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The Community Eligibility Provision (CEP) allows high-poverty schools participating in US Department of Agriculture meal programs to offer universal free school meals. Emerging evidence suggests benefits of CEP for student meal participation, behavior, and academic performance. Although CEP became available nationwide in 2014, in school year 2019–2020, one third of eligible schools were not participating. This study evaluates which school, district, and state factors are associated with CEP participation. Cross-sectional study comparing CEP-participating with eligible nonparticipating schools to assess the relationship between CEP participation and school, district, and state factors. US public schools eligible for CEP in school year 2017–2018 (n = 42,813). CEP participation. Penalized regression variable selection methods to determine which factors contribute information to the model. Generalized logistic regression to predict odds of CEP participation unadjusted and adjusted for each factor in the full sample and in stratified analyses by whether a state was part of the CEP phase-in period (early vs late implementing states). In the full sample, adjusted odds of CEP participation were greater in states where CEP had been available longer (odds ratio [OR], 1.50; 95% confidence interval [CI], 1.34, 1.67). In late implementing states, adjusted odds of CEP participation were higher in schools with more students directly certified for free meals (OR in schools with 80%–89% vs 30%–39% directly certified: 19.32; 95% CI, 12.98, 28.76), Title I schools (OR, 1.85; 95% CI, 1.55, 2.21), and urban schools (OR suburban vs urban, 0.46; 95% CI, 0.36, 0.59). Differences by school level, enrollment, district size, student race/ethnicity, and geographic region also existed. Findings may help advocates, state agencies, and policymakers understand potential barriers to adoption and guide research exploring effective strategies to promote uptake. Future research should use qualitative and longitudinal designs to explore barriers to adoption, including cost and state and local policies. [ABSTRACT FROM AUTHOR]

To address unhealthy restaurant food intake among children, localities and states are passing healthy restaurant kids' meal laws. However, there is limited knowledge of what these policies require and how they compare with expert and industry nutrition standards. The aim of this study was to develop a research instrument to evaluate healthy kids' meal laws and assess their alignment with expert and industry nutrition standards. The study team conducted a content analysis of healthy kids' meal laws passed between January 2010 and August 2020 in the United States. Using a structured codebook, two researchers abstracted policy elements and implementation language from laws, regulations, fiscal notes, and policy notes. Nutritional criteria for kids' beverages and meals were compared with existing expert and industry nutrition standards for meals and beverages. Measures included law characteristics, implementation characteristics, enforcement characteristics, definitions of key terms, and nutritional requirements for meals and default beverage options and alignment with expert and industry nutrition standards. Interrater reliability of the coding tool was estimated using the Cohen kappa statistic, and researchers calculated descriptive statistics of policy elements. Twenty laws were identified. Eighteen were healthy default beverage policies, two were toy restriction policies, and one was a nutrition standards policy. The nutrition standards, default beverage offerings, and implementation characteristics varied by location. No law met the expert nutrition standards for kids' meals or beverages. The variations in policy specifications may influence how restaurants implement the policies, and, consequently, the policies' influences on children's consumption. Future policies could use expert nutrition standards to inform the standards set for kids' meals and specify supports for implementation. [ABSTRACT FROM AUTHOR]