Health Services/Policy
The Association Between Free School Meals and Child Mental Health Diagnoses: Evidence from Medical Records Tom Lindman* Tom Lindman Jessica Jones-Smith
Background: The prevalence of ADHD, anxiety, and depression diagnoses among K-12 students in the U.S. has increased over recent decades, exposing challenges faced by children and youth. As a result, supporting mental health is increasingly a priority for public health agencies, schools, and policy makers. Income instability and low socioeconomic status negatively influence mental health, suggesting a role for social policy. Despite child mental health’s salience as a public health problem, little research assesses whether U.S. food assistance programs affect child mental health.
Methods: We evaluate whether exposure to free school meals affects the likelihood of ADHD, anxiety, and depression diagnoses among children visiting Federally Qualified Health Centers. Our study leverages the rollout of the Community Eligibility Provision (CEP), a federal policy allowing schools to provide universal free breakfast and lunch.
Our dataset links medical records from the OCHIN Data Warehouse for 2012-2019 with publicly available school data.
Our analysis uses a modern difference-in-differences approach, estimating the association of CEP exposure with mental health diagnoses. Models include child fixed effects and adjust for grade level.
Results: Our sample includes children who visited an OCHIN clinic during consecutive school years and attended a CEP-eligible school (n=201,295).
CEP exposure is associated with a 0.28 percentage point (0.4%) decrease in likelihood of ADHD diagnosis in the first year of exposure (CI: -0.483, -0.082). Estimates for subsequent years are not statistically significant.
CEP exposure is also associated with reductions in depression (-0.30; CI: -0.476, -0.128) and anxiety (-0.24; CI -0.440, -.0039) diagnoses. However, divergent trends for exposed and unexposed groups are present prior to exposure.
Conclusion: Exposure to universal free school meals is associated with a reduction in ADHD diagnoses in a predominantly low-income sample of K-12 students.