@article{3e7d11a2a8244a15ba1ccd0a3a584f05,
title = "Diet Quality and School Attendance: Cost Analysis Informing Absence-Reduction Strategies in Schools With Underserved Students",
abstract = "BACKGROUND: As school districts across the nation evaluate strategies and implement programs to reduce absenteeism, health-related interventions remain largely underutilized. This study provides the estimated cost of improving students' diet quality as a means to increase attendance. Then, it compares the costs and efficacy of improving diet quality to those of other absence-reduction interventions. METHODS: This study used child-level diet quality data from the Growing Right Onto Wellness (GROW) randomized control trial merged with Metro Nashville Public Schools (MNPS) absences data, as well as food cost estimates from Rose et al. to study the cost effectiveness of improving underserved elementary student attendance through improved diet quality. RESULTS: The results suggest that improving diet quality might be a cost-efficient way of improving attendance among elementary students in underserved areas. Further, improving diet quality compares favorably to other absence-reduction strategies, in terms of cost and effectiveness. CONCLUSIONS: Investments in school food programs to improve diet quality may be a cost-effective strategy to reduce student absenteeism, especially for schools with higher concentrations of students with lower diet quality. These results may assist decision-makers who allocate scarce resources aimed at improving school attendance.",
keywords = "HEI, attendance, cost analysis, diet quality, underserved students",
author = "Kukla-Acevedo, {Sharon A.} and Ernst, {Micah G.} and Sommer, {Evan C.} and Adams, {Laura E.} and Barkin, {Shari L.}",
note = "Funding Information: The authors have no conflicts of interest to disclose. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Joe C. Davis Foundation. This work is designed to assist decision-makers when allocating scarce resources toward improving students' diet quality and school attendance. At the local level, these calculations are intended to assist nutrition directors and superintendents in schools where students have average HEIs at the lower end of the “needs improvement” category. Among lower HEI scores, these marginal costs may present a tractable and attractive policy intervention to reduce student absenteeism. On the other hand, schools may understandably direct resources elsewhere when the average HEI is already at or near the “good” category because the marginal costs become increasingly expensive with higher HEI scores. Given that the average HEI in elementary schools is 53, the lower end of “needs improvement,” it is likely that raising HEI will be an applicable intervention for many schools. At the federal level, the US Department of Agriculture (USDA) administers Child Nutrition Programs, consisting of the National School Lunch and School Breakfast Programs and Child and Adult Care Food Programs (CACFP) which are responsible for feeding over 30 million school-aged children each day, reaching families most in need. By understanding the costs required to improve HEI, these data could inform judicious allocation of funding (such as the Coronavirus Aid, Relief, and Economic Security Act [CARES]) to support effective childhood nutrition for children most at-risk. Sufficient evidence demonstrates positive associations between daily food expenditures and higher nutritional value in the general population40 and in government supported programs.41 These findings emphasize the important role that funding has in the ability of these food programs to provide nutritious meals to millions of children every day. However, if nutrition directors use increased expenditures to simply meet specific food group requirements (such as fruit, vegetables, protein, dairy, whole grain), without seeking to maximize nutritive value, then increased diet quality may not be obtained. An investment to improve diet quality in school food programs may be a cost-effective strategy to improve student absenteeism, especially for schools with lower HEI. Preparation of this paper did not involve primary research or data collection involving human subjects, and therefore, no institutional review board examination or approval was required. The authors have no conflicts of interest to disclose. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Joe C. Davis Foundation. Publisher Copyright: {\textcopyright} 2022 American School Health Association.",
year = "2023",
month = jan,
doi = "10.1111/josh.13220",
language = "English",
volume = "93",
pages = "44--52",
journal = "Journal of School Health",
issn = "0022-4391",
publisher = "Journal of School Health",
number = "1",
}
