A new report shows that the number of children with high blood pressure (BP) is reduced when schools participate in Community Eligibility Provision (CEP): federally funded, universal free school meals. Anna M. Localio, PhD, MPH, of the University of Washington School of Public Health, Seattle, and colleagues, in a manuscript published online Thursday in JAMA Network Open. Children with high BP are at greater risk for developing hypertension in early adulthood, as well as other cardiovascular and kidney diseases. Leading causes of elevated BP in children are obesity, unhealthy diets and inactivity. Free and reduced-price meals are currently in place by the National School Lunch Program through the U.S. Department of Agriculture, but stigma surrounding lunch unaffordability and lack of lunch access for all students are still barriers to adequate meals. The CEP funds meals for schools in low-income neighborhoods so all children do not have to pay for lunches. This may also help decrease the prevalence of elevated BP in children, leading to better overall health outcomes. The investigators in this cohort analysis observed low-income public and charter schools in 12 states across the U.S. from 2013-2019. Patient data was taken from patients aged 4-18 years who received care from community health organizations in the OCHIN health care network who were matched to local schools based on their addresses. School-level proportions of patients with a high BP measurement, defined as the 90th percentile for age, sex and height, was the primary outcome in this study. Secondary outcomes included hypertensive measurements (≥95th percentile) and mean systolic and diastolic BP percentiles. A total of 1,052 schools and 155,778 patients (mean age=10.9 years, 50% female) were included in the data analysis, mostly from Orgeon or California (63.7%). Schools who participated in the CEP had –2.71 percentage point (95% confidence interval [CI]: -5.10 to –0.31, p=0.03) net reduction in the number of children who had high BP measurements. This corresponded with a –10.8% (95% CI: -20.4% to –1.2%) net decrease in BP over 5 years. Participation in the CEP also had a negative association with the proportion of children who met the hypertensive measurements: Schools using the CEP had fewer children with hypertensive BP. Overall, schools that participated in the federally funded CEP free meal program had fewer students with high BP and hypertension. The authors noted that these associations were still the same after adjusting for obesity. “Future research should assess whether this decrease is associated with the timing of the Healthy, Hunger-Free Kids Act’s improved school meal nutrition standards,” the authors wrote. This research was supported by the Eunice Kennedy Shriver National Institute of Child Health & Human Development of the National Institutes of Health. Source: Localio AM, Hebert PL, Knox MA, et al. School provision of universal free meals and blood pressure outcomes among youths. JAMA Network Open. 2025 September 25 (Article in press). Image Credit: LIGHTFIELD STUDIOS – stock.adobe.com