{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T14:01:46Z","timestamp":1789740106620,"version":"4.0.1"},"reference-count":79,"publisher":"BMJ","issue":"3","license":[{"start":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T00:00:00Z","timestamp":1789689600000},"content-version":"unspecified","delay-in-days":79,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100012349","name":"School for Public Health Research","doi-asserted-by":"publisher","award":["NIHR204000"],"award-info":[{"award-number":["NIHR204000"]}],"id":[{"id":"10.13039\/501100012349","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["bmjph"],"accepted":{"date-parts":[[2026,8,20]]},"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Food insecurity affects over one in four UK children. Free school meals (FSMs) may mitigate some adverse effects yet how well they reach food-insecure children is unclear. In September 2026, eligibility criteria will be changed but provision will not be universal. This study provides an analysis of FSM reach among food-insecure children and the potential impact of the 2026 eligibility changes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Data from the 2022\u20132023\u2009and 2023\u20132024 Family Resources Survey were merged, yielding 6563 children aged 8\u201317 in England. Household food insecurity over 30 days was assessed using a validated measure, with marginal, low and very low food security classified as food-insecure. Weighted proportions of food-insecure children not receiving FSMs were estimated. Logistic regression identified characteristics associated with food insecurity among those not receiving FSMs and non-uptake among eligible children. Projected impacts of 2026 eligibility changes were estimated under two scenarios.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>70.6% (95% CI 68.0% to 73.2%) of food-insecure children did not receive FSMs. Among these, 80.2% (95% CI 77.5% to 82.9%) were ineligible, while 19.8% (95% CI 17.1% to 22.5%) were eligible but not taking them up. Household characteristics associated with food insecurity included black\/African\/Caribbean ethnicity (aOR: 2.37, 95%\u2009CI 1.64 to 3.42) and disabled members (aOR: 1.71, 95%\u2009CI 1.41 to 2.06). Non-uptake was more common among older pupils (aOR per year: 1.19, 95%\u2009CI 1.11 to 1.28) and households without disability (aOR: 3.53, 95%\u2009CI 1.91 to 6.51). In modelled scenarios, over 270\u2009000 children may gain eligibility in 2026, yet 44.5% (95% CI 41.7% to 47.2%) of food-insecure children could remain ineligible.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>2026 FSM eligibility changes are likely to reach more food-insecure children, but many may remain ineligible, particularly those facing structural disadvantage. These findings highlight the limitations of benefit-based criteria. Universal FSM provision has been proposed as a more equitable approach, with the potential to ensure that all food-insecure children are reached.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjph-2025-004455","type":"journal-article","created":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T13:05:31Z","timestamp":1789736731000},"page":"e004455","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Do children in food-insecure households in England access free school meals? 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