","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>The Community Eligibility Provision is a federal universal free school meals policy for schools in low-income areas. Expanding access to school meals, which are children\u2019s most nutritious food source, may be a health-promoting policy.<\/jats:p><\/jats:sec>Objective<\/jats:title>To assess whether school-level adoption of the Community Eligibility Provision was associated with childhood blood pressure outcomes.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This cohort study used a difference-in-differences design for staggered policy adoption, observing low-income public and charter schools in 12 US states longitudinally from 2013 through 2019. The medical records for patients aged 4 to 18 years receiving care from community health organizations in the OCHIN health care network were matched to schools based on address. Data were analyzed from April 1 to July 5, 2024.<\/jats:p><\/jats:sec>Exposure<\/jats:title>School participation in the Community Eligibility Provision.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>The primary outcome was the annual school-level proportion of patients with a high blood pressure measurement (at or above the 90th percentile for age, sex, and height), and the secondary outcomes included a hypertensive measurement (at or above the 95th percentile) and mean systolic and diastolic blood pressure percentiles.<\/jats:p><\/jats:sec>Results<\/jats:title>The sample included 1052 schools matched to 155\u202f778 distinct patients. The mean (SD) proportions of patients based on race and ethnicity were as follows: 0.04 (0.08) Asian patients, 0.46 (0.33) Hispanic patients, 0.01 (0.03) patients of multiple races, 0.01 (0.02) Native Hawaiian or Other Pacific Islander patients, 0.13 (0.22) non-Hispanic Black patients, 0.25 (0.26) non-Hispanic White patients, and 0.09 (0.09) patients with unknown race and ethnicity. The majority of schools (n\u2009=\u2009670 [63.7%]) were located in California or Oregon. School participation in the Community Eligibility Provision was associated with a \u22122.71 percentage point (95% CI, \u22125.10 to \u22120.31 percentage point; P<\/jats:italic>\u2009=\u2009.03) net reduction in the proportion of patients with a high blood pressure measurement, corresponding to a \u221210.8% (95% CI, \u221220.4% to \u22121.2%) net decrease over 5 years. Participation was also negatively associated with the proportion of patients with a hypertensive measurement and with the mean diastolic blood pressure.<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>This cohort study of schools matched to child and adolescent patient medical records from a large network of community health organizations found that school participation in the Community Eligibility Provision was associated with a net reduction in blood pressure outcomes. These findings add to mounting evidence that universal free school meals may be associated with improved child health.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2025.33186","type":"journal-article","created":{"date-parts":[[2025,9,25]],"date-time":"2025-09-25T15:31:11Z","timestamp":1758814271000},"page":"e2533186","source":"Crossref","is-referenced-by-count":5,"title":["School Provision of Universal Free Meals and Blood Pressure Outcomes Among Youths"],"prefix":"10.1001","volume":"8","author":[{"given":"Anna M.","family":"Localio","sequence":"first","affiliation":[{"name":"Department of Health Systems and Population Health, University of Washington School of Public Health, Hans Rosling Center for Population Health, Seattle"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul L.","family":"Hebert","sequence":"additional","affiliation":[{"name":"Department of Health Systems and Population Health, University of Washington School of Public Health, Hans Rosling Center for Population Health, Seattle"},{"name":"Health Services Research & Development Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, Washington"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melissa A.","family":"Knox","sequence":"additional","affiliation":[{"name":"Department of Economics, University of Washington, Seattle"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wyatt P.","family":"Bensken","sequence":"additional","affiliation":[{"name":"OCHIN, Inc, Portland, Oregon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aileen M.","family":"Ochoa","sequence":"additional","affiliation":[{"name":"OCHIN, Inc, Portland, Oregon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Sonney","sequence":"additional","affiliation":[{"name":"Department of Child, Family, and Population Health Nursing, University of Washington School of Nursing, Seattle"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica C.","family":"Jones-Smith","sequence":"additional","affiliation":[{"name":"Department of Health Systems and Population Health, University of Washington School of Public Health, Hans Rosling Center for Population Health, Seattle"},{"name":"Department of Health, Society and Behavior, Joe C. 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