The purpose of this study is to assess the impact of an implementation strategy on participation in Universal School Meals (USM).

The purpose of this cluster randomized trial is to test the effectiveness of an implementation strategy on implementation and student health outcomes of universal school meals (USM). This will be completed by developing and tailoring of an implementation strategy and testing its effectiveness though a cluster randomized design. Primary implementation outcomes of this trial are acceptability, cost, feasibility, penetration, and sustainability. Secondary student health outcomes are changes in diet quality (district-wide survey for students), food insecurity (USDA 6-item screener), and weight status. Exploratory descriptive models will be run to assess differences between intervention and control schools. To provide evidence for approaches in adolescents at highest risk for poor dietary intake, food security, and obesity risk, racial and ethnic minority adolescents from the School District of Philadelphia will comprise the majority of the sample. The principal investigator has just completed a year-long needs assessment with 8 schools across the district. We will aim to recruit 4 schools to be randomized to 1 of 2 conditions. Recruitment is underway, final recruitment details will be added once randomization is complete. From these schools, we aim to randomize (2 intervention; 2 waitlist comparison) for the development and tailoring of an implementation strategy. At baseline and throughout the 2-year trial period, we aim to collect interview data and surveys, and analyze data on diet quality, food security, and weight status.

Inclusion Criteria:

• An elementary/middle or high school within the School District of Philadelphia (SDP) that provides free breakfast and lunch to students
• School is willing to be randomized to either a treatment or waitlist comparison condition
• School has a team of teachers, administration, and food service staff who are willing to complete interviews and surveys for data collection
• School has valid data for student Body Mass Index, meal participation, and food insecurity (parent reported).
• Students currently enrolled in a SDP elementary/middle/high school
• Students willing to participate in an interview and complete surveys
• Students have participated in school meals in the last year.

Exclusion Criteria:

• Charter schools and private schools
• Students not enrolled in school full time; students under 11 years of age.

Data elements: 1) Individual linked integrated database containing up to ~1000 records from the School District of Philadelphia from 2024-2027; 2) up to ~100 interview recordings and transcripts conducted with students in middle (6-8) and high (9-12) school grades, teachers, food service staff/personnel, administrators, and other staff; 3) up to ~30-50 survey entries to capture implementation outcomes of acceptability, feasibility, cost, and sustainability.

1) Data are accessible only to the study team through an existing data license agreement between Temple University and the School District of Philadelphia. We do not anticipate the ability to preserve and share these data. 2) Transcripts will be de-identified and any potentially revealing information will be removed prior to sharing. 3) Survey data will be de-identified and any potentially revealing information will be removed prior to sharing.

The data will be made available prior to publication of the first manuscript and will be made available open access until 10 years following the end of the trial period.