{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T00:20:24Z","timestamp":1789777224573,"version":"4.0.1"},"reference-count":35,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2025,12,4]],"date-time":"2025-12-04T00:00:00Z","timestamp":1764806400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of School Health"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Universal school meals (USMs) policies, which provide free meals to all students regardless of income, have the potential to improve child nutrition and reduce stigma. Quantitative evidence on the association between USM and stigma is limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Leveraging a natural policy variation in state\u2010level USM implementation, we surveyed 1066 middle and high school students from eight US states (four with USM, four without) during the 2022\u20132023 school year. Stigma was measured as self\u2010reported embarrassment about eating school lunch. We used generalized estimating equations to examine the associations between USM, embarrassment, and lunch participation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Overall about one in nine students (11.5%) across all surveyed states reported embarrassment, which was associated with 11% less frequent (aRR\u2009=\u20090.89, 95% CI: 0.83\u20130.97). School lunch participation overall, especially among those from low\u2010income families. While USM was associated with lower odds of embarrassment among students from low\u2010income families, higher\u2010income students in USM states were more likely to feel embarrassed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Implications<\/jats:title>\n                    <jats:p>Addressing stigma requires pairing USM with strategies to enhance meal quality, cultural relevance, and inclusive messaging.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>USM can alleviate stigma for lower\u2010income students yet may increase embarrassment among higher\u2010income peers, highlighting the need for comprehensive approaches benefiting all socioeconomic groups.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/josh.70098","type":"journal-article","created":{"date-parts":[[2025,12,4]],"date-time":"2025-12-04T09:36:07Z","timestamp":1764840967000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Universal School Meal Policies and Perceived Stigma: Quantitative Evidence From Eight US States"],"prefix":"10.1111","volume":"96","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8581-8714","authenticated-orcid":false,"given":"Dania","family":"Orta\u2010Aleman","sequence":"first","affiliation":[{"name":"Nutrition Policy Institute University of California Agriculture and Natural Resources  Oakland California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2758-9807","authenticated-orcid":false,"given":"Monica D.","family":"Zuercher","sequence":"additional","affiliation":[{"name":"Nutrition Policy Institute University of California Agriculture and Natural Resources  Oakland California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leah E.","family":"Chapman","sequence":"additional","affiliation":[{"name":"Department of Nutrition &amp; Public Health Merrimack College  North Andover Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8939-1954","authenticated-orcid":false,"given":"Marlene B.","family":"Schwartz","sequence":"additional","affiliation":[{"name":"Department of Human Development and Family Sciences, Rudd Center for Food Policy and Health University of Connecticut  Hartford Connecticut USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caitlin D.","family":"French","sequence":"additional","affiliation":[{"name":"Nutrition Policy Institute University of California Agriculture and Natural Resources  Oakland California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anisha I.","family":"Patel","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Stanford University  Palo Alto California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8038-1821","authenticated-orcid":false,"given":"Lorrene","family":"Ritchie","sequence":"additional","affiliation":[{"name":"Nutrition Policy Institute University of California Agriculture and Natural Resources  Oakland California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juliana","family":"Cohen","sequence":"additional","affiliation":[{"name":"Department of Nutrition &amp; Public Health, School of Nursing and Health Science Merrimack College  North Andover Massachusetts USA"},{"name":"Department of Nutrition Harvard T.H. Chan School of Public Health  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wendi","family":"Gosliner","sequence":"additional","affiliation":[{"name":"Nutrition Policy Institute University of California Agriculture and Natural Resources  Oakland California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,12,4]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/J.JNEB.2024.04.011"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/J.ECONEDUREV.2013.06.007"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1525\/9780520944411"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1093\/AJCN\/61.1.213S"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/J.JAND.2024.11.002"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/J.JAND.2019.10.022"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1001\/JAMANETWORKOPEN.2021.5262"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.3945\/JN.110.130823"},{"key":"e_1_2_10_10_1","volume-title":"School Nutrition and Meal Cost Study Final Report. 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