Rural adolescents suffer from poor nutrition, increasing their risk for obesity and other chronic diseases. The Summer Food Service Program (SFSP), an off-shoot of the National School Lunch Program, provides meals to qualifying children, including low-income, rural adolescents, under the age of 18. The purpose of this study was to: 1) examine the impact of the SFSP on the nutrition–related knowledge, self-reported fruit and vegetable (SRFV) consumption, and the constructs of the Theory of Planned Behavior (attitudes, subjective norms, perceived behavioral control, and behavioral intentions) of rural, low-income adolescents; and 2) examine the relationship between nutrition behaviors (quality food selection and consumption) and participation in the SFSP using digital photography. The participants (N = 78) were recruited from those enrolled in the Upward Bound (UB) Summer Program at a mid-sized university that utilized the SFSP. The UB, a federally funded program, provided the opportunity to reach high school students from low-income, rural areas to study the aforementioned effects of the SFSP. The quasi-experimental pre- post-intervention design used a survey (n = 57) to determine predictors of positive nutrition behaviors and digital photography (n = 43) to determine actual food selection and consumption of those enrolled in the SFSP. A nutrition quality scale (0-6, with 6 indicating higher quality) was developed in order to categorize food items within food groups according to their nutritional value, and aided in determining quality of foods selected and consumed. Paired samples t-test showed a significant increase in knowledge (t(56) = -8.09, p = .000) and SRFV consumption (t(56) = -3.20, p = .002) from pre- to post-intervention. Regression analysis demonstrated that all constructs of the Theory of Planned Behavior (TPB) were significant (F(4, 52) = 14.56, p < .001 with an R2of .53) for predicting behavior intentions, with perceived behavioral control (PBC) being the most salient predictor of intentions to increase fruit and vegetable consumption. A one-way repeated measures MANOVA was not significant for the comparison of pre- and post- survey scores for knowledge, SRFV consumption, and the constructs of the TPB, F (4, 53) = .604, p = .660. Digital photography showed a significant increase in consumption from week 1 (baseline) to week 5 (program completion) for fruit (t(42) = -2.04, p = .048) and milk (t(42) = -3.13, p = .003) at lunch, for milk (t(42) = -3.01, p = .003) at supper, and for milk overall (all three meals combined), t(42) = -3.08, p = .004. Vegetable consumption decreased significantly from week 1 to week 5 t(42) = 2.47, p = .018 at supper and overall (all three meals combined) t(42) = 2.65, p = .011. Two proportion z tests showed a statistically significant decrease in the selection of food items at quality level 2 from week 1 (.34) to week 5, z = 3.11, p = .002, and statistically significant increases in the selection of quality level 3 (.20), z = -2.15, p = .031, and quality level 5 (.17), z = -3.33, p < .000, item. Two proportion z tests showed a statistically significant decrease in the consumption of food items at quality level 5 from week 1 (.62) to week 5, z = 2.94, p = .003. However, the analysis showed no consistent increase in the quality of foods selected or consumed from week 1 to week 5. Opportunities for shaping adolescent nutrient intake and eating behaviors during and outside of enrollment in the SFSP exist. Reinforcing positive attitudes, subjective norms and perceived behavioral control while participants are enrolled in the SFSP may help to increase nutrition behavioral intentions and therefore, nutrition behaviors. Opportunities also exist for offering healthier food options for those participating in the SFSP. SFSP participants are a captive, impressionable group, and providing a supportive social and physical environment, and high nutritional quality choices in the SFSP more often may provide the potential for behavior change that may lead to an increase in healthy nutritious habits for adolescents from rural areas.

Objective. The purpose of this study is to examine the relationship between the COVID-19-related waivers and the number of Summer Food Service Program (SFSP) meals served, accessibility of SFSP sites, and implementation of the SFSP sponsored by the Office of Food and Nutrition Service (OFNS) of the New York City Department of Education (NYC DOE). Methods. This study is a convergent parallel mixed methods study. In the quantitative component, there are two research questions (“research question 1” and “research question 2”); the design is a non-experimental, one-group, completely within-subjects design; and the unit of analysis is NYC DOE geographic districts (n = 32). Research question 1 is “Among NYC DOE geographic districts, was there a significant difference in the number of SFSP meals served during the summers when the COVID-19-related waivers were used compared to the summers without the waivers?” Research question 2 is “Among NYC DOE geographic districts, was there a significant difference in the accessibility of SFSP sites during the summers when the COVID-19-related waivers were used compared to the summers without the waivers?” Both research questions 1 and 2 compare the first summer of the waivers (2020) to the six summers prior to the waivers (2014-2019) and the second summer of the waivers (2021) to the six summers prior to the waivers (2014-2019). In the qualitative component, there is one research question (“research question 3”); the methods consist of a document analysis of the policy memos for the waivers (n = 8) using the READ approach for document analysis of health policies. Research question 3 is “What were the intended relationships between the COVID-19-related waivers and SFSP participation, site accessibility, and implementation according to the policy memos for the waivers?” Data Analysis. For research question 1, the statistical tests are the repeated-measures analysis of variance (ANOVA) omnibus test and post-hoc analysis with Bonferroni adjustment. The primary outcome is the total number of SFSP meals served per student. For research question 2, the statistical tests are the repeated-measures ANOVA omnibus test and post-hoc analysis with the Bonferroni adjustment when the full sample is analyzed (n = 32), and the Friedman test and sign test with the Bonferroni adjustment when high poverty districts (n = 16), high non-White districts (n = 16), and high enrollment districts (n = 16) are analyzed. The primary outcome is the number of SFSP sites per 1,000 students. For research question 3, the analysis consists of deductive coding, inductive coding, and identification of themes. Results. For research question 1, the results show a significant increase in the number of SFSP meals served per student during the first summer of the waivers compared to summers 2016-2019 (p ≤ 0.01). However, there were no significant differences in the number of SFSP meals served per student during the second summer of the waivers compared to summers 2014-2019. Among the secondary outcomes, there was a significant increase in the number of breakfast meals served in August per student during both the first and second summer of the waivers compared to summers 2014-2019 (p < 0.05). For research question 2, the results show a significant decrease in the number of SFSP sites per 1,000 students during the first summer of the waivers compared to summers 2014-2019 (p < 0.01). Similarly, there was a significant decrease during the second summer of the waivers compared to summers 2015-2019 (p < 0.01). For research question 3, the results show that the Meal Service Time Flexibility Waiver may address pre-pandemic barriers in the SFSP, but the Parent/Guardian Meal Pickup Waiver may cause implementation issues. Conclusions. Among NYC DOE geographic districts, the waivers may increase the reach of breakfast meals served in August while decreasing the number of SFSP sites and making SFSP implementation easier. There is a need for a pilot study or more controlled study to establish causal relationships. Policymakers should consider making the Meal Service Time Flexibility Waiver and the Non-Congregate Feeding Waiver permanent flexibilities for summer meal programs.