Association for Public Policy Analysis & Management

When a household does not have enough money or other resources to buy food, food intakes are reduced and eating patterns disrupted, leading to food insecurity and its social, developmental, and nutrition consequences, especially for children (Institute of Medicine 2013). National estimates indicate that more than one in five low-income families (22%) in 2016 experienced food insecurity among children. In Chickasaw Nation territory, located in southwestern Oklahoma, rates of poverty and food insecurity are especially high.

The 2010 Child Nutrition Act called for the development of innovative strategies to “reduce the risk of childhood hunger or provide a significant improvement to the food security status of households with children” (U.S. Congress, P.L. 111-296, 2010). The U.S. Department of Agriculture subsequently awarded a $9.7 million grant to the Chickasaw Nation Nutrition Services (CNNS), which implemented the 25-month Packed Promise project from February 2016 through February 2018, targeted to school-age children (both Native American and non-Native American) eligible for free school meals or attending a school participating in the community eligibility provision (CEP), in which all school children receive free school meals. The project was implemented in 40 school districts (115 schools) in 12 counties within the Chickasaw Nation.

The project’s goals included reducing childhood food insecurity and hunger, increasing consumption of nutritious foods, increasing the diversity of foods in the home, and improving diet quality and well-being among children. Eligible households could order one food box per eligible child shipped to their home each month. Each food box contained 6 protein-rich items, 2 dairy items, 4 grain foods, 4 cans of fruit, and 12 cans of vegetables, along with a $15 Fresh Check for frozen/fresh fruits and vegetables. The checks were similar to WIC benefits for fresh fruits and vegetables and redeemable through the end of the project at a WIC-authorized store or participating farmstand or farmer’s market.

The evaluation sponsored by the Food and Nutrition Service (FNS) used a rigorous randomized controlled trial (RCT) design to estimate Packed Promise’s impact on the primary study outcome―food insecurity among children―and other outcomes, including children’s diet quality, household food spending, and nutrition program participation. A total of 4,875 households actively consented to the project. After the enrollment period, 20 school districts were randomly selected for the treatment group and 20 for the control group, which did not receive any additional benefits. Enrolled households with children in the treatment districts (Packed Promise households) could receive benefits for each month they met the eligibility criteria during the 25-month intervention. Outcomes were measured using two households surveys implemented about 12 and 18 months after the beginning of the project. In this paper, we address the following research questions:

• To what extent did eligible households participate in the demonstration project and receive Packed Promise benefits?
• What impacts did benefits have on food insecurity among children?
• What impacts did benefits have on children’s dietary quality as measured by a food frequency questionnaire?