Examining system-wide implementation of new flexibilities to the National School Lunch and Breakfast Programs - Examining system-wide implementation of new flexibilities to the National School Lunch and Breakfast Programs PROJECT SUMMARY BACKGROUND: Cardiovascular diseases (CVD) are the leading cause of death in the US and the underlying pathophysiological processes are evident in adolescence. Risk factors for CVD include obesity and prevention of obesity during adolescence can minimize adult CVD. Unfortunately, the prevalence of youth obesity in the US has nearly doubled in the past 20 years. Disparities in nutrition and healthy food access in schools and within certain communities contribute to higher prevalence of obesity among Hispanic, black, and low-income youth. The National School Lunch and Breakfast Programs (NSLP/SBP) are a complex system involving food suppliers, school food service directors, and student consumers. In 2018, a significant policy change to the NSLP/SBP allowed schools to decide if they wanted to implement relaxed school nutrition standards for milk, whole grains, and sodium. Such policy changes can lead to inefficient and inequitable implementation, ultimately affecting youth food consumption and health-related outcomes. GOAL: This proposal seeks to describe the impact of NSLP/SBP policy changes and flexibilities on the many levels involved in implementing these programs and to identify leverage points for which effectiveness and equity of implementation might be meaningfully and sustainably improved. AIMS AND METHODS: This is a three-phase study that takes a comprehensive approach, leading to the elucidation of more effective and equitable school food policy development and implementation. Phase 1 will assess current flexibility implementation practices and determinants of decision-making process. For this phase, we will engage School Nutrition Association (SNA) members: a nationally representative sample of over 4,000 school districts. Data collected will be merged with state level school data to understand how decisions relate to participation and health-related outcomes. Phase 2 involves interviewing food industry actors to understand how NSLP/SBP policy changes result in decisions to change food supply and distribution. Phase 3 seeks to develop an agent-based model (ABM). We will use this ABM as a “virtual policy laboratory,” analyzing ways to improve effective and equitable district-level implementation of the NSLP/SBP in silico and providing tools to inform real-world policymaking. All study phases will rely on close collaboration with key practice partners. INNOVATIONS AND IMPACT: This study is innovative and impactful because it will be the first to: (1) use the combination of an implementation science framework- the Consolidated Framework of Implementation and the Racial Equity and Policy Framework to assess and document implementation of flexibilities among school districts nationwide; (2) examine how decisions to implement flexibilities to NSLP/SBP result in inequitable food provision to youth; and (3) inform USDA rule- making and final rules in real time. These findings will contribute toward addressing school nutrition-related health inequities including those associated with enhanced risk of cardiovascular disease into adulthood.
