title: The impact of a school food aid program on household food insecurity.
abstract: BACKGROUND
  We had a unique opportunity to establish the extent of food insecurity and the potential impact of a large-scale school-based nutritional program, in low-socioeconomic status districts of Greece, during the current economic crisis.
  
  
  METHODS
  Around 162 schools with 25 349 students participated during the 2012-2013 school year. Each student received a daily healthy meal designed by nutrition specialists. Food insecurity levels, measured using the Food Security Survey Module were assessed at baseline and after a 1-8-month intervention period. Pre-post intervention responses were matched at an individual level.
  
  
  RESULTS
  Around 64.2% of children's households experienced food insecurity at baseline. This percentage decreased to 59.1% post-intervention,P< 0.001. On an individual level, food insecurity score diminished by 6.5%,P< 0.001. After adjustment for various socioeconomic factors, for each additional month of participation, the odds of reducing the food insecurity score increased by 6.3% (OR = 1.06, 95% CI: 1.02-1.11). Those experiencing food insecurity with hunger at baseline were more likely to improve food insecurity score than those who did not (OR = 3.51, 95%CI: 2.92-4.21).
  
  
  CONCLUSIONS
  Children and families residing in low socioeconomic areas of Greece, experience high levels of food insecurity. Our findings suggest that participation in a school-based food aid program may reduce food insecurity for children and their families in a developed country in times of economic hardship.
authors.affiliation: Environmental and Occupational Health, Prolepsis, Institute of Preventive Medicine, Maroussi, Greece Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece Department of Statistics, Athens University of Economics and Business, Athens, Greece.
authors.forename: Athanassios
authors.initials: A
authors.lastname: Petralias
authors.affiliation: Environmental and Occupational Health, Prolepsis, Institute of Preventive Medicine, Maroussi, Greece Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
authors.forename: Eleni
authors.initials: E
authors.lastname: Papadimitriou
authors.affiliation: Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
authors.forename: Elena
authors.initials: E
authors.lastname: Riza
authors.affiliation: Children's Environmental Health and Disease Prevention Research Center at Dartmouth, Hanover, NH, USA Section of Biostatistics and Epidemiology, Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Hanover, NH, USA.
authors.forename: Margaret R
authors.initials: MR
authors.lastname: Karagas
authors.affiliation: Department of Stem Cell and Regenerative Biology, Harvard University, Cambridge, MA, USA.
authors.forename: Alexia B A
authors.initials: AB
authors.lastname: Zagouras
authors.affiliation: Environmental and Occupational Health, Prolepsis, Institute of Preventive Medicine, Maroussi, Greece Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece a.linos@prolepsis.gr.
authors.forename: Athena
authors.initials: A
authors.lastname: Linos
mesh_terms: D000293:Adolescent; D002648:Child; D005260:Female; D063105:Food Assistance / Q000706:statistics & numerical data*; D005523:Food Supply / Q000706:statistics & numerical data*; D006115:Greece; D006801:Humans; D006815:Hunger; D008297:Male; D009752:Nutritional Status; D012959:Socioeconomic Factors