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*
Deputy Under Secretary, Research, Education and Economics, U. S. Department of Agriculture, Washington DC 20250 and
Special Assistant to the Secretary for Nutrition, U. S. Department of Agriculture, Washington DC 20250
2To whom correspondence should be addressed. E-mail: eileen.kennedy{at}usda.gov.
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INTRODUCTION |
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 TOP INTRODUCTION Special Supplemental Nutrition...Child nutrition programsSchool Breakfast ProgramSummer Food Service ProgramChild and Adult Care...Food StampsElements of program successThe future of the...REFERENCES |
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) in part "as a
measure of national security," i.e., healthy children equal healthy
soldiers. In the late 19th and early 20th centuries, many religious organizations provided meals to school children. For some groups, such efforts were regarded as charity. Others felt that the State should provide such meals as a matter of right. Aspects of these distinct philosophical views remain firmly in place today.
The development of child nutrition programs post-World War II was assisted by the dynamic interaction of many very diverse groups. These include local, state and national antihunger groups, university-based researchers, health and nutrition officials, Congress and the executive branch of government. Religious groups also played a major role. The mid-1990s debate over welfare reform bears a remarkable semblance to the debates in Parliament establishing the 1906 Provision of Meals Act in England and the Congressional debates over the creation of the 1946 National School Lunch Act. Would a nutrition program for children enhance learning or would such programs enhance dependence of the poor upon federal government?
Another major factor in the development and creation of child nutrition
programs was the Civil Rights movement and media coverage of hunger in
America in the 1960s. Discovery of widespread hunger in the South by a
team of physicians focused attention on the plight of poor, hungry
Americans. These events culminated in the 1969 Nixon White House
Conference on Food, Nutrition and Health (White House Proceedings 1970
). This was a watershed event not only because
it brought together the best thinking on issues related to public
health nutrition but more importantly because it led to a very
action-oriented agenda that helped shape the U.S. nutrition safety
net.
In May 2000, the successor to the 1969 conference was held in
Washington, DC. The National Nutrition Summit attracted nearly 2000
nutrition and health professionals to the nation’s capital to discuss,
debate and develop a national nutrition safety net plan for the next
quarter century (USDA/DHHS 2000
). Hunger issues were a
significant part of the agenda. There was also significant attention
paid to identifying interventions for Americans. In addition, the role
of physical activity in improving nutritional status and the epidemic
of childhood obesity were key topics of discussion. One clear
recommendation was that targeted research is required to identify the
range of benefits resulting from improved diets and physical activity
and how to translate this information into programs and policies.
With this background, this paper discusses the development of key child nutrition programs and the available scientific research highlighting the effects of programs on diet, health and nutritional status.
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Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) |
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TOPINTRODUCTIONSpecial Supplemental Nutrition...Child nutrition programsSchool Breakfast ProgramSummer Food Service ProgramChild and Adult Care...Food StampsElements of program successThe future of the...REFERENCES |
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) had a specific recommendation
for food supplementation of high risk pregnant women and their infants.
This recommendation was one of the major factors leading to the
creation of what is now known as the Special Supplemental Nutrition
Program for Women, Infants and Children (WIC). Today we think of WIC as having strong bipartisan support, but this was not always true. When WIC was authorized as a 2-y pilot project in 1972, it was opposed by the implementing agency, the USDA. USDA felt in part that WIC was a duplication of an existing program, the Commodity Supplemental Food Program, which provided commodities to pregnant women, infants and children. USDA was sued (U. S. District Court 1973, unpublished case) for release of funds appropriated for WIC. The expansion of this program was directly related to the leadership efforts of the members of the Senate Select Committee on Nutrition and Human Needs. Such leaders included Senators George McGovern, Robert Dole, Jacob Javits, Hubert Humphrey, Charles Percy and Ted Kennedy, as well as House leaders such as Representatives Carl Perkins, Shirley Chisholm and George Miller.
Given the somewhat stormy beginning of the WIC program, it may not be
surprising that WIC is a rather unusual example of the use of extensive
evaluative research in the policy arena. A series of studies were
conducted from the mid-1970s to the mid-1980s, indicating that WIC
participation was associated with improved neonatal outcomes for
prenatal participants (Kennedy 1999
). For infants and
children, a combination of improved growth, better hematological status
and/or diets has been associated with WIC participation (Kennedy 1999
). The individual WIC studies have used a combination of
research designs, each with its own strengths (Table 1
); this accumulating body of evidence has given policy makers confidence
that the nutrition and health benefits associated with WIC
participation are real. A more recent study of a nationally
representative survey of the U.S. population reports that WIC is
associated with improved diet quality (Basiotis et al. 1998
).
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); using data from five states, Florida, North Carolina,
South Carolina, Minnesota and Texas, results indicate that infant
mortality decreased with WIC participation. This finding is significant
in all but Minnesota. Most of the decline in infant mortality is due to
significant decreases in neonatal mortality. The effect associated with
WIC participation is independent of the receipt of prenatal health
care, which is also associated with large and significant reductions in
infant mortality. |
Child nutrition programs |
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TOPINTRODUCTIONSpecial Supplemental Nutrition...Child nutrition programsSchool Breakfast ProgramSummer Food Service ProgramChild and Adult Care...Food StampsElements of program successThe future of the...REFERENCES |
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). The oldest child nutrition program is the
National School Lunch Program. The program began in 1946. It was
established "as a measure of national security, to safeguard the
health and well-being of the Nation’s children and to encourage
the domestic consumption of nutritious agricultural commodities"
(National School Lunch Program 1946
). School lunch
programs are required by regulation to provide lunches that meet one
third of the Recommended Dietary Allowances (RDA) as measured over time
(over a 5-d period).
The National Evaluation of School Nutrition Programs, released in April
1983 by USDA and Systems Development Corporation (Wellisch et al. 1983
), found that the National School Lunch Program met
both of its legislated goals, i.e., promotion of agricultural products
and safeguarding the health of the nation’s school-age children
through the provision of nutritious foods to school children. The
evaluation found that "students who participate in School Lunch had
higher intakes of energy and more nutrients than students who do not
participate in any of the school nutrition programs"
(Welllisch et al. 1983
). The report went on to say,
"It is worth noting that of the many nutrients for which Lunch
Program participants show superior intakes, four (vitamins A and B-6,
calcium and magnesium) are ones that typically are deficient in the
diet of the school-age population" (Wellisch et al. 1983
).
In 1981, the Administration did consider changing the one third RDA
nutrition standard to one fourth of the RDA (sometimes referred to as
the "Ketchup as a Vegetable" regulations) but public and bipartisan
Congressional pressure prevented this occurrence. The School Nutrition
Dietary Assessment Study (Burghardt and Devaney 1995
),
conducted in 1992, once again confirmed that school lunches provided
one third or more of the RDA for key nutrients. However, the study also
found that school lunches exceeded the Dietary Guidelines goal of
providing meals with 
30% of energy from fat. Although there was no
legislative or regulatory requirement for school lunch programs to meet
the Dietary Guidelines in 1992, it became clear that over time, the
nutrition and health status of the 27 million participants (14 million
low income children) would be better served if the meals served
mirrored the Guidelines. Meals are now required to provide 30% of
energy from fat. There is encouraging news on this front with the
growing emphasis by school lunch directors on fresh fruits and
vegetables and new rules allowing schools to receive reimbursement for
yogurt and soy-based meals. Consumer Reports last spring released a
review of school lunches indicating that the meals in their survey were
quite close to the 30% goal (32% of energy is from fat in survey
meals).
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School Breakfast Program |
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TOPINTRODUCTIONSpecial Supplemental Nutrition...Child nutrition programsSchool Breakfast ProgramSummer Food Service ProgramChild and Adult Care...Food StampsElements of program successThe future of the...REFERENCES |
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) concluded that the principal
nutritional benefit of the Breakfast Program was that it increased the
likelihood that children would eat breakfast. This finding was
reconfirmed in a 1998 Mathematica study (Devaney and Stuart 1998
). In 1983, the School Breakfast Program was available to
only 39% of public school children. In the 1983 evaluation, it was
determined that, except for milk-related nutrients, school
breakfast was not superior to breakfasts children eat at home or
elsewhere. Congress remedied this situation in the 1980s by providing
additional reimbursements to schools so that more protein, fruits,
vegetables and grains in greater varieties could be served. Also, the
1992 School Nutrition Dietary Assessment Study (Burghardt and Devaney 1995
) found that school breakfasts provide one fourth
or more of the daily RDA for most nutrients, with the exception of
energy and zinc. The new funding and the new research with positive
findings on the value of School Breakfast have led to a renewed
commitment of parents, teachers, school food service workers and
administrators to the concept that there is a strong relationship
between nutrition and learning. As a result, School Breakfast
participation has skyrocketed. Today, nearly 75% of schools that offer
a lunch also offer school breakfast. In 1999, participation rose to >7
million students compared with 3.2 million in the late 1980s. Perhaps the most exciting development about the School Breakfast Program is the research funding that Congress provided last year for a rigorous evaluation of the potential benefits of universal school breakfast programs. "Universal" programs provide all children meals without charge. Recent studies and reports from Universities of Minnesota, Harvard, Boston and Tufts have suggested that participation in School Breakfast Programs has a positive effect on students’ attendance, behavior and academic achievement. Last year, Congress provided $7 million of the $13 million needed to conduct School Breakfast Research Pilots (6 universal free and 6 control schools in each of 6 school districts) to determine whether the links among breakfast, cognition and attendance stand up after rigorous review. The Food and Nutrition Service of the U.S. Department of Agriculture has selected the research pilot sites and the project is underway. Senators Thad Cochran, Patrick Leahy, Tom Harkin and Tim Johnson were the Congressional leaders most responsible for securing the funding for these research pilots.
The University of Minnesota study on universal school breakfast
(Minnesota Department of Children, Families, and Learning
1997) found that for students participating in the study,
"there is a general increase in composite math and reading percentile
scores." The Harvard University/Kellogg study (Murphy et al. 1998
) concluded that "when a free school breakfast is made
available to low income students, attendance, grades, behavior, and
emotional adjustments improve." This study was the first attempt to
assess the relationship of child hunger and standardized measures of
psychological functioning. The study found that children who experience
hunger at school tend to have greater trouble with teachers, are less
attentive in class and more likely to engage in fighting with other
children. Researchers at Boston and Tufts Universities found that
"elementary school children who participated in the School Breakfast
Program had significantly higher standardized achievement test scores
than eligible nonparticipants" (Meyers et al. 1989
).
These findings are supported by a new interim report of the Maryland
Meals for Achievement project. This project, begun in 1998 by the
Maryland State Department of Education, provides school breakfast in
the classroom, free to all students who want it. The purpose of the
study is to determine whether academic achievement improves as a result
of participation in the School Breakfast Program. Researches reviewed
test scores from the Maryland School Performance Assessment Program to
make this determination. A principal finding was that "over a two
year period, classroom breakfast schools showed a 22% improvement in
the composite index score of this test compared to a 13% improvement
for schools in the control group, and a 5% improvement for all
Maryland schools" (Murphy et al. 2000
). This report
was done by the same Harvard University researchers cited above.
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Summer Food Service Program |
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TOPINTRODUCTIONSpecial Supplemental Nutrition...Child nutrition programsSchool Breakfast ProgramSummer Food Service ProgramChild and Adult Care...Food StampsElements of program successThe future of the...REFERENCES |
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). The meals served by most sites supplied at least 33% of
the RDA for most nutrients. Vitamin B-6, magnesium, and iron did not
meet the RDA goal and the authors reported that this was probably
because few vegetables were served. The U.S. Department of Agriculture,
Economic Research Service is currently reviewing the Summer Food
Program, and this study should give us more data on the quality of
meals served. |
Child and Adult Care Food Program (CACFP, formerly the Child Care Food Program) |
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TOPINTRODUCTIONSpecial Supplemental Nutrition...Child nutrition programsSchool Breakfast ProgramSummer Food Service ProgramChild and Adult Care...Food StampsElements of program successThe future of the...REFERENCES |
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). A key finding was as
follows: "the nutritional quality of the diet and the quality and
variety of food served are significantly better in participating day
care facilities than in nonparticipating facilities," (Abt 1983
). A more recent study found that "nutritious meals
provided by the CACFP can improve diets and may promote health among
young, unborn children" (Bruening et al. 1999
).
The CACFP provides the parents of 2.4 million children the opportunity
to go to work knowing that their children are in safe, affordable,
quality child care where they will receive nutritious meals and snacks.
A U.S. General Accounting Office (GAO 1994
) report cited
the effectiveness of the program: "Because of its unique combination
of resources, training, and oversight, experts believe the food program
is one of the most effective vehicles for reaching family child care
providers and enhancing the care they provide."
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Food Stamps |
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TOPINTRODUCTIONSpecial Supplemental Nutrition...Child nutrition programsSchool Breakfast ProgramSummer Food Service ProgramChild and Adult Care...Food StampsElements of program successThe future of the...REFERENCES |
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Research related to the FSP is less likely to assess child
health/nutrition outcomes; research on the FSP has concentrated on
evaluating the effects of the FSP on household food expenditures and
household nutrient intake. Several recent reviews have summarized the
key studies assessing the effect of the FSP program (Fraker 1990
, Kennedy 1999
). This body of literature
indicates that FSP participation is associated with significant
increases in household food expenditures; the FSP is also associated
with improved nutrient consumption of a range of nutrients, although
the effect on food expenditures is stronger than the effect on
consumption. One recent study assessed the effect of the FSP on dietary
quality in a nationally representative sample of households and found
that for each food stamp dollar received, there was a significant
improvement in diet quality (Basiotis et al. 1998
).
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Elements of program success |
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TOPINTRODUCTIONSpecial Supplemental Nutrition...Child nutrition programsSchool Breakfast ProgramSummer Food Service ProgramChild and Adult Care...Food StampsElements of program successThe future of the...REFERENCES |
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The FSP had a major revision in the late 1970s when the purchase
requirement for food stamps was eliminated. In the early FSP years,
households had to spend a certain amount of money in order to
"purchase" a substantially larger amount of food stamps. Monitoring
data from the 1970s indicated that for the very poor households, the
purchase requirement was a barrier to participation in the program
(Senauer 1982
). Indeed, when the purchase requirement
was removed, participation by lower income households increased
(Senauer 1982
). The Thrifty Food Plan (the nutritional
basis of benefits of the food stamp program) was revised to include the
Dietary Guidelines as part of the food plan (USDA 1999
).
Similarly, the WIC program has evolved over time. The biggest change in
WIC has been the more precise targeting of program benefits. An income
eligibility requirement was added to WIC in the late 1970s, more
specific priority categories were established for nutritional risk, and
closer links between WIC and health care provision were specified. In
addition, nutrition education changed from being a discretionary to a
mandated service as part of the WIC program. Finally, specific efforts
for breast-feeding promotion were incorporated into WIC. The WIC
program has grown from a pilot program in 1972 with very few
participants to serving >7.3 million low income and nutritionally at
risk women, infants and children. WIC is the gateway into America’s
health care system. It improves the nutrition and health status of
millions of its participants. Also, in a recent survey of the top 30
highly rated government programs (American Customer Satisfaction Index 1999
), WIC was rated 2nd in overall customer
satisfaction.
The school nutrition programs were originally designed to assist farmers (outlet for surplus agricultural commodities), promote national defense (many recruits disapproved by draft board were rejected for nutrition-related reasons), and improve children’s nutrition and health status. These programs still meet these legislated goals.
A major reason why the School Lunch and Breakfast Programs have
survived for so long and assisted millions of children is because
committed members of Congress on a bipartisan basis have supported a
strong federal government role in child nutrition programs. As Senator
Robert Dole stated in a hearing before a subcommittee of the House
Education and Labor Committee: "There is and should be a continuing
primary responsibility of the federal government in these child
nutrition programs" (House Education and Labor Subcommittee
1982
). The federal role has been to require national minimum
standards for eligibility and nutrition. In 1967, 2 of 3 eligible
children did not participate in the National School Lunch Program.
Eligibility was determined by local school principals who frequently
had somewhat narrow views as to which children were "poor enough"
to participate and receive a free lunch. That changed in 1970 when
Congress established nationally uniform minimum standards for
eligibility after Senators McGovern and Dole visited local schools and
found poor, hungry children being denied access to school nutrition
programs. Today 94,000 schools have lunch programs serving 27 million
children every school day.
There have been attempts to terminate a federal role in school nutrition programs and return administration to the local level. All such attempts have been met with strong bipartisan opposition. In 1981, the Administration pursued a New Federalism proposal, and in 1994 the House majority proposed to "block grant" child nutrition programs. All of these efforts had a similar goal ... return administration of child nutrition programs to the local level. In each instance, the existence of federal nutrition standards played an important role in reversing these proposals. Congressional leaders and the general public understood that providing nutritious meals to children at school was good for all children and good for the country. Without federal nutrition standards, there would be no way to ensure that we as a nation were actually addressing the nutritional needs of our children. Senator Richard Lugar, Chair of the Senate Agriculture Committee, along with Senators Leahy and Harkin, all played leadership roles in supporting the retention of nutrition standards in child nutrition programs.
Today, we have school lunches, breakfasts and after-school snack
programs that provide meals consistent with the Dietary Guidelines for
Americans. Research is underway to determine whether the School
Breakfast Program has a positive effect on achievement test scores. The
Summer Food and Child Care Food Programs are also providing meals and
snacks for millions of children. Indeed, a study by the Families
and Work Institute (1995)
cited participation in the Child Care
Food Program as one of the major factors influencing quality care. The
study reported that "87% of the family child care homes considered
to be providing good quality care participated in the Child and Adult
Care Food Program" (Families and Work Institute 1995
).
A new After School Snack Program is available for children, with a particular focus on at risk teens. This new entitlement program provides funding for snacks served to children in after school care programs in school as well as eligible children participating in CACFP. These programs must provide educational or enrichment activities. Participation in School Lunch Snack Programs has grown from serving 400,000 snacks in the fall of 1998 to 4 million in the fall of 1999. The CACFP At Risk Snack Program has risen from a minimal number in the fall of 1998 to 1 million snacks in the fall of 1999, according to preliminary data from the U.S. Department of Agriculture.
The federal nutrition assistance programs have worked and worked well.
As George McGovern once stated "Of all the great society programs,
the Nation’s feeding programs have been the most successful" (Senate
Agriculture Subcommittee on Nutrition Hearing 1979
).
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The future of the nutrition safety net |
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TOPINTRODUCTIONSpecial Supplemental Nutrition...Child nutrition programsSchool Breakfast ProgramSummer Food Service ProgramChild and Adult Care...Food StampsElements of program successThe future of the...REFERENCES |
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). Part of this finding relates
to the lower level of participation of children in some nutrition
safety net programs. In 1995, 88 children received food stamps for
every 100 children who were poor compared with only 72 of 100 poor
children in 1998 (Porter and Primus 1999
). Not only does
the nutrition safety net continue to be important for underserved
children, but the benefits from the safety net may come to represent an
increasing share of overall household income. The empirical results strongly suggest that a nutrition safety net will continue to be important even in the best of economic times. Yet there continues to be tension between those policy makers who advocate broad-based economic reforms as a means of achieving nutrition objectives vs. those suggesting more targeted, programmatic approaches. The data presented in this paper would suggest that both types of strategies are needed. Indeed, the working poor (those who despite being fully employed still fall below the poverty level) will continue to rely on programs such as WIC, School Feeding Programs, CACFP, Summer Food and Food Stamps to ensure an adequate diet.
The long-term solution to persistent poverty and its resultant negative nutrition consequences will undoubtedly involve a combination of macro-economic policies with investments that benefit at-risk populations as well as targeted public health nutrition interventions.
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FOOTNOTES |
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3 Abbreviations used: CACFP, Child and Adult Care
Food Program; FSP, Food Stamp Program; RDA, Recommended Dietary
Allowances; WIC, Special Supplement Nutrition Program for Women,
Infants, and Children.
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REFERENCES |
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TOPINTRODUCTIONSpecial Supplemental Nutrition...Child nutrition programsSchool Breakfast ProgramSummer Food Service ProgramChild and Adult Care...Food StampsElements of program successThe future of the...REFERENCES |
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1. Abt I. A. Evaluation of the Child Care Food Program 1983 Abt Associates Washington, DC.
2. American Customer Satisfaction Index Survey Customer Satisfaction. Survey on the Special Supplemental Nutrition Program for Women Infants, and Children 1999 University of Michigan Business School Ann Arbor, MI.
3. Basiotis P. P., Kramer-LeBlanc C., Kennedy E. T. Maintaining food and nutrition security: the role of the Food Stamp Program and WIC. Fam. Econ. Nutr. Rev. 1998;11:4
4. Bruening K. S., Gilbride J. A., Possenante M. R., McClowry S. Dietary intake and health outcomes among young children attending two urban day-care centers, J. Am. Diet. Assoc. 1999;99:1529-1535
5. Burghardt J. A., Devaney B. L. School nutrition dietary assessment study, Am. J. Clin. Nutr. (suppl.) 1995;61:2055-2125
6. Devaney, B. & Schrim, A. (1993) Infant mortality among Medicaid newborns in 5 states: the effects of prenatal WIC participation, Mathematica Policy Research, Princeton, NJ.
7. Devaney B., Stuart E. Eating breakfast 1998 Effects of the School Breakfast Program. Mathematica Policy Research Princeton, NJ.
8. Families and Work Institute Study of Children in Family Child Care and Relative Care 1995 New York, NY.
9. Fraker T. M. The effects of food stamps on food consumption: a review of the literature 1990 Mathematica Policy Research Washington, DC.
10. General Accounting Office 1994 Child Care—Promoting Quality in Family Child Care 1994 Washington, DC.
11. House Education and Labor Subcommittee on Elementary, Secondary, and Vocational Education (1982) Hearing on resolution urging continuation of federal involvement in Child Nutrition Programs. H. Con. Res. 384: Washington, DC.
12. Kennedy E. Public policy in nutrition: the US nutrition safety net—past, present and future. Food Policy 1999;24:325–333; 343–347
13. Meyers A. F., Sampson A. E., Weitzman G., Rogers B. L., Kayne H. School breakfast program and school performance. Am. J. Dis. Child. 1999;143:1234-1239
14.
Murphy J. M., Pogano M. E., Nachman J., Sperling P., Kane S., Kleinman R. E. The relationship of school breakfast to psychosocial and academic functionings. Arch. Pediatr. Adolesc. Med. 1998;152:899-907
15. Murphy, J. M., Pogano, M. E., Nachman, J., Sperling, P., Kane, S. & Kleinman, R. E. (2000) Effects of a Universally Free, In-classroom School Breakfast Program, Results from the Maryland Meals for Achievement Evaluation, Year 2 Interim Report. Maryland State Department of Education, Baltimore.
16. National School Lunch Program (1946) Public Law 79–396, 42 USC Sec. 1751.
17. Porter, K. & Primus, W. (1999) Changes since 1995 in the safety net’s impact on child poverty. Center on Budget and Policy Priorities, Washington, DC.
18. School Breakfast Programs. Energizing the Classroom. (1997) Minnesota Department of Children, Families and Learning, Food and Nutrition Service, St. Paul.
19. Senauer B. & Young, N. (1982) Food stamps re-examined. Community Nutritionist. II : 22–25.
20. Senate Agriculture Subcommittee on Nutrition (1979) Hearing, Hunger in America: Ten Years Later.
21. Senate Select Committee on Nutrition and Human Needs (1974) To Save the Children: Nutritional Intervention Through Supplemental Feedings, Committee Print.
22. U.S. Department of Agriculture, Food and Nutrition Service Evaluation of the Summer Food Service Program, Final Report 1988 Washington, DC.
23. U.S. Department of Agriculture, Center for Nutrition Policy and Promotion Revised Thrifty Food Plan 1999 Washington, DC.
24. U.S. Department of Agriculture and the Department of Health and Human Services Proceeding: National Nutrition Summit 2001 U.S. Government Printing Office Washington, DC (in press).
25. Wellisch, J., Hanes, S. D., Jordon, L. A., Mauer, K. M. & Vermeersch, J. A. (1983) The national evaluation of school nutrition programs, vols. 1 and 2. Systems Development Corporation, Santa Monica, CA.
26. White House Proceedings White House Conference on Food Nutrition and Health 1970 U.S. Government Printing Office Washington, DC.
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