Student Perception of Healthfulness, School Lunch Healthfulness, and Participation in School Lunch: The Healthy Communities Study.

OBJECTIVE: To increase understanding about the healthfulness of school lunch and participation, this study measured 3 school lunch variables, students' perception of healthfulness, objective healthfulness, and participation, and examined associations between each pair of variables (3 associations).

METHODS: Multilevel models were used for a secondary analysis of data from the Healthy Communities Study, a 2013-2015 observational study of schools (n = 423) and children (n = 5,106) from 130 US communities.

RESULTS: Students who reported that school lunches were sometimes, often, or very often healthy ate school lunches more frequently per week (β = .71; P < .001) than did students who responded never or rarely. No associations were found with objective school lunch healthfulness.

CONCLUSIONS AND IMPLICATIONS: Student perception of healthfulness of school lunch is positively associated with participation but not with objective school lunch healthfulness. Understanding how student perception is associated with participation can inform effective communications to students to increase participation in the school lunch program.