In the 10 years since the federal government , studies have suggested the policy has wide-ranging benefits. Students in participating schools , are and .

Now, as cuts to food assistance programs threaten to slash access to universal school meals, a new study led by the 91̽�� finds another potential benefit to the programs: Students in participating schools were less likely to have high blood pressure, suggesting that universal free meals might be a powerful tool for improving public health.��

“High blood pressure is an important public health problem that isn’t studied as much on a population level as obesity,” said , a 91̽��postdoctoral researcher of health systems and population health and lead author of the study. “We have evidence that CEP increases participation in school meals, and we also have evidence that school meals are more nutritious than meals that kids obtain elsewhere. This is a public health policy that is delivering nutritious meals to children who may not have previously had access.”

For the study, , researchers linked two datasets that rarely interact. They obtained medical records of patients ages 4-18 from community health organizations, and used patients’ addresses to identify the school they attended. The data encompassed 155,778 young people attending 1,052 schools, mostly in California and Oregon.

Researchers estimated the percentage of students with high blood pressure before and after schools opted into universal free meals, and compared those results against eligible schools that had not yet participated in the program. They also tracked students’ average systolic and diastolic blood pressure readings. All data were aggregated at the school level.��

They found that school participation in the CEP was associated with a 2.71% decrease in the proportion of students with high blood pressure, corresponding to a 10.8% net drop over five years. School participation in CEP was also associated with a decrease in students’ average diastolic blood pressure.��

“In previous work on the health impacts of universal free school meals, our team found that adoption of free meals is associated with decreases in and , which are closely linked to risk of high blood pressure,” said , a professor of health, society and behavior at the University of California Irvine’s Joe C. Wen School of Population & Public Health and senior author of the study. Jones-Smith conducted much of this research while on faculty at the 91̽��School of Public Health. “So in addition to directly affecting blood pressure through provision of healthier meals, a second pathway by which providing universal free meals might impact blood pressure is through their impact on lowering risk for high BMI.”��

Improved nutrition of school meals may have helped drive the decrease, researchers said. The 2010 law that established the CEP also created stronger nutritional requirements for school meals. As a result, those meals now more closely resemble the , which to be an effective tool for managing hypertension.��

Despite the evidence supporting the DASH diet’s effectiveness, public health officials previously lacked an effective mechanism to encourage people with high blood pressure to follow its recommendations. “We know there are a lot of barriers to people eating this diet,” Localio said, but the combination of universal free meals and increased nutritional standards likely helped students overcome those barriers.

The study also contradicts the common misperception that universal free meals mostly benefit wealthier students, because students from low-income families would already receive free meals. The study sample consists primarily of low-income patients, with 85% of included students enrolled in public health insurance such as Medicaid.

“There is a perception that providing universally free school meals will only improve outcomes for students of relatively higher-income families, but our findings suggest that there are benefits for lower-income children as well,” Jones-Smith said. “Potential mechanisms for this include decreasing the income-related stigma around eating school lunch by providing it free to all students and eliminating the time and paperwork burden of individually applying, thus decreasing barriers to participation in school meals.”

These findings come at an uncertain time for universal free meals. A school is eligible to participate in the CEP if . In this way, recent cuts to the Supplemental Nutrition Assistance Program (SNAP), the nation’s largest food assistance program, may affect schools’ access to the program.

“We’re in a contentious time for public health, but it seems like there’s bipartisan support for healthy school meals,” Localio said. “There’s legislation being considered in a number of states to expand universal free meals, and these findings could inform that decision-making. Cutting funding to school meals would not promote children’s health.”��

Co-authors on the study include , research professor emeritus of health systems and population health at the UW; , teaching professor of economics at the UW; Wyatt Benksen and Aileen Ochoa of OCHIN; and , associate professor of nursing at the UW. This study was funded by the Eunice Kennedy Shriver National Institute of Child Health & Human Development.��

For more information or to contact the researchers, email Alden Woods at acwoods@uw.edu.

When 91̽�� President Ana Mari Cauce launched the Population Health Initiative in 2016, she spoke in soaring, ambitious terms. “We have an unprecedented opportunity to help people live longer, healthier, more productive lives – here and around the world,” she said. 91̽��researchers have leapt at that opportunity, forging connections across the university, working side by side with community partners and breaking down traditional barriers to improving public health. ��

In just eight years, the Initiative has funded 227 innovative, interdisciplinary projects. Many are focused right here in Western Washington, where projects have helped in South Seattle, identified soil contaminants in community gardens in the Duwamish Valley, and improved how community leaders along the Okanogan River . Other projects have reached across the globe, targeting health disparities in Somalia, Peru, Brazil and more.����

“In this relatively short period of time, we’ve demonstrated the power that accrues when faculty and staff across the various areas of our campuses are working together and also exposing students to the cutting-edge work of tackling grand challenges,” Cauce said in her most recent .��

And they’re just getting started. Many PHI-funded projects are still in their earliest stages, leveraging initial funding to show proof-of-concept for their ideas and setting the stage for future work. Fourteen projects so far have received much larger grants to empower researchers and community partners to expand successful projects and scale up for greater impact.��

With the Initiative now a third of the way into its 25-year vision, 91̽��News checked in with three projects that recently received funding to scale their efforts.��

Spotting potential memory health issues in rural Washington

Diagnosing memory health issues in the best of circumstances is extraordinarily difficult. Patients typically make multiple visits to their doctor and take a many of which can produce flawed results — people who take the same test more than once, for example, will often score higher, potentially masking memory loss. ��

It’s even harder in rural America, which has a Patients seeking memory care might have to make a long, expensive trip to a major city, which leads many people to wait until a problem becomes apparent. By then, it’s often too late — modern treatments can slow the progress of memory loss, but there’s no way to regain what’s been lost.��

“So, how do you catch it early?” said , a 91̽��associate professor of psychology. “We give people an app to have them check for themselves.”����

Stocco and , director of the 91̽��Alzheimer’s Disease Research Center, together with Hedderik van Rijn of the University of Groningen in the Netherlands, led the development of an online program that can measure a person’s memory and predict their risk of memory disorders. Like a flash-card app that helps students cram for a test, the program shows pictures and asks the user to recall what they saw a few minutes earlier. The app records how quickly and accurately the user responds to each question and makes the next one a little easier or more difficult.����

Researchers have long understood that a person’s ability to recall a specific memory tends to fade over time. This is called the “.” In�� Stocco and van Rijn found that they could measure individual differences in the slopes of such curves.�� The app works by comparing a person’s responses to an internal model of forgetting and adjusting the slope of the model until it matches the responses. The resulting slope can be used to estimate the likelihood that their memory is fading faster than normal.����

By taking the test regularly, a person can track their memory’s decline over time. But preliminary tests, Stocco said, have shown that even a single use can spot a potential problem.��

“Just by looking at a single lesson, based on the result, there’s almost a perfect correspondence between the speed of forgetting and your probability of being diagnosed by a doctor,” Stocco said. “It can be as accurate as the best clinical tests but, instead of taking two or three hours, this can be done in eight minutes, and you don’t need a doctor.”��

A Tier 3 grant from the Population Health Initiative and a collaboration with the will allow the researchers to share the app with up to 500 people in rural and counties. Participants can take the test on their own time, and the results will be shared with researchers. If a potential problem emerges, the researchers plan to invite participants to Seattle for an in-person evaluation.����

“It’s a solution that seems to solve these problems of early access and diagnostic bottlenecks,” Stocco said. “If this works, there’s no problem giving it to everybody in the state. We’re really interested in expanding and adding people from underrepresented populations and underrepresented areas, and the grant will allow us to do that.”��

Nancy Spurgeon of the Central Washington Area Health Education Center is also a collaborator on the project to test the prototype app, which is not yet available to the public.��

Revamping the Point-In-Time Count to better understand King County’s unhoused population��

For years, volunteers fanned across King County on a cold night each January, flashlights and clipboards in hand, searching for people sleeping outside. They’d also gather the shelter head counts for that night. Officially called the , this effort attempted to tally the number of people who lacked stable housing. This endeavor was replicated in cities across the country, and the results were combined to create a national count that influences how the federal government allocates funding.��

There’s just one problem – the count is Volunteers can’t possibly find everybody. It captures only a single moment in time, and collects only limited data on people’s circumstances or personal needs. A person sleeping in their car might need different services than a person who sleeps in a tent, and the count didn’t fully capture that distinction.��

So, a team of 91̽��researchers designed a better way to count. Their method, detailed in a published Sept. 4 in in the American Journal of Epidemiology, taps into people’s social networks to generate a more representative sample, which the researchers then ran through a series of calculations to estimate the total unhoused population.������

Called “respondent-driven sampling,” the method stations volunteers in common “hubs,” like libraries or community centers, and offers cash gift cards for in-person interviews and peer referrals. Volunteers collect detailed information on people’s circumstances and needs, giving each person three tickets to share with their unhoused peers. When those peers come in for an interview and show the ticket, the person who referred them receives another small reward. The new person gets a gift card and another three tickets.��

“This method gives people a more active voice in being counted. It’s a more humane way to count people, and it’s also voluntary,” said , a 91̽��associate professor of sociology and co-lead on the project. “The regular PIT (Point-In-Time) count just counted people. Now we can collect all sorts of information from people on their circumstances and their needs. Should policymakers want to, they could leverage that data to change service offerings.”��

The researchers received a Tier 2 grant to develop the system. They launched it in partnership with King County in 2022 and 2024, and were recently awarded a Tier 3 grant to test out the feasibility of running it quarterly.����

“Running the count quarterly allows us to estimate how many people move in and out of homelessness and whether there are seasonal changes, which are rarely measured,” Almquist said. “Also, people’s needs change depending on the time of year, and this method will help us better understand those rhythms.”����

Other cities and counties have expressed interest, the researchers said. The team has also begun to expand the effort, aiming to improve data across the broad spectrum of housing and homelessness services.����

“A very important byproduct of this work across schools and departments at 91̽��is that we can create an ecosystem of people and projects,” said , a 91̽��professor emeritus of health systems and population health and co-lead on the project. “We’ve spun off projects on sleep assessments, relationships with organizations that collect data on homelessness, and we’re mapping the sweeps of encampments in relationship to where people choose to be located. We have a whole network of homelessness-related research now.��

“These PHI grants gave us the fuel to ignite these projects.”��

Other collaborators are of the 91̽��Department of Health Systems and Population Health and of the VA Health Services Research and Development; of the 91̽��Departments of Sociology and Statistics; of the Center for Studies in Demography & Ecology and the eScience Institute; and Owen Kajfasz, Janelle Rothfolk and Cathea Carey of the King County Regional Homelessness Authority.��

Engaging community to mitigate flood risk in the Duwamish Valley��

More than a century ago, Seattle leaders set out to control and redirect the Duwamish River. They dredged the riverbed and dug out its twists and turns. Wetlands were filled in, the valley was paved over and a system of hydrology was severed. What had been a wild, winding river valley with regular flooding became an angular straightaway built for industry. But when 91̽��postdoctoral scholar looks out at the Duwamish, she sees the river fighting back.����

“The water was always there,” Jeranko said, “and now it’s fighting to come back up.”����

The river returned with devastating effect in December 2022, when a king tide and heavy rainfall , submerging homes and shuttering local businesses. The underserved neighborhood faces a significant risk of future floods.��

To mitigate that risk, the City of Seattle has updated the neighborhood’s stormwater drainage system and launched a new flood-warning system. But the , a nonprofit focused on river pollution and environmental health, saw an opportunity for something greater. The DRCC asked a team of 91̽��researchers to help develop flood adaptation plans that are community-based, culturally responsive and that enrich the local environment.����

“In the community, people don’t think there’s been enough engagement. There’s all this talk about flood mitigation, but all they see are sandbags,” Jeranko said. “So DRCC was like, ‘Look, we really need the people who live in the flood zone to understand the solutions.’ Because we have this long-lasting relationship with them, they see us as someone who’s able to provide a list of solutions, not favor one over the others, and do it in an informative way.”��

Boosted by a Tier 3 grant from the PHI, Jeranko and a team representing five 91̽��departments, the Burke Museum and the DRCC are engaging with the community. This fall, the team will present the neighborhood with an expansive list of flood mitigation options and encourage city leaders to consider people’s preferences. Early work shows the community would favor nature-based solutions, Jeranko said. Floodable parks, for example, would provide ecological, recreational and public health benefits to the entire community, while storing flood water during storms.����

“It has been wonderful to collaborate with the 91̽��team on this to make sure we are centering community voices in every single step of the planning for climate resilience,” said Paulina López, executive director of the DRCC. “Community leadership and representation is indispensable to bring climate justice to the Duwamish Valley.”��

Jeranko hopes their community-based model will be replicated by communities across the country facing similar risks from climate change and sea level rise.��

“Even though 91̽��and a lot of other universities really support and invest in community-engaged work, a lot of times it’s fundamentally hard to make that research happen,” Jeranko said. “But the Population Health Initiative grant was about supporting all those things.”��

Other collaborators on the project are , and of the Department of Environmental & Occupational Health Sciences; of the Department of Landscape Architecture; of the Department of Civil & Environmental Engineering, of the School of Environmental and Forest Sciences; of the Quaternary Research Center and the Burke Museum; and López and Robin Schwartz of the DRCC.��

For more information on any of the projects mentioned, or to learn more about the 91̽��Population Health Initiative, visit the Initiative’s website or contact Alden Woods at acwoods@uw.edu.����