Findings from a new study of food distribution last spring by the nation’s four largest urban school districts (New York City, Los Angeles, Chicago and Houston) could help guide meal provision both in future public health emergencies and during ongoing federal efforts to combat food insecurity.

The study, co-authored by Julia McCarthy, Deputy Director of the Laurie M. Tisch Center for Food, Education & Policy, and published this week in The Journal of Urban Health, is among the first to address food security in the United States during the COVID-19 pandemic. A key focus of the research is on how to ensure that both children and adults have equitable access to healthy food during emergencies, particularly given that youngsters who are food-insecure are at increased risk for obesity and diabetes — two of the most common risk factors associated with COVID-19 hospitalizations.

[Read the study, titled “Addressing Food Insecurity through a Health Equity Lens: a Case Study of Large Urban School Districts during the COVID-19 Pandemic.” McCarthy’s co-authors include nutrition and public health researchers at Washington University in St. Louis, the University of North Carolina at Greensboro, the University of Illinois at Urbana-Champagne, the Harvard T.H. Chan School of Public Health, and St. John’s University. The Tisch Food Center is housed within Teachers College’s Program in Nutrition.]

While the four districts varied in many of their strategies and outcomes, all enacted certain measures that the researchers deem “best practices.” These include increasing access to healthy food options; providing at least one meal per day for students; displaying food safety information; and advertising that all children could eat for free regardless of where they were enrolled. All four districts also partnered with community groups to maximize food distribution, both geographically and in terms of frequency (for example, on weekends).

In addition, the study also underscores the importance of accommodating different dietary needs and preferences and providing information in multiple languages. New York City’s Department of Education was the leader on both fronts, promoting kosher, halal, and vegetarian options and publishing materials about food distribution in 11 languages, including Arabic, Bengali, Creole and Urdu.

The nation’s four largest urban school districts all increased access to healthy food options; provided at least one meal per day for students; displayed food safety information; and advertised that all children could eat for free regardless of where they were enrolled. All four districts also partnered with community groups to maximize food distribution, both geographically and in terms of frequency.

New York had the lowest rate of participation in its food distribution programs, but the researchers believe this outcome owes primarily to the fact that the city was the nation’s epicenter for the pandemic during the time of the study. They draw no conclusion about the relative effectiveness of centralizing distribution, as Los Angeles and Chicago did, or maintaining more distribution sites, as New York City and Houston did. But the study does note that Houston maintained the highest number of distribution centers in “food deserts” — areas in which residents live at least half a mile from a supermarket — and that living in such a neighborhood is a greater predictor of food insecurity than race or socioeconomic status.

In contrast, many rural school districts have not distributed food while closed during the pandemic, and children in low-income families in those areas have often suffered greater food insecurity and eaten less-healthy food. In an opinion piece published this week in the Portland (Maine) Press Herald, McCarthy and co-author Michele Polacsek, a public health researcher at the University of New England, argue that in the absence of nutrition programs, children are far more susceptible to advertising (often on digital learning sites) for unhealthy snack food.

With most school districts around the country set to continue working online through the fall, the researchers “strongly urge equity to be placed at the forefront of decisions pertaining to school emergency food services.” They argue that “continuation of meal sites that serve meals to students and families may serve as a vital strategy” to offset ongoing food deprivation, particularly for “families/children at greater risk for contracting COVID-19 who wish to remain at home and/or for parents who still cannot return to work through job loss or ongoing furlough.” Ultimately, they conclude, “continuation of various waivers granted by the USDA [U.S. Department of Agriculture] may therefore be necessary to combat rising food insecurity rates and ease the transition of going back to school amid the pandemic.”