Date of Award

January 2025

Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)

Department

School of Public Health

First Advisor

Debbie Humphries

Second Advisor

Rafael Pérez-Escamilla

Abstract

BackgroundEight states have passed legislation to codify universal school meal programs (USMPs) for public and nonprofit schools. These programs provide free school breakfasts and lunches to all students with no exclusions. A strong link exists between health, education, and social outcomes and the presence of subsidized school meal programs, and these outcomes are often used to advocate for such programs. This study assesses the prevalence of other state policies passed to address health, education and social outcomes (Medicaid expansion, universal pre-k, and state child tax credits) among states which have also passed USMP policies. We hypothesized that USMP passage would be most strongly correlated with the passage of the education outcomes-oriented policy, universal pre-k.

MethodsThis analysis uses Medicaid expansion as a proxy for states ‘political will to address health outcomes, universal pre-k policy as a proxy for states’ political will to address education outcomes, and state child tax credits as a proxy for states’ political will to address socioeconomic outcomes. This study utilizes data from public resources to identify the eight states that have passed legislation to codify USMPs, the 40 states which have passed Medicaid expansion, the 14 states which have passed universal pre-k, the 16 states which have passed state child tax credits. This analysis assesses the overlap of these three policies with the passage of USMPs. It also compares the passage of these three policies among the USMP states to the passage of these three policies across the United States as a whole to garner national context.

ResultsThrough this analysis we found that the health outcomes-oriented policy (Medicaid expansion) is the most strongly correlated policy to USMP passage of the three policies considered. Additionally, Democratic partisanship in state-level government is highly correlated with USMP passage.

ConclusionsThis study suggests that policymakers in other states across America may successfully pass universal school meal legislation by leaning into the health benefits that such policies generate when advocating for their enactment. This thesis also suggests that states without universal school meal programs that have passed the prevention-focused policies of interest (Medicaid expansion, universal pre-k, and state child tax credits) should be considered as the primary candidates for further advancing USMP policy.

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This is an Open Access Thesis.

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