Figure 1.

Using theories to inform the National School Lunch Program (NSLP) and School Breakfast Program (SBP).^21,22

NSLP and SBP policies	Theory			Policy/research considerations
	Getting to Equity Framework	Family Ecological Model	Stigma and Food Inequity Framework
UFSMab	Social and Economic Resources: UFSM as part of a nutrition assistance program (NSLP/SBP) Increase Access to Healthy Options: UFSM provides healthy meals to children, especially those living in food swamps and food deserts Reduce Deterrents: (1) Students who consume healthier meals through UFSM may be less likely to consume unhealthy foods after school, which may especially benefit children in communities often targeted by unhealthy food marketing/ outlets (eg, fast food) (2) UFSM removes policies that create challenges for families to complete school meal applications	Media and Policy Factors: UFSM as part of a nutrition assistance program (NSLP/SBP) Community Factors: UFSM increases the availability of healthy foods for students Social Disparities and Chronic Stress: UFSM alleviates household economic stress and reduces food insecurity	Anticipated Stigma: Providing UFSM no longer identifies students from lower-income households Structural Manifestation of Stigma: (1)Students who consume healthier meals through UFSM may be less likely to consume unhealthy foods after school, which may especially benefit children in communities often targeted by unhealthy food marketing/outlets (eg, fast food) (2)UFSM removes policies that create challenges for families to complete school meal applications	(1)Research examining the influence of UFSM on students who are near eligible for free or reduced-priced meals (2)Consideration of alternative measures/data sources to allocate educational funding to schools in an equitable manner (an unintended consequence of no longer collecting free/reduced priced meal applications with a UFSM policy), such as income data from Medicaid (3)Greater consideration of opportunities to build community capacity/ engagement, family knowledge, and social norms (eg, innovative involvement of parents while recognizing their limited time and bandwidth) (4)More research examining the equity of impact of breakfast in the classroom policies (5)Consideration of local, state, and federal policies mandating minimum lunch period lengths (eg, 25 to 30 minutes) (5)Consideration of state and federal grants with greater allocations of funds for historically marginalized communities
BICc	Reduce Deterrents: Students will no longer need to arrive early to school to receive a school breakfast (eg, children in rural communities traveling longer distances to school) Increase Access to Healthy Options: BIC provides healthy breakfasts to children, especially those living in food swamps and food deserts	Media and Policy Factors: BIC as part of a nutrition assistance program (SBP) Community Factors: BIC provides healthy breakfasts to children, especially those living in food swamps and food deserts Social Disparities and Chronic Stress: BIC alleviates household economic stress and reduces food insecurity	Structural Manifestation of Stigma: BIC mitigates structural inequities in the way students participate in SBP (eg, needing to arrive early) Anticipated Stigma: Providing BIC no longer identifies students from lower-income households (vs school breakfast before the bell consumed primarily among students who are eligible for free/reduced price meals)
Minimum lunch period lengths	Reduce Deterrents: Students, especially those in schools with a greater number of students receiving free/reduced price meals, will have sufficient time to consume school meals	Community Factors: Longer lunches increases access via sufficient time to consume healthy foods	Structural Manifestation of Stigma: Longer lunches mitigates structural inequities in student having sufficient time to eat between children who receive school lunches compared with those who bring lunch from home
Grants for equipment, infrastructure, and training opportunities for cafeteria employees	Social and Economic Resource: Policies that allocate more funds for equipment and infrastructure to schools in historically marginalized communities (eg, lower-income communities and communities of color) can help address inequities in access to healthier school meals Increase Access to Healthy Options: Improvements in equipment and infrastructure can support schools’ ability to serve healthier meals to students	Family History: Improved equipment, infrastructure and trainings can help to provide culturally preferred meals Family Knowledge and Social Norms: Trainings for cafeteria staff can lead to increases in nutrition knowledge and self-efficacy regarding the preparation of healthier foods, which can be particularly beneficial to cafeteria workers who also are from historically marginalized communities	Structural Manifestation of Stigma: (1)Greater allocation of funds for equipment and infrastructure to schools in historically marginalized communities can help address structural inequities in existing school kitchen environments (2)Training opportunities for cafeteria staff can help to partially overcome the differential ability of schools to have meals reviewed by a nutritionist Stigma Among Perceivers: Training opportunities for cafeteria staff can also help to partially overcome decisions on which foods to serve that may perpetuate nutrition inequities

^aTemporary policy implemented as a result of the coronavirus disease 2019 pandemic.

^bUFSM = Universal Free School Meals.

^cBIC = Breakfast in the Classroom.